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IPAP JUNIOR SEM. > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Define Lung Cancer

A

Lung cancer, or bronchogenic carcinoma, is a proliferative malignant neoplasm arising from the primary respiratory epithelium.

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2
Q

What is the most common malignant neoplasm among men

A

Lung Cancer

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3
Q

What is the most common Cancers in women

A

Breast is MC

Then cervical then Lung (3rd)

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4
Q

Small Cell Lung Cancer is most common to what demographic

A

Smokers

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5
Q

What is the most common Non Small Cell Lung Cancer

A

Adenocarcinoma

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6
Q

What are the three types of Non Small Cell Lung CA

A

Adenocarcinoma (MC)

Squamous Cell

Large Cell Carcinoma Subtypes

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7
Q

What is the biggest risk factor for development of Lung Cancer

A

Smoking is #1

Then radiation, 2nd hand smoke/ exposure to toxins, then genetics

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8
Q

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

A

No change in 2 years mean benign and no further workup is needed

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9
Q

You find a solitary pulm nodule on CXR, the pt is low risk for malignancy

What is the F/u approach

A

Serial CRT scan at 3, 6, 9, 12, 18 and 24 months

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10
Q

You find a single pulm nodule on CXR, and the pt is high risk of malignancy, what is the F/u approach

A

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

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11
Q

What is the criteria to determine high risk of malignancy F/u for a single pulm nodule

A

Smoking History

Or nodule size greater than 8mm

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12
Q

A pt presents with chest pain, hemoptysis, clubbing of the fingers, anemia , and fever, wt loss, and fatigue

With clubbing on the fingers think

A

CANCER!

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13
Q

What is the percent of brain metastases with small cell and adenocarcinoma

A

20-30% for small cell

10% for adenocarcinoma

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14
Q

A pt with lung cancer that has a recent change in voice should raise high index of suspicion of what ..

A

Involvement with the recurrent larygeal nerve

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15
Q

All Suspected Lung Cancer pts should get what work up labs

A

CBC and CMP

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16
Q

What is the definitive Diagnosis for lung cancer

A

FNA of palpable lymph nodes , direct Bronchoscopy, or transthoractic needle aspiration

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17
Q

What would be the route to Dx a mediastinal mass

A

Transbronchial needle aspiration (TBNA)

Endobronchial ultrasound with Fine Needle Aspiration (EBUS-FNA)	

Esophageal endoscopic ultrasound with fine needle aspiration (EUS-FNA)

Anterior mediastinotomy

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18
Q

What are the indications for Low dose Helical CT scan screening

A

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

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19
Q

A Soliatery pulm nodule less than 3 cm is considered a

A

Nodule

20
Q

A solitary pulm nodule greater than 3 cm is considered a..

A

Mass

21
Q

What are the features of a pulm nodule that are most likely to be malignant

A

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

22
Q

What are the two CT calcifications that are likely to be malignant in a single pulm nodule

A

Stippled or Eccentric

23
Q

What should we Always evaluate old films in the work up for malignancy

A

allows est. of doubling time (important marker for malignancy)

Rapid progression (<30d) suggests infection

Long term stability (>365d) suggests benign lesion

24
Q

What the the imaging tool of choice to evaluate a single pulm nodule

A

Chest CT

25
Q

What is the most common pathway for metz lung cancer

A

Pulmonary Artery MC

26
Q

What are the most common primary tumors that metx to the lungs

A

Kidney, breast, colorectal, cervix, and malignant melanoma

27
Q

What are the findings of Metz lung cancer on Chest XRay

A

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

28
Q

Small cell carcinoma is commonly associated with what endocrine d/o

A

SIADH

29
Q

What is the most common primary lung cancer

A

Adenocarcinoma

30
Q

Adenocarcinoma arises from what glands

A

Mucus glands

31
Q

You find intraluminal sessile or polyploid mass that presents with hemoptysis

Think

A

Squamous cell

Common in women and non smokers that spreads LOCALLY

32
Q

Where do large cell carcinomas most commonly present

A

Peripheral masses

33
Q

What is the major diff between Small Cell and non small cell CA

A 
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

34
Q

What is the common tumor type in a pan coast tumor

A

NSCLC

35
Q

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

A

Pancoast syndrome

36
Q

A pt is presenting with SAID, what type of cancer is this associated with

A

Small cell CA

37
Q

A pt presents with hypercalcemia

What type of cancer is this associated with

A

Squamous cell CA

38
Q

What are some common tumor complications

A

Recurrent larygeal nerve- voice hoarseness
Phrenic nerve injury_ Diaphram elevation
SVC syndrome _facial/ neckl edema, mimics HF
MG
SIAD
Hypercalcemia

39
Q

What is the difference between limited and extensive small cell carcinoma

A

Limited (about 30%) one side of lung and regional nodes

Extensive (about 70%) both lungs and/or distant spread

40
Q

What is the prognosis of Lung Cancer

A

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

41
Q

What are the s/s fro carcinoid syndrome

A

Flushing, diarrhea, wheezing, HOTN

Tx: surgical excision

42
Q

What is the specific assay for Carcinoid syndrome

A

24 hr urine excretion of 5 Hydroxyindoleactice acid

43
Q

Describe mesothelioma

A

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
44
Q

What is the treatment and prognosis for mesothelioma

A

Chemo

Median survival less than 12 months

45
Q

What are the most common tumors associated with anterior mediastinal mass

A

Thymoma, teratoma, thyroid lesions, “terrible” lymphoma, mesenchymal tumors (lipoma, fibroma)

The Terrible Ts

46
Q

What are the common masses found in the middle mediastinal area

A

Lymphadenopathy, pulm artery enlargement, Aortic Aneurism, Developmental cyst

47
Q

What are the common masses found in posterior mediastinal area

A

Hiatal hernia, neurogenic tumor, meningocele, esophageal tumor, thoracic spine lesions

IPAP JUNIOR SEM. (43 decks)

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