LA pulm-cancers/nodules

Question 1

5 year survival rate for bronchogenic cancer

Answer 1

15%

Question 2

SCLC

occurance rate, location, mets, tx

Answer 2

• Oat cell 25-35% cases
• AGGRESSIVE, prone to early mets, spreads early
• originate in CENTRAL bronchi and mets to regional lymphnodes
• chemo. rarely amenable to sx.
• • Kulchitsky cells(dk blue cells)
    **can secrete ADH and ACTH

Question 3

5 year survival rate for NSCLC

Answer 3

35-40%, grows slowly and amenable to surgery

Question 4

squamous cell

occurance rate, location, dx

Answer 4

25-35% of cases.
bronchial in origin, it is a centrally located mass
hemoptysis so do a sputum cytology.
**hypercalcemia; keratin pearls

Question 5

** Kulchitsky cells(dk blue cells)

Answer 5

SCLC

Question 6

**hypercalcemia; keratin pearls

Answer 6

squamous cell

Question 7

adenocarcinoma

occurance rate, location, dx

Answer 7

overall most common. 40%
arise from mucous glands, usually appears on PERIPHERAL
cannot do a sputum cytology
**NON SMOKERS, clubbing

Question 8

bronchoalveolar subtype

Answer 8

from adenocarcinoma. low grade.

CXR has hazy infiltrates. Good prognosis.

Question 9

large cell carcinoma

characteristics, location, dx

Answer 9

10%
rapid doubling time; mets early; poor prognosis
central or peripheral mass
do cytology
do surgery. less responsive to chemo
**polymorphic giant cells, secrete b HCG(gynocomastia)

Question 10

**polymorphic giant cells, secrete b HCG(gynocomastia)

Answer 10

large cell carcinoma

Question 11

which cancers are central

Answer 11

squamous and small cell

Question 12

lung cancer mets locations

Answer 12

LABB: liver, adrenal, brain, bone

Question 13

bronchial carcinoid tumor

prognosis, mets, sx

Answer 13

good prognosis and mets rare.
carcinoid syndrome
** nests of neuroendocrine cells

Question 14

** nests of neuroendocrine cells

Answer 14

bronchial carcinoid tumor

Question 15

carcinoid syndrome

Answer 15

flushing, diarrhea, tachycardia, bronchoconstriction, hypoTN

think bronchia carcinoid tumor

Question 16

S/S of lung cancer

Answer 16

symptoms: new or changing cough, hemoptysis, pain, anorexia, wt loss, athenia, night sweats, resistant pneumonia
signs: lymphadenopathy, hepatomegaly, clubbing
* paraneoplastic syndromes 10-20%

Question 17

tests to order for lung cancer dx

Answer 17

CXR, CT, cytologic exam of sputum,
bronchoscopy and central biopsy, exam of pleural fluid
*FNA if peripheral

Question 18

horner’s syndrome

Answer 18

apical pancoast tumor compresses sympathetic trunk, ptosis, miosis, facial anhidrosis

Question 19

lung ca FEV1 and ratio

Answer 19

both low

Question 20

solitary nodule in non smoker screening

Answer 20

CT every 6 months for 2 years

Question 21

low dose CT scan annual screening for who

Answer 21

ages 55-74, 30 pack/yr, quit smoking in the last 15 years

Question 22

stages TMN

Answer 22

tumor size, mets, node

Question 23

stage 1 tx

Answer 23

only lung: resection and radiation (75% survival)

Question 24

stage 2 tx

Answer 24

lung and hilar nodes: resection and chemoradiation (50% survival)

Question 25

stage 3 tx

Answer 25

lung and mediastinal nodes: chemoradiation

Question 26

stage 4 tx

Answer 26

lung and distant mets: chemotherapy only

Question 27

what causes an increased risk of malignancy in a solitary pulm nodule

Answer 27

spiculated nodule, upper lobe, over 40 y/o

Question 28

what is the most common mediastinal tumor

Answer 28

thymoma

Question 29

etio most common with a solitary pulm nodule

Answer 29

infectiour granulomas

Question 30

imaging of choice for solitary pulm nodule

Answer 30

CT chest, get CXR first

Question 31

bronchoscopy shows pink to purple well vascularized centrall located tumor

Answer 31

bronchial carcinoid tumor

Question 32

what tumor is resistant to radiation and chemotherapy

Answer 32

bronchial carcinoid tumor

Question 33

1st and 2nd most common locations for carcinoid tumor

Answer 33

1. GI tract 2. lung

Question 34

may secrete serotonin, ADH, ACTH, melanocyte stimulating hormone

Answer 34

bronchial carcinoid tumor

Question 35

octreotide

Answer 35

reduces symptoms in bronchial carcinoid tumor. decreases secretion of active hormones.

Question 36

second most common cancer dx in US (after prostate and breast)

Answer 36

lung

Question 37

what is synergistic with smoking and lung cancer

Answer 37

asbestosis

Question 38

lung ca screening with low dose CT in what ages

Answer 38

55-80 who have no symptoms plus a 30 PPY current smoking hx or quit within15 years

Question 39

most common primary lung cancer in smokers and non smokers; what is second

Answer 39

1. adenocarcinoma 2. squamous cell lung carcinoma

Question 40

lung cancer for pts with exposure to silica, asbestos, radon, heavy metals

Answer 40

adenocarcinoma

Question 41

peripheral on CXR; lepidic (non invasive growth along intact alveolar septae)-voluminous sputum and interstitial lung pattern

Answer 41

adenocarcinoma

Question 42

histology: gland formation and mucin production

Answer 42

adenocarcinoma

Question 43

bronchial in origin. arises from proximal portions of tracheobronchial epithelium.

Answer 43

squamous cell lung carcinoma

Question 44

bx: keratinization and/or intracellular desmosomes (bridges)

Answer 44

squamous cell lung carcinoma

Question 45

CCCP characteristics of squamous cell lung carcinoma

Answer 45

centrally located, cavitary lesions, hypercalcemia, Pancoast syndrome

Question 46

s/s of hypercalcemia

Answer 46

confusion, lethargy, nausea, abd pain, tachycardic, short QT interval think squamous cell lung carcinoma

Question 47

confusion, lethargy, nausea, abd pain, tachycardic, short QT interval

Answer 47

hypercalcemia squamous cell lung carcinoma

Question 48

what comprises 15% of all lung cancers, aggressive and associated with early mets

Answer 48

small cell(oat cell)

Question 49

paraneoplastic syndromes in which lung cancer

Answer 49

small cell(oat cell)

Question 50

SVC syndrome, SIADH(hyponatremia), cushing syndrome, lambert eaton syndrome

Answer 50

paraneoplastic syndromes small cell(oat cell)

Question 51

histology: sheets of small dark blue cells with rosette formation

Answer 51

small cell(oat cell)

Question 52

small cell(oat cell) located where and tx

Answer 52

central. chemotherapy with or w/out radiation

Question 53

what is lambert eaton syndrome

Answer 53

antibodies against presynaptic voltage gated calcium channels prevent acethycholine release, leading to muscle weakness

Question 54

antibodies against presynaptic voltage gated calcium channels prevent acethycholine release, leading to muscle weakness

Answer 54

lambert eaton syndrome paraneoplastic syndrome/small cell ca

Question 55

proximal muscle weakness that IMPROVES with repeated use; hyporeflexia

Answer 55

lambert eaton syndrome

Question 56

pancoast tumor, what cancer is most common

Answer 56

non small cell, squamous

Question 57

Pancoast tumor compression of ____ brachial plexus, ___ nerve, and central ____ nerve chain

Answer 57

lower brachial plexus ulnar nerve central sympathetic nerve chain

Question 58

most common initial symptoms of pancoast tumor

Answer 58

shoulder and arm pain

Question 59

3 tests pancoast tumor

Answer 59

1. CXR initial test 2. MRI better to assess extent of infiltration of adjacent tissues 3. needle bx definitive dx

Question 60

80% of chronic asbestos exposure can lead to what

Answer 60

mesothelioma

Question 61

CXR: unilateral pleural thickening

Answer 61

mesothelioma