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NM By Myself > Lung Cancer NM > Flashcards

Lung Cancer NM Flashcards

1
Q

Lung cancer T

A
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2
Q

Lung cancer N

A

N1 - peribronchial or hilar or intrapulmonary
N2 - mediastinal or subcarinal
N3 - contralateral

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3
Q

Lung cancer M

A

Liver
Adrenal
Bone
Brain
M1a - separate nodule in contralateral lobe
M1b - single extra thoracic MTS
M1 multiple extra thoracic MTS

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4
Q

Central tumor

A

Cough
Dyspnea
Atelectasis
Post obstructive pneumonia
Wheezing
Hemoptysis

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5
Q

Peripheral tumor

A

Cough
Dyspnea
Severe pain (parietal pleura)

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6
Q

Superior vena cava syndrome

A

Facial edema
Dusky skin color
Conjunctival edema
Upper extremity edema
Upper chest wall veins retrograde flow

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7
Q

Pancoast syndrome

A

Compression of brachial plexus root
Intense radiating pain in hand

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8
Q

Horner syndrome

A

Ipsilateral ptosis, miosis, enophtalmos, anhidrosis

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9
Q

NSCLC 85-90%

A

Adenocarcinoma - - peripheral solitary nodule or mass
SCC - smoking, large central tumor
Large cell carcinoma

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10
Q

SCLC 15%

A

Men >60y, 99% smokers
Central location - - main bronch - - obstruction
Larger tumor - - cavitation - - aggressive with early mediastinal LN - - 80% respond to chemo

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11
Q

Never smoke

A

15% men
>50% women

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12
Q

EGFR mutation 15% adenocarcinoma

A

Non smokers
62% Asian - - good prognosis

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13
Q

Lung cancer risk

A

Smoking 80%. Passive smoking 25%
Asbestos - - 5-fold increase risk
Radon 2-3% annually
HIV - 6.5-fold increase risk
Emphysema, chronic bronchitis - - impact on treatment
Idiopathic pulmonary fibrosis - 3-7-fold increase risk, 20% develop cancer

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14
Q

Paraneoplastic syndrome
SCLC

A

SIADH,
Parat hormone - - hyperparathyroidism
Cushing - - ACTH
Hyponatremia - - ADH
Hypocalcemia - - Calcitonin
gynecomastia - - gonadotropins
Carcinoid - - serotonin
Encephalomyelitis
Lambert - Eaton sy
Sensory neuropathy

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15
Q

Paraneoplastic syndrome
Adenocarcinoma

A

Clubbing
Hypertrophic pulmonary osteoarthropathy
Trousseau sy of hypercoagulopathy
Dermatomyositis / polimyositis

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16
Q

Surgery
Lung cancer

A

No mediastinal disease or invasion
Stage I and II only NSCLC
Lobectomy
Poor pulmonary reserve or peripheral nodule <2 cm, >50% GGO or doubling time >400 days - - wedge resection

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17
Q

NSCLC treatment

A

Stage I-II - - surgical resection
Resectable stage III - - surgery, chemo, radio or combi
Unresectable stage IIIA - - chemo radio
Stage IV - - chemo, palliative radio

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18
Q

SCLC treatment

A

Chemo radio
Neoadjuvant chemo and Surgery for 5% T1-2N0-1M0

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19
Q
A

Adenocarcinoma
Consolidation with air bronchogram
Peripheral nodule with pleural tail

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20
Q
A

SCC
15% cavitation
Central/perihilar

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21
Q

Large cell carcinoma

A

Large peripheral mass with necrosis

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22
Q

CT
Extent of primary tumor

A

Chest wall invasion - - >3 cm contact
Mediastinal invasion - - >3 cm contact
Pleural/pericardial effusion
Separate nodules
Important for staging - around tumor, same lobe, other lobes, contralateral

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23
Q

CT
Nodal disease

A

Mediastinal >10 mm
Subcarinal >13-15 mm
Lymphangitic carcinomatosis - - mimic interstitial lung disease

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24
Q

CT distant MTS

A

Lung - - contralateral, pleural nodules, effusion
Adrenal - - >3 cm, HU>10, Irregular rim enhancement
Bone - - vertebra, ribs, pelvis
Lytic>blastic
Elevated Ca, AlcPhos

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25
Q

CT special scenario

A

2 separate lesions - - separate staging
Part-solid nodule - - adenocarcinoma with lepidic component
Patchy GGO, consolidation - - mucinous/lepidic adenocarcinoma

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26
Q

PET CT
Lung cancer

A

Most accurate
Limited for brain, can detect unexpected brain MTS >1.5 cm
Patients selected for Operation - - 24% MTS
Adrenal - - uptake >liver
Lepidic adenocarcinoma - -Tis - - minimal uptake

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27
Q

RECIST response criteria
Lung cancer

A

Unidimensional measurements
At least 1 measurable lesion at baseline
Min size 10 mm
After radio - - 3 months

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28
Q

MRI
Lung cancer

A

Most sensitive for brain MTS
Chest - - cardiac invasion, brachial plexus, vertebra
Subclavian vessels and carotid/vertebral artery - - precludes surgical resection

29
Q

MRI
Lung cancer
Abs Contra surgery

A

Invasion of brachial plexus roots/trunks above T1
>50% vertebral body
Esophagus / trachea

30
Q
A

NSCLC
Left hilar mass
Elevated left hemidiaphragm - - phrenic nerve involvement - - stage T3

31
Q
A

Pancoast tumor
At least T3
T4 if invade brachial plexus, spine or great vessels

32
Q

Paraneoplastic syndrome SCC

A

Hypercalcemia due to parathyroid like hormone
Cushing

33
Q

Immunotherapy

A

Tumor shrinkage later than after chemo or targeted therapy
Temporal increase in tumor size - - pseudo progression

34
Q

N2 treatment
Lung cancer

A

Most undergo mediastinoscopy
N2 negative after neoadjuvant - - critical for selection for thoracotomy
EUS-FNA - - no adequate visualization of lower paratracheal LN
Better - repeat FDG for restaging after neoadjuvant

35
Q

Mesothelioma N

A

N1 - bronchopulmonary, hilar, mediastinal
N2 - contralateral mediastinal or supraclavicular LN
Nodal spread - - poor prognosis

36
Q

Mesothelioma M

A

Lung
Peritoneum
Bone
Subcutaneous tissue
Liver

37
Q

Mesothelioma presentation

A

Dyspnea
Unexplained Pleural effusion
Chest pain

38
Q

Mesothelioma type

A

Epithelioid 55-65% - - best prognosis
Sarcomatoid 10-15% - - poor prognosis
Biphasic 20-35%
Desmoplastic 10%

39
Q

Mesothelioma risk

A

Arise from mesothelium (peritoneum, pericardium, tunica Vaginalis)
Asbestos 80% - - latency >20 y
Prior radio
SV40 virus
Intrapleural Thorotrast

40
Q

Mesothelioma surgery

A

Non Sarcomatoid (biopsy proven)
T1-3N0-1M0
Sufficient respiratory reserve
Fit to chemo radio
EPP = extrapleural pneumonectomy - - pleura, lung, pericardium, diaphragm
Pleurectomy / decortication - - symptom control, not cure

41
Q

Mesothelioma treatment

A

Stage I, II, III - - EPP + chemo + postop radio
Stage III and IV unresectable - - palliative chemo and pleurodesis (sterile talc)
Chemo - - cisplatin, premetrexed
Immunotherapy - - pebrolizumab

42
Q

Mesothelioma CT

A

Unilateral Pleural effusion 95%
Tumoral encasement of lung
Interlobular fissure thickening
Calcified pleural plaque 20%
Volume loss hemithorax
Pleural thickness >1 cm

43
Q

Mesothelioma CT treatment response

A

Measure tumor thickness perpendicular to chest wall or mediastinum in 2 locations

44
Q

Mesothelioma PET CT

A

High avid
SUV cutoff 3.0
Higher uptake - - shorter survival time
SUV >2.0 - - biopsy
>50% of circumference of vascular structure surrounded - - invasion
Recurrent SUV 8.9

45
Q

Mesothelioma MRI

A

Assess local disease
Invasion of diaphragm, fascia, chest wall

46
Q
A

Mesothelioma T1

47
Q
A

Mesothelioma T1
Rind around lung

48
Q
A

Mesothelioma T4

49
Q
A

Mesothelioma T4N2

50
Q

Thymus carcinoma M

A

Pleura
Lung
LN
Mediastinum (thymoma)
Bone (thymic cancer)
Liver (thymic cancer)

51
Q

Thymoma

A

> 40 y
Slow grow
Risk of B lymphoma, GIT cancer, sarcoma after resection
Paraneoplastic - - 30% myasthenia gravis (10% наоборот), 30-50% pure red cell aplasia, 3-6% Good sy (hypogammaglobulinemia), glomerulonephritis, autoimmune hepatitis

52
Q

Thymic carcinoma

A

50 y
More aggressive
Worse prognosis

53
Q

Thymic NET

A

2-5%
Carcinoid
MEN1
Paraneoplastic - - Cushing, Lambert Eaton, carcinoid

54
Q

Thymus biopsy

A

Not recommended
Seeding

55
Q

Thymus CT

A

No dd thymoma vs thymic carcinoma
No matter size
Thymoma more homogenous
Thymoma - - encapsulated
Thymic carcinoma - - larger, with necrosis

56
Q

Thymus PET CT

A

SUV >5.0 - - thymic carcinoma or lymphoma
SUV 2.0-4.0 benign

57
Q

Thymus resectable

A

Invasion of innominate vein
Heart
Great vessels
Phrenic nerve

58
Q

Thymus unresectable

A

Pleural or pericardial MTS
Distant disease
Chemo radio

59
Q

Pulmonary nodule + high likelihood for malignancy by CT
Next step

A

Trans thoracic needle aspiration or thoracoscopy with wedge resection

60
Q

Pulmonary nodule + low likelihood for malignancy by CT or Indeterminate
Next step

A

PET CT FDG

61
Q

SUV mean cut off benign vs malignant pulmonary nodule

A

2.5

62
Q

Negative PET

A

Excludes high grade lung carcinoma

63
Q

% of nodules negative on PET that are malignant

A

5-10%

64
Q

Normal size nodal MTS

A

15%

65
Q

PET in mediastinal nodules

A

Negative - - no LN MTS
Positive - - still need diagnostic mediastinoscopy

66
Q

Uptake of FDG correlates with

A

Tumor grade

67
Q
A

Adenocarcinoma

68
Q

Multifocal lung adenocarcinoma

A

Slow growth
Women, non smokers
Longer median survival

69
Q
A

Sarcoidosis

NM By Myself (25 decks)

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