Lung cancer Flashcards
- What type of cancer is usually superior sulcus tumor?
- What is pancoast syndrome? (3 things)
- SCC (Superior Sulcus and squamous both start w/ S)
- Shoulder pain
C8-T2 Radicular pain
Horner syndrome
- When is pancoast tumor not resectable? (4 things)
- What is a good imaging modality to see if resection is still an option?
- Brachial plexus
diaphram paralysis
greater than 50% vertebal body invasion
distal mets.
- MRI to evaluate brachial plexus.
Popcorn calcification pattern in nodule is suggestive of what?
Hamartoma.
Intra-lesional fat in lung nodule is suggestive of what?
Hamartoma or lipoid granuloma.
Features of benign nodules?
Small, calcification, non-round shape, subpleural, clustering (infectious)
Nodule morphology suggesting malignancy
Large size, Irregular edge or spiculated margin, round shape, cavitary nodule/cystic space
Fleischner f/u recommendations for patients >35 years old without a hx of malignancy and with a noncalcified nodule
<4mm - LR: no f/u. HR: 12 month follow up
4-6mm. LR: 12 month f/u. HR: 2 follow ups with the first in 6-12 month
6-8mm - LR: follow-up starting in 6-12 months. HR: 3 followups starting in 3-6 months.
>8mm. Regardless of risk, get a PETCT or biopsy or 3 followups starting at 3 months.
Types of lung cancer (6)
Adenocarcinoma, SCC, BAC, Small cell, Large cell, carcinoid
Lung adenocarcinoma - a/w smoking, but not as much as SCC
- Where does it occur in the lung?
- typical radiographic appearance.
- Pathologic marker?
- Peripheral lung
- pulmonary nodule, which may have spiculated appearance due to fibrosis. Cavitationcan occur, but this is more common in SCC.
- TTF-1 (thyroid transcription factor) - positive in adenocarcinoma and negative in mets.
Squamous cell carcinoma
- Why is this less common now
- Where do they arise from?
- Common radiologic findings
- Filtered cigarettes
- Majority of SCC arise centrally from main, lobar, or segmental bronchi. May present as Hilar mass
- Lobar atelectasis, mucoid impaction, consolidation, bronchiectasis. Propensity to cavitate.
Bronchioalveolar carcinoma - Lepidic growth
- What is lepidic growth?
- appearance on PET?
- Nonmucinous BAC vs. Mucinous BAC
- Spreading of malignant cells using alveolar walls as scaffold.Opposite of lepidic growth is ‘hilic’ growth, which describes growth by invasion of lung parenchyma
- Can be PET negative
- Non-mucinous: ground glass or solid nodule with air bronchograms. Better prognosis
Mucinous: chronic consolidation, worse prognosis.
Pathologic classification/spectrum of BAC (5)
Adenomatous hyperplasia (AAH) - precursor lesion
Adenocarcinoma in situ (preinvasivel esion)
Minimally invasive adenomarcinoma
Adenocarcinoma, predominantly invasive with some nonmucinous lepidic growth
invasive mucinous adenocarcinoma
Small cell lung cancer - 3rd most common lung cancer. Strongly a/w smoking.
- cells of origin
- presentation
- Neuroendocrine cells, a/w paaraneoplastic syndrome
- tend to occur in central bronchi and invade through bronchial wall. May involve SVC and cause SVC syndrome
Large cell carcinoma - waterbasket term for lung cancer that is not SCC, adeno, or smallcell.
- Where does it occur?
- Lung periphery. Large mass.
Carcinoid tumor
- Cells and location of origin
- Presentations
- Typical vs. atypical carcinoid
- Uncommon precursor lesion to typical carcinoid tumor
- Neuroendocrine cells in bronchial wall
- Endobronchial mass distal to carina. Sometimes it may present as pulmonary nodule.
- Typical (low grade)
Atypical (high grade) - nodal or distal mets. Arise peripherally.
- DIPNECH - Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Characterized by multiple foci of neuroendocrine hyperplasia or tumorlets (carcinid foci <5mm in size), bronchiolitis obliterans.
Various presentations of lung cancer
Solitary pulmonary nodule (lung mass), segmental or lobar atelectasis, consolidation, hilar mass. Superior sulcus tumor, lymphangitic carcinomatosis, pleural effusion, pneumothorax
- What is T stage of superior sulcus tumor?
- What is M stage of malignant effusion
- T3 (at least stage IIIA)
- M1 - (Stage 4)
- Stages of lung cancer where you can use surgery/chemo
- Stage that is unresectable
- Stave IIB or IIIA may get surgery/chemo/radiotherapy
- Stage IIIB can’t be resected (N3 - contralateral or supraclavicular lymph nodes, or T4 - seperate tumor)
Lung cancer, T staging
T1: <3cm - surrounded by lung or visceral pleura
T2: 3-7 cm - or local invasion of visceral pleura or endobronchial lesions >2cm from carina
T3: >7cm - or endobronchial lesions <2cm from carina
T4: Separate tumor nodule in a different lobe in same lung, or invasion of mediastinal structures
N (node) staging
N1: Ipsilateral hilar/intrapulmonary nodes (levels 10-14)
N2: ipsilateral mediastinal nodes (levels 2-9)
N3: Any supraclavicular or contralateral node
M (mets) staging
M0: Metastatic disease
M1a: local thoracic mets
M1b: distant or extrathoracic metastatic disease
