Neoplasm Flashcards
1
Q
new cases rank?
Death rank?
A
2 new cancer
2
Q
Unfiltered cigs
A
More carcinogenic
3
Q
Risk factors
A
FH cancer before 60 y/o
Women more
More non-smokers now (genetic)
HIV (even if non-smoker)
4
Q
Women never smokers?
A
1/2 get cancer worldwide
5
Q
Classifications
A
Small cell (SCLC)
*MC non-small cell (NSCLC) = adeno, squamous, large
6
Q
- MC type
- non-smokers
- more distant/peripheral metastisis than squamous
A
Adenocarcinoma
NSCLC
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
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
9
Q
- peripherally located
- high mitotic, necrosis
- difficult to dx
- less common
- AGRESSIVE
- smoker
A
Large cell cancer
NSCLC
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
11
Q
*Dry cough
*hemoptysis
*chest pain
*bronchial obstructin
*dysnpea
Infx
Fever
A
Primary tumor
12
Q
*chest pain
*hoarsness
*SVC obstruction
*dysphagia
cardio
A
Intrathoracic extrapulm extension
13
Q
Metastisis
A
Mostly to lymph nodes
Also CNS, bone/marrown, cutaneous/subcutaneous
14
Q
Anorexia
Weight loss
Weakness
Paraneoplastic syndrome
A
systemic nonmetastatic symptoms
15
Q
SCLC hormones
A
- ACTH –> cushing’s
- ADH –> hyponatremia
- Calcitonin –> hyperCa2+
16
Q
Squamous hormones
A
Parathormone
17
Q
Adenocarcinoma homrone
A
Growth hormone
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)?
19
Q
Solitary pulmonary nodule
Consider:
A
Patient characteristics:
Age, smoker, hz other tumor
Nodule characteristics:
Diameter, spiculation, upper lobe location
20
Q
Size?
A
Bigger = more chance of malignancy
21
Q
Border type
Good –> worse
A
- smooth
- lobulated
- SPICULATED
- CORONA RADIATA
22
Q
Benign
Vs
Nonspecific calcifiation
A
Benign
- central
- laminar
- diffuse
- popcorn
Nonspecific
- stippled
- eccentric
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
24
Q
DX
A
- Sputum (NO)
- FIBEROPTIC BRONCHOSCOPY/ TRANBRONCHIAL BIOPSY
- Endobrochial ultra
- thoracentesis
- trans-thoracic needle biopsy
Surgical
- mediastinoscopy
- VATS
25
Staging
Invasive vs. non-invasiv
Non-invasive
* CT
* PET
Invasive
* non surgical EUS, EBUS
* surgical
26
Bronchoscopy
DIRECT ENDOBROCHIAL BX
* endobronchial brush
* wash
FOR PERIPHERAL (smaller they are, less likely for positive)
27
CT guided FNA
Better specificity, better view
28
Pleural fluid cytology
Highest stage
Least invasive
*often not positive, if not 2x send to surgery to biopsy (NO BLIND)
29
How to obtain tissue
Transbronchial Needle Aspiration (TBNA)
Endobronchial Ultrasound (EBUS)
30
Staging
Anatomic extent of cancer
* Size/location of primary
* growth directly outside lung
* metastases to regional lymph nodes in hilar area + Mediastinum
* distant metastases
31
Staging
TMN
T1abc23etc= each cm matters
32
T3 tumor
* Large = 5-7cm
* Invade something (not lung, not essential)
* Have 2nd tumor in same lobe
33
T4 tumor
* >7cm
* invade something they can't remove
* 2nd tumor = same side, diff lobe
34
N component
```
N0= no
N1 = intrapulmonary/hilar
N3 = opposite/supraclavicular
```
35
Small Cell Lung Cancer
Stages
VA study group system
* Extensive stage = distant metastases , + pleural/pericardial effusion
* limited stage = only in 1 hemothorax, medastinium, supraclavicular nodes
36
Resection
* NSCLC
* stage 1-2
* operable candidate= high risk, COPD, heart, old
37
Surgery
Bad PFTs
Probably no surgery
38
Short -term risk
* not age alone (fit or not?)
* hypoxemia/hypercapnea
* low FEV1
* EXERCISE TOLERANCE
39
Cardiac Eval
Could code if need to intubate w/ Rx
EKG
40
Planned lobectomy
Planned pneumonectomy
Post BD FEV1
>1.5 lobectomy
>2.0L Planned pneumonectomy
Lobectomny also segmental method
Pneumonectomy also V/Q
41
Extensive (mets) SCLC
Tx
CHEMO
(Cis-platin+ VP-16)
2 cycles then re-assess
NO SURGERY (already mets)
42
Extensive SLCL
Survival
6-12 months
43
Radiation?
No benefit to primary extensive SCLC
44
Limited SCLC
Tx
Chemo + Radiation
Concurrent > sequential
Survival 16-24 months
* NO SURGERY (probably already mets)
* prophylactic cranial irradiation (avoid mets)
45
Immunotherapy
Blocking PDL1 (causes evasion of T cells)
46
Pancoast Tumor
In apex, invades contiguous structurs
* brachial plexus
* pain
* HORNER's SYNDROME (sympathetic chain/stellate ganglion) = Ptosis, meiosis, ipsilateral anydrosis
47
Lung cancer screening
* NO routine CxR
* Low Dose CT scan
TO PATIENT = must meet criteria, tell that if false positive, will need biopsy
48
Metastises
MC site
Lung
Breast
Colon
Kidney
49
* asbestos exposure
| * 50-70 yrs old
Mesothelioma
*Poor survival
50
* NOT smokers
* Females
* <40yrs
Carcinoid tumor
51
Main risk lifestyle factors (3)
* 30+ pack year smoking history
* quit less than 15 years ago
* 55 year old
52
NSCLC
Stage 3a
No cycles of surgery b/f chemo
53
NSCLC Tx
Stage 1-4
```
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
Dx
Biopsy
* supraclavicular nodes
* liver lesions
* adrenal enlargement
55
Methods of obtaining tissue
* transbronchial needle aspiration
* Endobronchial ultrasound EBUS (Stage mediastinum, better than TBNA)
* Esophageal Ultrasound EUS f
56
Bronchial carcinoid
Path
* rare
* neuroendocrine cells
* slow growth, low mets
* well differentiated, low grade
57
* asymptomatic
* diarrhea
* +/-SIADH, Cushings, Obstruction
* bronchoscopy: pink/purple, well-vascularized central tumor
Bronchial Carcinoid
58
Bronchial Carcinoid
| Tx
Surgery
