Lung CA

Question 1

Solitary Pulmonary Nodule (SPN) is?

Answer 1

“coin lesion” (U) benign

<3cm
defined edges
dense, central calcification

Question 2

SPN risks for malignancy, epidemiology?

Answer 2

> 60yo
lifestyle
co-existing lung dz
infection risk/exposure

Question 3

SPN risks for malignancy, physical findings?

Answer 3

weight loss
LAD
fixed/local wheeze
joint tenderness

Question 4

SPN imaging findings?

Answer 4

Review old films for stability (growth)

↑ risk of malig if:

Φ calcification
poor definition
> 3 cm

Question 5

Small Cell CA characteristics?

Answer 5

Bronchial origin (central)
Compresses bronchi
Micrometastases
Poor prog (Φ surgery)

Question 6

Non-small Cell CA (NSC):

Adenocarcinoma characteristics?

Answer 6

Most common,
Mucous gland origin (peripheral),
Met to distant organs,
Nodules or masses

Question 7

NSC Squamous Cell CA characteristics?

Answer 7

Bronchi epith origin (central),
Hemoptysis common,
Met to regional lymph nodes,
(P) cavitation

Question 8

NSC Large Cell CA characteristics?

Answer 8

Lung periphery,
Met to distant organs,
Undifferentiated,
Rapid/aggressive

Question 9

Lung CA presentation:

Primary Lesion sxs?

Answer 9

Cough
Sputum
Dyspnea
Hemoptysis
Chest pain
Unilat/Local wheeze

Question 10

Lung CA presentation:

Intrathoracic Spread sxs?

Answer 10

Pleural effusion
Pericardial effusion
Hoarseness (compressed laryn n, U L side tumors)

Question 11

Superior Vena Cava Synd is?

Answer 11

compression/invasion of SVC

(U) a/w small cell

Question 12

SVC Synd sxs?

Answer 12

HA
Dyspnea
Facial/extrem swelling
Plethora
Venous pattern on chest

Question 13

Pancoast Synd is?

Answer 13

compression of brachial plexus/cervical sympathetic nn

Question 14

Pancoast Synd sxs?

Answer 14

Horner's: Ipsilateral of tumor
miosis
anhidrosis
ptosis
sunken eyeball

Rib destruction
Hand atrophy
Pain C8 - T2

Question 15

Lung CA presentation:

Paraneoplastic Syndromes

Answer 15

anorexia
weight loss
wasting
fever
↓ immunity

Question 16

Paraneoplastic Syndromes are?

Answer 16

disorders from tumor secretions

hormones, peptides, cytokines

Question 17

Paraneoplastic Syndrome presentation: Hematologic?

Answer 17

thrombophlebitis (e.g. Trousseau’s)

hypercoaguability

Question 18

Paraneoplastic Syndrome presentation: Endocrine?

Answer 18

PTH-like: hyperCa2+
HCG (gonad): gynecomastia
SIADH: hypoN+
Cushing’s: ACTH

Question 19

Paraneoplastic Syndrome presentation: Neurologic?

Answer 19

Eaton-Lambert: NMJ antibodies -> mm weakness

peripheral neuropathy

Question 20

Most common metastasis sites?

Answer 20

Liver
Bone
Adrenal gland
Brain

Question 21

Lung CA workup?

Answer 21

Tissue dx
Staging
Performance status

Question 22

Staging of SCLC?

Answer 22

Limited: in ipsil hemithorax

Extensive: beyond hemi, includes effusion

Question 23

Staging of NSC?

Answer 23

TNM system

T - primary tumor
N - nodal involvement
M - distant mets

Question 24

Stage 1?

Answer 24

localized

Question 25

Stage 2?

Answer 25

in lymph nodes at top of lung

Question 26

Stage 3?

Answer 26

into chest wall

Question 27

Stage 4?

Answer 27

met elsewhere

Question 28

Performance status: post-op complication predictor is?

Answer 28

FEV < 60%

Question 29

Positive Emission Tomo (PET) used for?

Answer 29

staging

Question 30

Lung CA management: small cell

Answer 30

chemo always

(P) whole brain prophy radiation

Question 31

Lung CA management: non-small cell

Answer 31

surgery

Stage IIIa-IV: radiation/chemo