Lung Cancer - clinical approach Flashcards

1
Q

smoking + asbestos leads to which lung cancer?

A

bronchogenic

(small cell or non-small cell)

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2
Q

lung cancer in _____ degree relative increases lung cancer risk?

A

first

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3
Q

Does diet prevent lung cancer?

A

higher intake of fruits/veggies may; unsure

B-carotene or vit E non conclusive

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4
Q

only definitive prevention of lung cancer

A

smoking cessation

NEVER too late to benefit from smoking cessation
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5
Q

lung cancer screening

A

LDCT (low dose helical CT)

(sputum and plain CT not effective)

medicare approved

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6
Q

lung cancer screening

A

LDCT (low dose helical CT)

(sputum and CT does not effective)

medicare approved if asymptomatic + risk factors and over 55 yo

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7
Q

tabacco smoking history that increases lung cancer risk

pack/day x years smoking hx

A

20 pack years

85% risk;

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8
Q

when do you hear stidor

A

inspiration

wheezing is exhalation

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9
Q

sx of lung cancer (5)

A
  1. cough; new or changed
  2. hemoptisys
  3. stridor or wheezing
  4. anorexia
  5. weight loss
  6. asthenia (loss of energy/strength)
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10
Q

What imaging abdormalities are seen in lung cancer?

A
  1. enlarging nodule or mass
  2. persistent atelectasis, opacity or pleural effusion

must compare to previous imaging (changes in 2 years)

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11
Q

Define “nodule”

A

<3mm round opacity

if > 3 mm = mass

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12
Q

Describe a benign nodule

on CXR or CT

A

calcification that is diffuse, central or laminar

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13
Q

3 CT features suspicious for malignancy of lung

A
  1. spiculated edges
  2. irregular margins
  3. lymphadenopathy
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14
Q

When do you get a CT scan of suspected lung cancer?

A

nodule > 4mm or no previous films

if stable < 4 mm = no f/u needed

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15
Q

when do you consider biopsy of suspected lung cancer?

A

nodule 8 mm & high risk

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16
Q

When do you consider PET/CT of suspected lung cancer?

A

> 8mm & low risk

17
Q

S/sx of regional spread (5)

A
  1. tracheal obstruction
  2. hoarseness
  3. dysphagia
  4. pleural effusion
  5. CP
18
Q

s/sx bone metastasis from lung (2)

A
  1. cytopenia
  2. leukoerythroblastosis
19
Q

s/sx liver metastasis from lung (3)

A
  1. fever
  2. anorexia
  3. weight loss
20
Q

Deifine paraneoplastic syndrome

A

syndrome due to substances produced by tumor

Ab produced and cross-react with healthy tissue

21
Q

hypercalcemia of malignancy (2 sx)

paraneoplastic syndrom

A
  1. polyuria
  2. polydipsia

lethargy, N/V

22
Q

cause of hypercalcemia of malignancy

(paraneoplastic syndrome)

A
  1. PTH-related peptide secreatted –> osteolytic metastases
  2. ectopic parathyroid hormon production
23
Q

Hypercalcemia malignancy management

A
  1. hydration
  2. meds: bisphosphonates, denusomab
  3. dialysis
24
Q

What are the 6. paraneoplastic syndromes associated w/lung cancer?

A
  1. hyponatremia
  2. cushings
  3. acromegaly
  4. dermatomyositis/polymyositis
  5. LEMS
  6. osteoarthropathy (clubbing)
25
Q

what is the most accessible site (method) with the least invasive method of evaluating lung cancer?

A

biopsy

26
Q

Which 5 labs would you order for lung cancer work-up?

A
  1. blood count
  2. calcium
  3. liver test
  4. electrolytes
  5. creatinine
27
Q

Staging is done with which tests?

A
  1. US: bronco, thoraco, mediastinum
  2. CT
  3. PET
28
Q

Which lung cancers are removed w/surgery?

A
  1. non-small cell cancer
  2. mesothelioma
29
Q

6 Treatments for non-small cell lung cancer?

A
  1. surgery
  2. radiation
  3. cytotoxic therapy
  4. target chemo against driver mutation (EGFR or ALK)
  5. immunotherapy
  6. smoking cessation
30
Q

4 Sx of mesothelioma

A
  1. SOB
  2. non-pleuritic CP
  3. diminished breath sound
  4. dullness to percussion
31
Q

Dx of mesothelioma (2)

A
  1. CT: pleural effusion or pleural plaques
  2. biopsy
32
Q

tx of mesothelioma (2)

A
  1. chemo
  2. surgery + radiatiton
33
Q

Presentation of pancoast tumor

A
  1. horner syndrome
  2. CP
  3. shoulder pain/ hand atrophy
  4. neuropathy in ulnar n. distribution
34
Q

cause of hypercalcemia of malignancy

(paraneoplastic syndrome)

A
  1. PTH-related peptide secreatted –> osteolytic metastases
  2. ectopic parathyroid hormon production