Lung CA Flashcards
MC cause of CA related deaths in US
lung CA
MC RF for lung CA
smoking
what two RF are synergistic for causing lung CA
smoking and asbestos
what is included in non-small lung CA
adenocarcinoma
large cell
squamous cell
lepidic pattern
btwn non-small cell and small cell lung CA, which is more aggressive and usually metastatic at time of presentation
small cell lung CA
what is normally tx of choice for non-small cell lung CA
surgical resection
what is normally tx of choice for small cell lung CA
chemotherapy - bc more aggressive and usually metastatic at presentation
USPSTF screening guidelines for lung CA
annual low-dose CT screening for those 50-80 who have no sx of lung CA + a 20 PPY smoking hx who currently smoke or have quit within 15 years
when should screening for lung CA be d/c
when a person has not smoked for 15 years or develops a health condition that substantially limits life expectancy or the ability or willingness to undergo curative surgery
what is the MC primary lung CA in smokers, women, men, and nonsmokers (50%)
adenocarcinoma of the lung
strongest RF for adenocarcinoma of the lung
smoking
chest XR for adenocarcinoma of the lung
usually peripherally located
CT guided biopsy for adenocarcinoma of the lung
gland formation (glandular appearance) w mucin production
second MC of lung CA after adenocarcinoma
squamous cell lung CA
characteristics of squamous cell lung CA
typically centrally located - associated w cavitary lesions (central necrosis w cavitation), hypercalcemia, and pancoast syndrome
sx of small cell lung CA
paraneoplastic syndromes - superior vena cava syndrome, Lambert eaton syndrome, SIADH (hyponatremia), Cushing syndrome (ectopic ACTH production), Horner syndrome
chest XR for small cell lung CA
mass often centrally located
what will histology show for small cell lung CA
sheets of small dark blue cells w rosette formation (about 2x the size of resting lymphocytes)
MC type of lung CA
non-small cell lung CA
which lung CA is less likely to be associated w smoking
adenocarcinoma
MC cause of superior vena cava syndrome
small cell lung CA
sx superior vena cava syndrome
facial, neck, upper extremity edema
facial plethora
chest pain
respiratory sx
neurologic manifestations
dyspnea (MC presenting sx)
PE for superior vena cava syndrome
dilated and prominent neck and chest veins
sx lambert-eaton myasthenic syndrome
proximal muscle weakness that improves w repeated muscle use
autonomic sx - dry mouth MC
PE for Lambert eaton myasthenic syndrome
hyporeflexia
sluggish pupillary response
no significant muscle atrophy
sx superior sulcus (pan coast) tumors
shoulder and arm pain MC initial sx
Horner syndrome - triad of ipsilateral ptosis (drooping of eyelid), miosis, anhidrosis due to involvement of the paravertebral sympathetic chain
weakness atrophy of the muscles of the hand and/or arm
may have ulnar neuropathy
MC cause of mesothelioma
chronic asbestos exposure in 80% (industrial worker in 1930s-1940s increases risk)
sx malignant mesothelioma
pleuritic chest pain
dyspnea
fever
night sweats
weight loss
hemoptysis
chest XR mesothelioma
unilateral pleural thickening and blood pleural effusions
solitary pulmonary nodule
single, small (</= 30 mm) usually well-circumscribed lesion that is surrounded entirely by pulmonary parenchyma
lesions measuring > 30 mm are considered masses and have higher malignant potential
a nodule showing sizable increase over a period of days is likely
nonmalignant (infectious or inflammatory)
a nodule showing sizable increase over a period of months is likely
malignant
nodule characteristics that are likely benign
< 6 mm
very fast or no growth on repeat imaging 2 years apart
“popcorn” calcification pattern
solid
multiple pulmonary nodules that are < 5 mm in diameter, juxtaposed to either the visceral pleural or an interlobar fissure
nodule characteristics that are likely malignant
> 8 mm (50% risk if > 20 mm)
rapid doubling time (within 100 days)
spiculated
subsolid
upper lobe
multiple pulmonary nodules that are >/= 1 cm in diameter
patient characteristics that are likely benign (nodule)
lifelong nonsmoking
< 35 yo
no hx of malignancy
patient characteristics that are likely malignant (nodule)
smoking hx
occupational exposure (asbestos)
>/= 35 yo
prior dx of CA
CT scan indications for pulmonary nodule
no prior films for comparison
nodule has increased in size for more than 2 years
findings suggestive or CA or CA related findings
no nodule on previous chest radiograph
Indications for PET scan pulmonary nodule
Nodules >/= 1 cm
if positive, do biopsy
indications for chest imaging 3 mos (pulmnary nodule)
nodules that are benign based on CT findings
