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Pulmonology > Neoplasm > Flashcards

Neoplasm Flashcards

1
Q

new cases rank?

Death rank?

A

2 new cancer

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2
Q

Unfiltered cigs

A

More carcinogenic

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3
Q

Risk factors

A

FH cancer before 60 y/o

Women more

More non-smokers now (genetic)

HIV (even if non-smoker)

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4
Q

Women never smokers?

A

1/2 get cancer worldwide

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5
Q

Classifications

A

Small cell (SCLC)

*MC non-small cell (NSCLC) = adeno, squamous, large

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6
Q
  • MC type
  • non-smokers
  • more distant/peripheral metastisis than squamous
A

Adenocarcinoma

NSCLC

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7
Q
  • non-smokers female
  • Bronchocorrhea
  • MUCH sputum
  • CXR = interstitial pattern
  • slow growing, late metastises
  • solitary nodule, lobar consilodation or mutliple nodule
  • BEST PROGNOSIS
A 
Bronchoalveloar subtype (adenocarcioma)
NSCLC
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8
Q

“CCCP”

  • Centrally located
  • CAVITARY LESIONS
  • hyperCa2+
  • Pancoast syndrome
  • plug bronchus
  • presents as pneumonia, or obstruction
  • polypoid /sessile mass
  • smoking hx
  • related to Paraneoplastic syndromes
A 
Squamous Cell (SCC)
NSCLC
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9
Q
  • peripherally located
  • high mitotic, necrosis
  • difficult to dx
  • less common
  • AGRESSIVE
  • smoker
A

Large cell cancer

NSCLC

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10
Q
  • declining incidence
  • smoking
  • mitosis necrosis
  • major bronchi
  • infiltration of wall w/ extrinsic narrowing
  • early metastasis to regional nodes (found on presentation)
A

SCLC

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11
Q

*Dry cough
*hemoptysis
*chest pain
*bronchial obstructin
*dysnpea
Infx
Fever

A

Primary tumor

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12
Q

*chest pain
*hoarsness
*SVC obstruction
*dysphagia
cardio

A

Intrathoracic extrapulm extension

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13
Q

Metastisis

A

Mostly to lymph nodes

Also CNS, bone/marrown, cutaneous/subcutaneous

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14
Q

Anorexia
Weight loss
Weakness
Paraneoplastic syndrome

A

systemic nonmetastatic symptoms

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15
Q

SCLC hormones

A
  • ACTH –> cushing’s
  • ADH –> hyponatremia
  • Calcitonin –> hyperCa2+
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16
Q

Squamous hormones

A

Parathormone

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17
Q

Adenocarcinoma homrone

A

Growth hormone

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18
Q

CXR

A

Get 6 weeks after resolution also

  • hilar prominence/mass
  • parenchymal mass
  • localized trapping
  • bronchial obstruction w/ atelectasis/consolidation
  • mediastinial mass widening
  • pleural effusion
  • Elevation of hemidiaphragm
  • TRACHEA deviation towards (w/ lung collapse)?
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19
Q

Solitary pulmonary nodule

Consider:

A

Patient characteristics:
Age, smoker, hz other tumor

Nodule characteristics:
Diameter, spiculation, upper lobe location

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20
Q

Size?

A

Bigger = more chance of malignancy

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21
Q

Border type

Good –> worse

A
  • smooth
  • lobulated
  • SPICULATED
  • CORONA RADIATA
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22
Q

Benign

Vs

Nonspecific calcifiation

A

Benign

  • central
  • laminar
  • diffuse
  • popcorn

Nonspecific

  • stippled
  • eccentric
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23
Q

Staging work up

A
  • Hz, goals, weight loss, PE
  • blood, serum, UA
  • CXR
  • CT chest/ab/pelvic, PET
  • Determine procedures

LEAST INVASIVE APPROACH
HIGHEST STAGING
CONSIDER CO-MORBIDITIES

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24
Q

DX

A
  • Sputum (NO)
  • FIBEROPTIC BRONCHOSCOPY/ TRANBRONCHIAL BIOPSY
  • Endobrochial ultra
  • thoracentesis
  • trans-thoracic needle biopsy

Surgical

  • mediastinoscopy
  • VATS
25
Q

Staging

Invasive vs. non-invasiv

A

Non-invasive

  • CT
  • PET

Invasive

  • non surgical EUS, EBUS
  • surgical
26
Q

Bronchoscopy

A

DIRECT ENDOBROCHIAL BX

  • endobronchial brush
  • wash

FOR PERIPHERAL (smaller they are, less likely for positive)

27
Q

CT guided FNA

A

Better specificity, better view

28
Q

Pleural fluid cytology

A

Highest stage
Least invasive

*often not positive, if not 2x send to surgery to biopsy (NO BLIND)

29
Q

How to obtain tissue

A

Transbronchial Needle Aspiration (TBNA)

Endobronchial Ultrasound (EBUS)

30
Q

Staging

A

Anatomic extent of cancer

  • Size/location of primary
  • growth directly outside lung
  • metastases to regional lymph nodes in hilar area + Mediastinum
  • distant metastases
31
Q

Staging

TMN

A

T1abc23etc= each cm matters

32
Q

T3 tumor

A
  • Large = 5-7cm
  • Invade something (not lung, not essential)
  • Have 2nd tumor in same lobe
33
Q

T4 tumor

A
  • > 7cm
  • invade something they can’t remove
  • 2nd tumor = same side, diff lobe
34
Q

N component

A 
N0= no 
N1 = intrapulmonary/hilar
N3 = opposite/supraclavicular
35
Q

Small Cell Lung Cancer

Stages

A

VA study group system

  • Extensive stage = distant metastases , + pleural/pericardial effusion
  • limited stage = only in 1 hemothorax, medastinium, supraclavicular nodes
36
Q

Resection

A
  • NSCLC
  • stage 1-2
  • operable candidate= high risk, COPD, heart, old
37
Q

Surgery

Bad PFTs

A

Probably no surgery

38
Q

Short -term risk

A
  • not age alone (fit or not?)
  • hypoxemia/hypercapnea
  • low FEV1
  • EXERCISE TOLERANCE
39
Q

Cardiac Eval

A

Could code if need to intubate w/ Rx

EKG

40
Q

Planned lobectomy

Planned pneumonectomy

Post BD FEV1

A

> 1.5 lobectomy

> 2.0L Planned pneumonectomy

Lobectomny also segmental method
Pneumonectomy also V/Q

41
Q

Extensive (mets) SCLC

Tx

A

CHEMO

(Cis-platin+ VP-16)
2 cycles then re-assess

NO SURGERY (already mets)

42
Q

Extensive SLCL

Survival

A

6-12 months

43
Q

Radiation?

A

No benefit to primary extensive SCLC

44
Q

Limited SCLC

Tx

A

Chemo + Radiation
Concurrent > sequential

Survival 16-24 months

  • NO SURGERY (probably already mets)
  • prophylactic cranial irradiation (avoid mets)
45
Q

Immunotherapy

A

Blocking PDL1 (causes evasion of T cells)

46
Q

Pancoast Tumor

A

In apex, invades contiguous structurs

  • brachial plexus
  • pain
  • HORNER’s SYNDROME (sympathetic chain/stellate ganglion) = Ptosis, meiosis, ipsilateral anydrosis
47
Q

Lung cancer screening

A
  • NO routine CxR
  • Low Dose CT scan

TO PATIENT = must meet criteria, tell that if false positive, will need biopsy

48
Q

Metastises

MC site

A

Lung
Breast
Colon
Kidney

49
Q
  • asbestos exposure

* 50-70 yrs old

A

Mesothelioma

*Poor survival

50
Q
  • NOT smokers
  • Females
  • <40yrs
A

Carcinoid tumor

51
Q

Main risk lifestyle factors (3)

A
  • 30+ pack year smoking history
  • quit less than 15 years ago
  • 55 year old
52
Q

NSCLC

Stage 3a

A

No cycles of surgery b/f chemo

53
Q

NSCLC Tx

Stage 1-4

A 
SURGERY
1 = surgery
2 = surgery + chemo
3 = Radiation + chemo
4 = chemo, targeted therapy, immunotherapy

*Lobe w node sampling disection (VATS)

*follow up H+P plus CT every 6mos for 2 years THEN yearly for 5 yrs
+/- LowDoseCT

54
Q

Dx

Biopsy

A
  • supraclavicular nodes
  • liver lesions
  • adrenal enlargement
55
Q

Methods of obtaining tissue

A
  • transbronchial needle aspiration
  • Endobronchial ultrasound EBUS (Stage mediastinum, better than TBNA)
  • Esophageal Ultrasound EUS f
56
Q

Bronchial carcinoid

Path

A
  • rare
  • neuroendocrine cells
  • slow growth, low mets
  • well differentiated, low grade
57
Q
  • asymptomatic
  • diarrhea
  • +/-SIADH, Cushings, Obstruction
  • bronchoscopy: pink/purple, well-vascularized central tumor
A

Bronchial Carcinoid

58
Q

Bronchial Carcinoid

Tx

A

Surgery

Pulmonology (12 decks)

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