Lung Neoplasms Flashcards
Neoplasm? v Tumor?
neoplasm = abnormal growth of tissue
- can be benign or malignant
tumor = a non-specific term for neoplasm (think of more as a lump than just a spot)
types of neoplasms in the lung
nodule v mass
nodule = neoplasm < 3 cm “coin lesion or single pulmonary nodule”
mass = neoplasm > 3 cm
you see a noudule on chest imaging.. what are some possibilites for the nodule
- infection/inflammatory granuloma
- malignant neoplasm (primary or a metastisis)
- benign neoplasm
- get good hx. to decide what it migh the
characteristics of a pulm. nodule that you need to consider when it appears on imaging
2 most important 3 addtional
- SIZE: > 2cm is high risk malignancy
- RATE OF CHANGE: doubling in size in 12 months = malignant
- also consider the boarders/marigins
- smooth and roungd - benign
- lobulated or spiculated - malignant - density
- solid: uniform throughout
- subsolid: areas of cavitation (not uniform)
** thick walls with cavities – think malignant
- calcification
benign
- diffuse (all the same)
- central (dot in middle)
- popcorn (hamartoma)
- laminated (lines)
malgnant
- stippled
- eccentric (dot not in middle)
how do you manage a pulmonary nodule?
- depends on what
- what do you do for low risk? high?
- depends on the calculated probabiltiy of it being malignant – calculate with pt. hx., risk factors, and previous imaging ** FLISCHNER GUIDLINES**
low risk: watchful waiting with repeat imaging
high risk: repeat imaginge more frequent depending on the size
- STABLE: repeat 18-24 months
- UNSTABLE: get advanced imaging (PET)
what is lung cancer? types & categories
lung cancer: carcinoma – cancer of the epithelial cells in the respiratory tract
Large Neuroendocrine
- small cell carcinoma
- bronchial carcinoid tumors
Non-small cell lung cancer
- squamous cell
- adenocarcinoma
- large cell carcinomas
pt risk factors for developing lung cancer
- SMOKING!!!! #1 risk
- second-hand smoke
- asbestosis, radon, radiation and air pollution expsoure
- 70 years old
- COPD, TB
- history of cancer
what is the clincial presentation of lung cancer?
signs and symptoms
- often asymptomatic - found on imaging
- S&S depend on loaction of the mass
- cough (50%)
- hemoptysis, CP, SOB
- constitutional symptoms of cancer (NS, WL, F)
- mass involvment, effusion if local invasion
- paraneoplastic disorders
specific signs of local tumor invasion
- if central = see signs of airway obstruction (blocking)
- hoarsness (laryngeal nerve)
- diaphragm paralysis (mediastium involvement)
- SVC syndrome: swelling face and arm and veins (+ pemberton sign)
- pancoast syndrome: NSCLC (get brachial plexus numbness and horner syndrome
signs and symptoms of metastatic disease (spread from blood and lymph)
- evidence in liver, adrenal glands, bones and brain of lesions
- liver: late stage only
- adrenal glands: usually asymptomatic but common
- bone: pt. will complain of this symptom becuase its so painful
- brain: headache, visual, CN issues
NSCLC: Adenocarcinoma
- who gets it
- what tissue affected
- where in the lung
- additional findings
- most common in smokers F>M
- from glandular tissue : adeno
- affects mucous glands – common in peripheral lungs therefore chest was erosion more common to have sx. and metastize
- gene mutations assocaited
- nail clubbing
NSCLC: Squamous Cell Carcinoma
- who
- what cells
- where
- what paraneo. syndrome
- smokers M>F
- epithelial cells change from columnar to squamous
- found more ** centrally in the large airways**
- associated with PTHrP
NSCLC: large cell carcinoma
- DOES NOT RESPOND WELL TO CHEMO – poor prognosis
- smoking
- rapidly growing in peripheral areas and found late
- anaplastic undifferentiated cells
Neuroendocrine large cell: Bronchial Carcinoid Tumors
- what cells
- syndrome assocaited
- Kulchitsky Cells = indicate its neuroendocrine and NOT NSCLC
- central or peripheral involvement
- pedunculated or not with teh central bronchi
assocaited with ** Seritonin syndrome** – > Carcinoid syndrome
Neuroendocrine Large Cell: Small Cell Lung Cancer
- who
- prognosis
- where
- associated features
- SMOKERS: most assocaited with smokers and most aggressive
-
Kultchitsky cells – indicated its not SCLC
-invloves central airway and mediastium involved (close to hilum is where tumor grows)
S = smokers
C = Chromagranin A (protein secreted)
L = L-myc oncogene
S = SIADH paraneo.
C = Cushings (ACTH)
L = Lambert-Eaton
