Lung Neoplasms and Malignancies

Question 1

What are the risk factors for lung cancer?

Answer 1

Cigarettes
Occupational 
Ionizing Radiation
Env Tobacco Smoke
Pum Fibrosis
Radon 
Chronic Bonchitis
P450 Polymorphisms
Chromosome Fragility

Question 2

What are the most common Signs and Symptoms of Lung Cancer?

Answer 2

Cough
Weight loss
Dyspnia
Chest Pain

Question 3

What is the first step in evaluating a CXR abnormality?

Answer 3

LOOK AT AN OLD CXR TO COMPARE!

After that CT for size/location/charicteristics

Question 4

How can you tell the difference between cancerous and benign Solitary pulmonary nodules?

Answer 4

.

Question 5

What are the most common cancers that metastasize to the lung?

Answer 5

Breast
Colorectal
Prostate
Cervical
Endometrial

Question 6

What are the types of lung malignancy?

Answer 6

Small cell lung cancer

Non-Small Cell Lung Cancer
-Squamous Cell CA
-AdenoCA
Large Cell CA

Meothelioma

Question 7

What is charicteristic of Small cell lung cancer?

Answer 7

.

Question 8

What is charicteristic of AdenoCA of the lung?

Answer 8

#1 cancer in non-smokers
Cancer of young women
Bronchoalveolar, no invasion, grows along alveoli- solitary mass, fluffy infiltrates, ground glass

Question 9

What is charicteristic of Large Cell CA?

Answer 9

Lower incidence
Peripherally located
Large cells with poor differentiation
Sheets of cells with necrosis
Cavitiating mas
late distant metastasis

Question 10

What are the Lung cancer associated Complications?

Answer 10

Horner Syndrome
-Miosis, anhydrosis, ptosis
-invasion of cervical ganglion
-apical tumors
Pancoast's Syndrome
-Horner's + Brachial Plexus
Superior VC Syndrome

Question 11

What are Paraneoplastic Syndromes associated with Lung cancer?

Answer 11

Squ Cell CA
-hyperCalcemia
Small Cell
-Cushing's 
-SIADH
-Eaton Lambert Synd (gets stonger with repeated motion)
AdenoCA
-DIC, Thrombophlebitis, Microangiopathic hemolytic anemia
Large Cell CA
-Gynecomastia

Question 12

Waht are the most likely metasastic sites of cancer?

Answer 12

Liver
Brain
Bone
Adrenal

Question 13

How is Cancer diagnosed?

Answer 13

EBUS(Endobronchial ultrasound guided biopsy)
Biopsy a palpable LN
Biopsy of metastatic lesion or
Eval of pleural effusion

Question 14

What are the indications of Low dose CT scan?

Answer 14

Age 55-74
>30 pack year smoking history
Current smoker or have quit within the last 15 years
In relatively good health

Question 15

What is the staging system of Lung cancer?

Answer 15

TNM = Tumor, node, Metastasis

Question 16

What charicteristics make a Tumor Stage 4? other?

Answer 16

ANY METASTATIC LESION = STAGE4
The bigger the tumor, the higher the stage
If it invades other mediastinal structures, it will be T4

Question 17

What are the different Treatments for Lung cancer?

Answer 17

Palliative to improve QOL
Non Small Cell
Small Cell

Question 18

What are the Biologic Treatments for Lung cancer?

Answer 18

Nivolumab
Pembrolizumab
Both Monoclonal IgG4 Ab

Question 19

What are the most common causes of Benign Pulmonary Neoplasms?

Answer 19

Hamartomas

• peripheral
• normal tissue

Bronchial Adenoma
-central, slow growing, endobronchial
Chronic cough, hemoptysis