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Clin Med II- Exam 2 > Lung CA > Flashcards

Lung CA Flashcards

1
Q

“coin lesion”

A

solitary pulmonary nodule (SPN)

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2
Q

Characteristics of SPN

A

< 3cm isolated, rounded opacity
completely surrounded by pulmonary parenchyma
not associated w/ infiltrate, atelectasis or adenopathy

most are benign

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3
Q

Signs of benign

A

smooth, well-defined edges

dense central calcification

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4
Q

Most common SPN

A

infectious granulomas

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5
Q

Mass characteristics

A

> 3 cm in size
greater chance of malignancy
CA until proven otherwise

Goal:

  • determine which needs resection
  • limit invasive procedures for benign disease
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6
Q

Causes of benign nodules

A

infectious (80%): TB, Cocci, abscess
Hamartoma
vascular
inflammatory

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7
Q

Risk factors for malignancy

A 
tobacco
female
FHx
emphysema
previous malignancy
asbestos exposure
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8
Q

PE findings

A

unexplained weight loss
supraclavicular LAD
fixed or localized wheeze
joint tenderness

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9
Q

Approach to SPN

A
  1. Review old films: malignant nodules typicallyd ouble in 20-400 days; minimal growth = benign
  2. Calcification = benign
  3. Shape: smooth, well defined = benign
  4. Size: >5cm = 90% CA
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10
Q

Imaging for SPN

A

CT w/o contrast w/ low radiation (thin 1 mm slices)

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11
Q

Low probability <5% management nodule >8 mm

A

get CT @ 3 mo

  • no growth = serial CT at 9-12 and 18-24
  • growth = patho eval
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12
Q

Intermediate probability (5-65%) nodule > 8 mm

A

FDG PET/CT and/or Bx

CT survellience at 3,9-12 and 18-34 mo (alt. to bx)

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13
Q

High probabilty >65% nodule > 8 mm

A

biopsy or excision (staging with PET/CT may be helpful)

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14
Q

Nodule <8 mm step

A

6-8 mm: follow w/ CT @ 6-12 mo then repeat as indicated

<6mm: doesn’t usually require f/u; CT @ 12 mo optional

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15
Q

Lung malignancy types

A 
SCLC: oat cell carcinoma
NSCLC:
-adenocarcinoma (42%)
- squamous cell carcinoma (22%)
- large cell carcinoma (2%)
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16
Q

Oat cell lung cancer (SCLC) location

A

CENTRAL airways

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17
Q

Presentation of SCLC

A

large hilar mass w/ bulky mediastinal adenopathy
cough, dyspnea, weight loss, debility
HIGHLY AGGRESSIVE

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18
Q

Prognosis of SCLC

A

6-18 weeks w/o tx

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19
Q

Categories for SCLC

A

limited (ipsilateral hemithorax and regional ndoes)

extensive (70%)

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20
Q

Adenocarcinoma etiology

A

arises from mucous glands or any epithelial cell in or distal to the terminal bronchioles

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21
Q

Location of adenocarcinoma

A

peripheral (distal or in terminal bronchioles)

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22
Q

Squamous cell carcinoma location

A

centrally or in main bronchus

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23
Q

Squamous cell carcinoma etiology

A

bronchial epithelium

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24
Q

Characteristics of squamous cell carcinoma

A 
intraluminal growth in bronchi
may detect by sputum cytology
more likely to cause hemoptysis
likely to metastasize to regional lymph nodes
can cavitate
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25
Q

More likely to cause hemoptysis

A

squamous cell

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26
Q

Found in bronchial tube

A

squamouss

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27
Q

found centrally

A

SCLC

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28
Q

Found distal to terminal bronchioles

A

Adenocarcinoma

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29
Q

Large cell carincoma location

A

central or peripheral masses

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30
Q

Characteristics of large cell

A

metastazes to distant organs
relatively undifferentiated
AGGRESSIVE - rapid doubling time

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31
Q

Metastasized to lymph nodes

A

squamous

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32
Q

metastasizes to distal organs

A

adeno and large cell

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33
Q

Sx result from

A

paraneoplastic syndromes

metastasis: may have no lung complains

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34
Q

paraneoplastic syndrome

A

altered immune system response to neoplasm (ataxia, eye movements, etc)

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35
Q

Most common sx of lung canger

A

cough

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36
Q

Cough is most frequent with

A

squamous and small cell

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37
Q

poor prognosis for lung CA

A

weight loss

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38
Q

Hemoptysis

A

squamous cell

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39
Q

What is the most common cause of hemoptysis

A

bronchitis

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40
Q

Sx of intrathoracic pread

A

PE (direct pleural extention, mediastinal node involvement, lymph obstruction)
pericardial effusion
hoarseness (compression of laryngeal nerve; > w. left sided tumors)

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41
Q

Cause of SVC syndrome

A 
patho process of:
right lung
lymph nodes
other mediastinal structure
thrombosis of devices
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42
Q

Most common to cause SVC

A

SCLC

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43
Q

Sx of SVC syndrome

A

dyspnea!
facial swelling/head fullness (worse w/ forward bend)
arm swelling, cough, chest pain, dysphagia

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44
Q

PE for SVC syndrome

A

facial edema
dilated neck veins
prominent venous pattern on chest

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45
Q

Dx for SVC syndrome

A

CXR
Duplex U/S (initial for indwelling devises or arm swelling)
CT w/ contrast (level and extent of block)
Superior vena cavogram (GOLD STANDARD) - identify and extent of thrombus formation

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46
Q

Gold standard for dx SVC syndrome

A

superior vena cavogram

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47
Q

Tx goals for SVC syndrome

A

alleviate sx and underlying disease

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48
Q

Tx options for SVC syndrome

A

Emergency RT
venous stent
chemo if indicated
removal of devices and anticoag

49
Q

Indications for emergency RT (radiation)

A

stridor from central airway obstruction or laryngeal edema

coma from cerebral edema

50
Q

Pancoast syndrome

A

tumor involving superior sulcus (apical chest); compresses brachial plexus and cervical sympathetic nerves

51
Q

Horner’s Syndrome

A

injury of sympathetic nerves of the face

52
Q

Pancoast syndrome sx

A 
right shoulder > forearm, scapula and finger pain
ipsilateral to side of tumor 
miosis
anhidrosis
ptosis
rib destruction
atrophy of hand mm.
pain C8, T1, T2 nerve roots
53
Q

Most common to cause pancoast syndrome

A

Squamous cell

54
Q

Sx of paraneoplastic syndrome

A 
anorexia
weight loss
cachexia
fever
suppressed immunity
55
Q

Hematologic dysfunction in paraneoplastic syn.

A 
hypercalcemia (bone destruction)
anemia (fatigue, dyspnea)
leukocytosis (poor prognosis)
thrombocytosis (shortened survival)
hypercoagulability
56
Q

Poor prognosis in paraneoplastic

A

leukocytosis and thrombocytosis

57
Q

Endocrine dysfunction in paraneoplastic

A

PTH-like substance: hypercalcemia

Excess HCG production: gynecomastia, milky nipple d/c

58
Q

Most likely to cause hypercalcemia due to PTH

A

Squamous

59
Q

Most likely to cause gynecomastia and nipple d/c

A

large cell

60
Q

SIADH causing hyponatremia

A

small cell

61
Q

Presentation of SIADH

A 
irritable
restlesss
personality changes
confusion
coma
seizure
resp. arrest
62
Q

Cushing syndrome due to ectopic ACTH

A

small cell

63
Q

Small cell can cause what effects in paraneoplastic syndrome

A

SIADH and Cushings (ACTH) and Eaton-Lambert

64
Q

Presentation of cushings

A 
muscle weakness
weight loss
HTN
Hirsuitism
Osteoporosis
65
Q

Neuro sign in paraneoplastic

A

Eaton-Lambert Syndrome

66
Q

Eaton-Lambert Syndrome

A

immune mediated

antibodies at NMJ: defective release of Ach, mm. weakness

67
Q

Causes Eaton-Lambert

A

small cell

68
Q

Most common sites of metastases

A

Liver (elevated LFT)
bone (elevated ALP)
adrenal (rarely symptomatic)
brain

69
Q

What is most likely to metastasize to brain

A

SCLC

70
Q

1 cause of brain metastasis

A

lung CA

71
Q

Sx of brain metastasis

A 
HA
N/V
seizures
confusion
personality chagnes
72
Q

Staging of SCLC

A

limited vs extensive

73
Q

Staging of NSCLC

A

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

74
Q

Dx of Lung CA

A

bx

75
Q

Obtaining tissue sample for tissue bx

A

sputum (central lesion- squamous)
Bronchoscopy w/ bx
thoracentesis (remove fluid from pleural space)
fine needle aspiration/CT-guided needle bx
transbronchial aspiration
VATS
Thoracotomy

76
Q

Performance status

A

0- fully active
1- strenous activity restricted
2- capable of all self-care; can’t carry out work activities; up >50% of walking hours
3= limited self care; confined to bed or chair
4 = completely disabled; no self-care

77
Q

PFT

A

<60% = strongest indicator of post-op complications

78
Q

used for staging

A

PET

79
Q

used in PET

A

fluorodeoxyglucose (FDG)

80
Q

Limitations of PET

A

does not detect all CA (bronchoalveolar CA)

infections may be +

81
Q

Normally light up in PET

A

kidneys
bladder
heart

82
Q

Tx for NSCLC

A 
surgical resection (I-IIIA)
IIIB-IV = palliative radiation or combo chemo
83
Q

Tx for SCLC

A 
chemo regardless of stage
(cisplatin + etoposide)
limited disease: chemo + radiation
radiation
prophylactic cranial radiation
relapse commo
surgery option <5%
84
Q

Main tx for NSCLC

A

resection

85
Q

Main tx for SCLC

A

chemo +/- radiation

86
Q

Malignant effusion tx

A

thoracentesis
pleurodesis (chem agent)
pleurx catheter

87
Q

SE of surgery

A

pain

88
Q

SE of radiation

A

fatigue

89
Q

SE of chemo

A 
anemia, neutropenia
nephrotoxicity
cutaneous toxicity
n/v, anorexia, weightloss
fatigue, "chemo brain"
90
Q

Stage 1 NSCLS tx

A

resection (lobectomy)

alt: radiation

91
Q

1B NSCLC tx

A

resection + chemo

92
Q

Stage 2 NSCLC tx

A

surgical resection + chemo

93
Q

Stage 3 NSCLC

A

unresected: chemo
resected: adjuvant chemo; RT if uncertain resection margin

94
Q

Stage 4 NSCLC tx

A

palliative (sx baed)
chemo, clinical trials
resection of metastasis
“targeted therapy” - EGF-R inhibitors

95
Q

Used for lung cancer screening

A

Low-dose helical CT (LDCT)

96
Q

Who should get screened?

A

age 55-74 w/ 30 pack/yr history
or quit w/i 15 yrs
or 20 pack/yr hx with one more risk factor

97
Q

Smoking cessation drugs

A

Zyban (wellbutrin)
Chantix (varenicline)
Nicotine replacement

98
Q

chantix MOA

A

blocks alpha-4-beta-2 nicotinic acetylcholine receptors

99
Q

Effects of chantix

A

stop smoking in 7 days

Rx 12-24 weeks

100
Q

Precaution of chantix

A

unstable CVD

101
Q

drug interrxns with chantix

A

synergistic w/ nicotine

102
Q

Adverse rxns of chantix

A

dizziness, HTN, palpitations, GI upset

103
Q

zyban MOA

A

inhibits neuronal uptake of NE and dopamine

104
Q

Effects of zyban

A

stop smoking 5-7 days

105
Q

precaution of zyban

A

avoid EtOh

106
Q

Black box warning

A

zyban;

increased suicide in children, young adults, adolescents

107
Q

Adverse rxns of zyban

A

seizures*, agitation, wt. loss

108
Q

Nicotine replacement

A 
nicotrol NS (nasal spray)
nicotrol inhaler
109
Q

Precautions of nicotine replacemetn

A

unstable CVD

110
Q

Adverse rxns of nicotine replacement

A

dizziness, HTN, palpitations, GI upset

111
Q

OTC nicotine replacement

A

nicoderm CQ
nicorette
commit lozenge

112
Q

thrombophlebitis

A

adenocarcinoma

113
Q

most common NSCLC

A

adenocarcinoma

114
Q

central bronchi

A

squamous cell

115
Q

associated with PTH

A

squamous

116
Q

slow growing, late metastasis

A

squamous

117
Q

dx of exclusion

A

large cell

118
Q

main cause of adenocarcinoma

A

smoking

119
Q

associated with SCLC

A

cushing, eaton-lambert, SIADH

Clin Med II- Exam 2 (7 decks)

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