Lung CA

Question 1

95% of all lung cancers can be broken down into what two types

Answer 1

• small cell lung CA (SCLC)
• non-small cell lung CA (NSCLC)

Question 2

describe a Coin lesion

Answer 2

• < 3 cm
• isolated
• smooth
• dense central calcification
• Benign

Question 3

when is a solitary pulmonary nodule considered a mass

Answer 3

> 3 cm in size

Question 4

what is the problem with a solitary pulmonary nodule > 3 cm (mass)

Answer 4

greater chance of being malignant

Question 5

list some causes of benign solitary pulmonary nodule

Answer 5

• infectious: TB; cocci
• pulm abscess
• Hamartoma
• Vasculitic lesion

Question 6

risk factors of lung CA

Answer 6

• smoking
• exposures: asbestos, radiation
• genetic predisposition

Question 7

endobronchial tumor can present as what on physical exam

Answer 7

fixed or localized wheeze

Question 8

solitary pulmonary nodule that presents with lymphadenopathy usually affects which nodes

Answer 8

• supraclavicular
• scalene nodes

Question 9

what parameters should you look at when assessing a solitary pulmonary nodule on xray

Answer 9

1. Stability
   
   • review old films; minimal growth in 2 yrs -> benign
2. calcification
   
   • no calcification = elevated risk of CA
3. shape
   
   • poorly defined, irregular = elevated risk of CA
4. size

• **refer if lesion is not stable, not calcified, not rounded, or > 3 cm

Question 10

non-small cell types can be broken down into what 3 catagories

Answer 10

1. adenocarcinoma
2. squamous cell carcinoma
3. large cell carcinoma

Question 11

Which two types of lung CA are centrally located

Answer 11

1. small cell lung CA
2. NSCLC- Squamous cell carcinoma

Question 12

Which two types of lung are the most aggressive

Answer 12

1. small cell lung CA
2. NSCLC- Large cell Carcinoma

Question 13

which type of lung CA

• arises from mucous glands
• occurs in lung periphery
• most prevalent lung CA in both sexes

Answer 13

Adenocarcinoma

Question 14

squamous cell carcinoma may be able to be detected by

Answer 14

sputum cytology

Question 15

Which type of lung CA

• occurs centrally
• more likely to cause hemoptysis
• likely to metastasize to regional lymph nodes
• can cavitate

Answer 15

squamous cell carcinoma

Question 16

What is the most common symptom of primary lesion

Answer 16

cough

• most frequently occurs with squamous and small cell

Question 17

hemoptysis is most associated with which lung CA

Answer 17

squamous cell

Question 18

what is the most common cause of hemoptysis

Answer 18

Bronchitis

Question 19

Lung CA can have intrathoracic spread and present as what conditions

Answer 19

1. pleural effusion
2. pericardial effusion
3. hoarsness (compression of recurrent laryngeal nerve; most common with Lt sided tumors)

Question 20

What is superior vena cava syndrome

Answer 20

• due to compression or direct invasion (centrally located CA)
• symptoms
  
  • HA
  • dyspnea
  • facial or upper extremity swelling
  • plethora
  • dilated neck veins
  • prominent venous pattern on chest

Question 21

What is Pancoast syndrome

Answer 21

• tumor involving superior sulcus compresses brachial plexes and cervical sympathetic nerves

Question 22

what does Pancoast syndrome present with

Answer 22

• Horner’s syndrome
  
  • Miosis
  • Anhidrosis (lack of sweating)
  • Ptosis (lid droop)
• atrophy of hand muscles

Question 23

Which paraneoplastic syndrome is most associated with Adenocarcinoma

Answer 23

• carcinogenic thrombophlebitis (Traousseau’s syndrome)
• hypercoagulability

Question 24

Which paraneoplastic syndrome is most associated with NSCLC Squamous

Answer 24

• PTH-like substance
  
  • hypercalcemia

Question 25

Which paraneoplastic syndrome is most associated with NSCLC **Large cell**

Answer 25

* excess HCG production * gynecomastia, mikly nipple discharge

Question 26

Which paraneoplastic syndromes are most associated with SCLC (small cell)

Answer 26

* **SIADH** -\> hyponatremia * **Cushing's syndrome**: ectopic ACTH * **Eaton-Lambert syndrome**: mucle weakness due to defective release of acetylcholine

Question 27

What are the most common sites of distant metastases for lung CA

Answer 27

1. **Liver** 2. **Bone** (elevated alk phos) 3. **Adrenal glands** 4. **Brain** (noted in 20-30% of patients with SCLC)

Question 28

Small cell lung carcinomas can be diagnosed as one of what two stages

Answer 28

* **Limited disease** * tumor limited to ipsilateral hemithorax * **Extensive disease** * tumor extends beyond hemithorax, included pleural effusions

Question 29

Non- small cell lung carcinomas can be diagnosed using TNM system. describe it

Answer 29

* T: Primary tumor * N: nodal involvement * M: distant metastases

Question 30

How is tissue sample obtained to diagnose lung CA

Answer 30

1. sputum culture: best for central lesion 2. bronchoscopy with biopsy 3. fine needle aspriation (CT guided)

Question 31

List stages for NSCLC

Answer 31

1. stage 1: localized CA 2. stage 2: spread to lymph nodes 3. stage 3: spread into chest wall 4. stage 4: spread to another part of body (ex: liver)

Question 32

PFTs are done prior to lung biospy, what is the strongest indicator of post-op complications

Answer 32

FEV1 \< 60%

Question 33

treatment of stage 1 and stage 2 NSCLC

Answer 33

1. stage 1 * 75% 5 yr survival * surgical resection 2. stage 2 * 40% 5 yr survival * surgical resection + chemo

Question 34

Low dose helical CT should be used for screening instead of CXR for those at high risk. who falls into this category

Answer 34

* ages 55-74 with 30 pack year history * or quit within 15 years * or 20 pack year history with one additional risk factor (other than second hand smoke exposure)

Question 35

primary adverse reaction to wellbutrin: used for smoking cessation

Answer 35

seizures

Question 36

which type of lung CA is this * rapid doubling time * centrally * hilar and mediastinal lymphadenopathy * assoc with * SVC syndrome * paraneoplastic syndrome * SIADH * Cushings * Eaton-lambert

Answer 36

small cell lung ca