Lung Cancer Flashcards
Define Lung Cancer
Lung cancer, or bronchogenic carcinoma, is a proliferative malignant neoplasm arising from the primary respiratory epithelium.
What is the most common malignant neoplasm among men
Lung Cancer
What is the most common Cancers in women
Breast is MC
Then cervical then Lung (3rd)
Small Cell Lung Cancer is most common to what demographic
Smokers
What is the most common Non Small Cell Lung Cancer
Adenocarcinoma
What are the three types of Non Small Cell Lung CA
Adenocarcinoma (MC)
Squamous Cell
Large Cell Carcinoma Subtypes
What is the biggest risk factor for development of Lung Cancer
Smoking is #1
Then radiation, 2nd hand smoke/ exposure to toxins, then genetics
If a solitary pulm nodule has not changed from an old CXR or Ct in the past two years.. what further work up is required
No change in 2 years mean benign and no further workup is needed
You find a solitary pulm nodule on CXR, the pt is low risk for malignancy
What is the F/u approach
Serial CRT scan at 3, 6, 9, 12, 18 and 24 months
You find a single pulm nodule on CXR, and the pt is high risk of malignancy, what is the F/u approach
Pet scan, Bronchoscopy, or FNA biopsy
To determine if benign or malignant.
If benign then serial Ct Scans at 3-6-9-12-18-24 months
If Malignant refer for SRGRY
What is the criteria to determine high risk of malignancy F/u for a single pulm nodule
Smoking History
Or nodule size greater than 8mm
A pt presents with chest pain, hemoptysis, clubbing of the fingers, anemia , and fever, wt loss, and fatigue
With clubbing on the fingers think
CANCER!
What is the percent of brain metastases with small cell and adenocarcinoma
20-30% for small cell
10% for adenocarcinoma
A pt with lung cancer that has a recent change in voice should raise high index of suspicion of what ..
Involvement with the recurrent larygeal nerve
All Suspected Lung Cancer pts should get what work up labs
CBC and CMP
What is the definitive Diagnosis for lung cancer
FNA of palpable lymph nodes , direct Bronchoscopy, or transthoractic needle aspiration
What would be the route to Dx a mediastinal mass
Transbronchial needle aspiration (TBNA)
Endobronchial ultrasound with Fine Needle Aspiration (EBUS-FNA) Esophageal endoscopic ultrasound with fine needle aspiration (EUS-FNA)
Anterior mediastinotomy
What are the indications for Low dose Helical CT scan screening
Adults 50-80 years old
+20 pack year history
+currently smokes or quit within the past 15 years
Or life expectancy that would support ability of willining to have a curative lung cancer screening
A Soliatery pulm nodule less than 3 cm is considered a
Nodule
A solitary pulm nodule greater than 3 cm is considered a..
Mass
What are the features of a pulm nodule that are most likely to be malignant
Age over 30, smokers, with any PmHx of Ca,
Greater than 8 cm at discovers
Or eccentric calcification, thick walled cavitations, or ill defined borders that are speculated
Also Corona radiata margins
What are the two CT calcifications that are likely to be malignant in a single pulm nodule
Stippled or Eccentric
What should we Always evaluate old films in the work up for malignancy
allows est. of doubling time (important marker for malignancy)
Rapid progression (<30d) suggests infection
Long term stability (>365d) suggests benign lesion
What the the imaging tool of choice to evaluate a single pulm nodule
Chest CT
What is the most common pathway for metz lung cancer
Pulmonary Artery MC
What are the most common primary tumors that metx to the lungs
Kidney, breast, colorectal, cervix, and malignant melanoma
What are the findings of Metz lung cancer on Chest XRay
The findings of metastatic lung cancer on CXR are:
Multiple, spherical densities with sharp margins
Most are < 5cm
Bilateral
More common in the lower lung fields
Cavitations—suggests squamous cell
Small cell carcinoma is commonly associated with what endocrine d/o
SIADH
What is the most common primary lung cancer
Adenocarcinoma
Adenocarcinoma arises from what glands
Mucus glands
You find intraluminal sessile or polyploid mass that presents with hemoptysis
Think
Squamous cell
Common in women and non smokers that spreads LOCALLY
Where do large cell carcinomas most commonly present
Peripheral masses
What is the major diff between Small Cell and non small cell CA
Small Cell Lung Ca (SCLC) -Early hematogenous spread -Rarely amenable to surgical resection -Very aggressive course (6-18 wk survival, untreated)
Non-Small Cell Lung Ca (NSCLC)
(the other 4 types)
-Slower spread
-Resection of early disease leads to high cure rates
-Chemo tailored to specific histological findings but poor response
What is the common tumor type in a pan coast tumor
NSCLC
A pt presents with Shoulder and arm pain with horners syndrome with weakness and atrophy of the hand
With face/neck Edelman, dyspnea and chest pain
Shoulder pain radiates downt eh c8 and T1 nerve roots
Think what D/o/ Tumor
Pancoast syndrome
A pt is presenting with SAID, what type of cancer is this associated with
Small cell CA
A pt presents with hypercalcemia
What type of cancer is this associated with
Squamous cell CA
What are some common tumor complications
Recurrent larygeal nerve- voice hoarseness
Phrenic nerve injury_ Diaphram elevation
SVC syndrome _facial/ neckl edema, mimics HF
MG
SIAD
Hypercalcemia
What is the difference between limited and extensive small cell carcinoma
Limited (about 30%) one side of lung and regional nodes
Extensive (about 70%) both lungs and/or distant spread
What is the prognosis of Lung Cancer
Overall 5-year survival rate is 10-15%
Cell type, age, and general health are major factors
Squamous cell survival with resection does better than adenocarcinoma or large cell
Small cell rarely live past 5 years after diagnosis
What are the s/s fro carcinoid syndrome
Flushing, diarrhea, wheezing, HOTN
Tx: surgical excision
What is the specific assay for Carcinoid syndrome
24 hr urine excretion of 5 Hydroxyindoleactice acid
Describe mesothelioma
Primary tumor of surface lining of pleura (80%) or peritoneum (20%)
Men : Women- 3:1
Proven association w/ asbestos exposure
10% lifetime risk for asbestos workers Typically 20-40 yrs after exposure -Mining, milling, manufacturing -Shipyard work, insulation -Construction, demolition, roofing
What is the treatment and prognosis for mesothelioma
Chemo
Median survival less than 12 months
What are the most common tumors associated with anterior mediastinal mass
Thymoma, teratoma, thyroid lesions, “terrible” lymphoma, mesenchymal tumors (lipoma, fibroma)
The Terrible Ts
What are the common masses found in the middle mediastinal area
Lymphadenopathy, pulm artery enlargement, Aortic Aneurism, Developmental cyst
What are the common masses found in posterior mediastinal area
Hiatal hernia, neurogenic tumor, meningocele, esophageal tumor, thoracic spine lesions
