Neoplasms Flashcards
what is the USPSTF recommendations for lung cancer screenings
Grade: B
Adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
what are ways that nodules can be defined
perifissural nodules
solid nodules
part solid nodules
non-solid nodules
endobronchial nodules
complete, central, popcorn, concentric, rings and fat containing nodules
What are the characteristics of Benign nodules
< 3cm (30mm)
solid nodules
Age < 30
non-smokers
dense central calcifications
well defined borders and no halo
round
doubling time >400 days
negative FH or personal hx of cancer
history of underlying lung disorder
what are characteristics of malignant nodules
> 3 cm (30mm)
sub-solid (ground glass or part solid)
age > 30
smokers
stippled or eccentric calcifications
irregular margins (spiculated or halo)
Cavitary with thick walls
lobular
doubling time < 400 days
located in upper lobes
postive FH or personal hx
+/- pervious underlying lung disorder
What are ways to determine benign vs malignant nodules
Brock Calculator
Mayo Clinic Risk calculator
What are solitary pulmonary nodules
primarily benign lung nodules
discrete, round and size < 3cm “aka coin lesion”
not fixed to pleura or chest wall
NO lymphadenopathy, infiltrate or atelectasis
what is any nodule > 3cm considered
a mass
Who do we often see solitary pulmonary nodules in
M>W but if looking at only non-smokers, W>M
more prevalent in high risk patients - smokers, COPD, older
incidental CXR + CT scans
what are benign solitary pulmonary nodules
infectious granuloma*
-atypical mycobacteria, coccidioidomycosis, histoplasmosis, TB
hamartoma
What are malignant solitary pulmonary nodules
adenocarcinoma
squamous cell carcinoma
solitary metastasis (breast, colon, kidney)
small cell carcinoma
What is the workup for solitary pulmonary nodules
if found on CT - no further images
if found on CXR - chest CT
+/- PET scan if concern for malignancy
chest CT preferred for follow-up imaging
Definitive diagnosis with biopsy
what is the most common etiology of solitary pulmonary nodule
Infectious granulomas
what makes a person at high risk for solitary pulmonary nodules
any history of smoking
+ FH lung CA
carcinogen exposure
upper lobe nodule
emphysema
pulmonary fibrosis
What is the Fleischner Guidelines used for
management of incidentally detected solid pulmonary nodules in adults + sub-solid nodules
What are traditional ‘lung’ cancers
bronchiogenic carcinomas
#1 cause of cancer deaths
what is the median age for bronchogenic carcinomas
median age: 70
rare prior to 40 years old
5 year survival rate about 19%
What are risk factors for bronchogenic carcinomas
secondary to smoking (85-90%)
+FH
pre-existing pulmonary disease (pulmonary fibrosis, COPD, sarcoidosis)
exposure-related risks (second hand, radon, asbestos, diesel exhaust, etc.)
what is the leading cause of preventable death in the US
cigarette smoking
causes more than 480,000 deaths each year
where else can smoking cause cancer in within the body
bladder
blood
cervix
colon and rectum
esophagus
kidney and ureter
larynx
liver
oropharynx
pancreas
stomach
trachea, bronchus and lung
what are the types of bronchogenic carcinomas
small-cell and non-small cell cancer types
what is another name for small-cell cancer
AKA ‘oat cell’
what are adenocarcinomas, squamous cell carcinomas, large-cell carcinomas part of
non-small cell cancer
what cells do small cell cancer affect
neuroendocrine cells
what cells do squamous cell cancers affect
bronchial epithelial cells
what cells do adenocarcinomas affect
glandular (mucous) cells
what cells do large cell cancer affect
undifferentiated (cell types that don’t fit others)
what is the population affected by small cell carcinoma
strong association with smoking
decreasing in incidence - decrease in smoking rates
M>F Most cases over age of 50, avg age: 70
White>black patients
What is the presenation of small cell carcinoma
rapid onset of symptoms (8-12 weeks), paraneoplastic syndromes common, mets common at presentation, central (bronchial) masses
what are the populations affected by adenocarcinoma
most common type of lung cancer even in non-smokers
M>F, most over age of 50. mean age:71
most with p53 gene mutation
what is the presentation of adenocarcinoma
often found incidentally (asymptomatic)
paraneoplastic syndromes rare
peripheral masses
what does the treatment of adenocarcinomas target
Gene therapy targets:
EGFR mutation and ALK mutations
what populations are affected by squamous cell carcinomas
second most common lung cancer
strong association with smoking
M>F
Most cases over age 50
what is the presentation of squamous cell carcinoma
often present with hemoptysis, central (bronchial masses)
what is Large cell carcinoma
diagnosis of exclusion
M>F most cases over age 50
may present as peripheral or central masses
What is the general presentation of bronchiogenic carcinomas
some found incidentally
NEW or WORSENING cough or dyspnea is the most common
hemoptysis
chest pain
hoarseness
malaise
anorexia
weight loss
What is horner’s syndrome
includes: mioisis (pupil bigger than other), ptosis (drooping eyelid), anhydrosis (lack of sweating) - pancoast tumor
what is pancoast syndrome
shoulder/UE pain, weakness; hand atrophy
from invasion of brachial plexus by pancoast tumor
what are paraneoplastic syndrome
syndrome of inappropriate anti-diuretic hormone (SIADH)
Bushings syndrome
what are symptoms from mets
bone pain, AMS, lymphadenopathy
what is the best way to evaluate a central lesion
bronchoscopy for biospy
what does CT-guided FNA scan increase the risk for
Pneumothroax
what is the after diagnosis workup for bronchiogenic carcinomas
PET scan, Ct abdomen and pelvis, +/- bone scan
MRI of chest if concern for adjacent structures
Head CT/MRI
lymph node biopsy
what is the mainstay of treatment for small-cell carcinomas
chemo + radiation
can consider resection if localized disease (rare)
what is the treatment for non-small cell lung cancer
stage 1-2: resection alone
advanced stage 2-3: add chemotherapy
stage 3 unresectable or stage 4: chemo _ radiation
+/- adjunctive immunotherapy (-mabs)
If EGFR +: add an EGFR tyrosine kinase inhibitors (-nibs)
if ALK+: add ALk tyrosine inase inbiits (-nibs)
what is a very rare, malignant neuroendocrine tumor
carcinoid rumor
what is the presentation of carcinoid tumors
most present as central masses - bronchial masses
what are the symptoms of carcinoid tumors
primarily due to bronchial obstruction
- cough, wheezing, hemotysis, atelectasis, PNA
what is carcinoid syndrome
facial flushing, SOB, HTN, weight gain, Hirsutism, asthma
what is the workup for carcinoid tumors
CXR
chest CT = modality of choice
PET scan to differentiate between types
serum lab tests (plasma charomogranin A (CgA), CBC, CMP)
how do we definitively diagnose carcinoid tumors
bronchoscopy and biopsy
hat is the treatment for carcinoid tumors
resection (lobetcomy) perferred
+/- chemo and/or radiation
possible use of octreotide for hormonal control
what are pulmonary metastasis
second most common form of lung cancer, and site of metastasis
all metastases to the lungs
what is the presentation of pulmonary metastasis
often asymptomatic
cough, hemoptysis, dyspnea, hypoxia, pleural effusion
generalized SSX: N/V, back pain, fatigue, anorexia, weight loss
SSX of primary tumor
what is the most common initial test for pulmonary mets
chest x-ray
what is the treatment of pulmonary mets
solitary pulmonary nodules - resection
mets limited to the drug and few in number - consider resection
multiple nodules, multiple mets sites, unreachable - palliative care
what is nearly always seocndary to asbestos exposure
mesothelioma
where do mesotheliomas arise from
mesothelial tissue (pleura)
what is the presentation of meothelioma
through screening
dyspnea, non-pleuritic CP most common
constitutional symptoms are rare
pleural effusion present in 95%
how do we workup mesotheliomas
CXR common
CT for further exam
thoracentisis for Pleural effusion
pleural biopsy
open biopsy if needed
CT, MRI, PET, bronchoscopy for staging