Neoplasms Flashcards
- What does SPN stand for?
- What is another name for it?
- Solitary Pulmonary Nodule
- “coin lesion”
Describe a SPN (6 things)
- Well circumscribed
- Isolated
- Round opacity
- Completely surrounded by normal lung
- NOT associated w/ infiltrate, atelectasis, or adenopathy
- 3 cm or less
“WIRCN’ till 3”
4 most common etiologies of SPN
- Bronchogenic carcinoma
- Metastatic lesion
-
Infectious granuloma
- histo
- cocci
- TB
- fungal
- Calcification
- Why are SPNs important?
- What is the goal of evaluating a SPN?
- could be cancerous
- to decide if this is malignant
- calculate risk
- DON’T do invasive tests on low risk pts
- Do advanced testing for high risk pts
Clinical presentation of SPN (2 things)
- Usually asymptomatic
- Found incidentally on CXR
- What are the 2 most important things for evaluating pt w/ SPN?
- What is the most important risk factor?
- Getting a thorough history
- Getting a thorough physical exam
- Age (as age increases, chances of malignancy increase. 60+ there is 50% chance of malignancy)
What is part of the evaluation process of a SPN which is not always available but should be utilized when it is?
Review and compare to old imaging studies
- Doubles in size over an extended period of time (1 year)
- Less calcification (stippled / eccentric pattern)
- Cavitations (thick walls >16mm)
- NOT well circumscribed
- Spiculated margins on CT
- Peripheral halo on CT
- Density on CT
SPN concerning for malignancy
- Hamartoma
- Doubles in size in short duration (1 month)
- Dense calcification of central or laminated pattern
- Smooth/well circumscribed
SPN which is not likley malignant
- Hamartoma: popcorn calcification (benign connective tissue)
When evaluation the probability of malignancy (risk assessment), what are 3 things which would make a patient “low risk” <5%?
- Under 30 yrs old
- Stable lesion for 2 years or more
- Characteristic benign calcification pattern
(only need 1 of the 3 to be “low risk”)
If a patient has a “low risk” SPN, what is the next step in management?
Watchful waiting (serial imaging w/ CXR or CT)
If a patient has an “intermediate risk” SPN what is the next step in management?
- Diagnositc biopsy (transthoracic needle aspiration or bronchoscopy)
- PET scan
If a patient has a “high risk” SPN, what is the next step in management?
Resection
What is an important part of management of SPNs?
- Pt education
- Shared discussion w/ pt (some pts are conservative and are okay w/ watchful waiting, while others want immediate resection or biopsy)
After _____ , if the nodule is unchanged / stable, there is no need for further follow up (benign lesion)
24 months
The ____ the nodule, the more aggressive the monitoring needs to be. (earlier imaging / more frequent imaging)
Larger
Another name for lung cancer
Bronchogenic carcinoma
Lung cancer is a malignant neoplasm of the lung arising from the ___ ____.
Respiratory epithelium (bronchi, bronchioles, alveoli)
What are the 2 most common types of lung cancers?
- Adenocarcinoma
- Squamous Cell Carcinoma (SCC)
What are the 2 main groupings of lung cancer?
- Non-small cell lung cancer (NSCLC)
- Small cell lung cancer (SCLC)
Is “non-small” or “small” more common?
Non-small cell lung cancer (NSCLC)
What is the 2nd most common cancer among men/women?
Lung Cancer
What is the leading cause of cancer death among both men / women?
Lung Cancer
Most people diagnosed w/ lung cancer
- Over the age of ___
- Average age of dx is ____
- Unusual under the age of ____
- 65+
- avg: 70
- Under: 40
Is lung cancer more common in men or women?
Men
(1 in 15 for men)
(1 in 17 for women)
Are white men or black men more prone to lung cancer?
By what %?
Black men are 20% more likely
Are white women or black women more prone to lung cancer?
By what %?
White women
Black women are 10% less likely
Tobacco smoke causes what % of lung cancers?
80%
What are the top 3 causes of lung cancer?
- Tobacco smoke (includes cigar, pipe, low tar, “light cigarette,” & menthol)
- Radon exposure
- Asbestos exposure (mesothelioma)
Genetics is a risk factor for lung cancer. What chromosome is affected?
6
Non-small cell lung cancer (NSCLC) is most common making up about 80-85% of lung cancers.
- What are the 4 types of non-small cell?
- Adenocarcinoma
- Adenosquamous carcinoma
- Squamous cell carcinoma
- Large cell carcinoma
What is the most common non-small cell lung cancer?
Adenocarcinoma
Which type of cancer?
- accounts for 40% of lung cancers
- is associated w/ smoking
- is most common type of cancer in non-smokers
- from mucus glands or any epithelial cell within or distal to the terminal bronchioles
Adenocarcinoma
(Non-small cell)
Is adenocarcinoma:
- Central or peripheral nodules/masses?
- Slow or fast growing?
- Peripheral
- slow growing
Which cancer?
- composed of >10% malignant glandular & squamous components
Adenosquamous carcinoma
(Non-small cell)
Which cancer?
- 25-30% of lung cancers
- Arise from bronchial epithelium (centrally located / large airways)
- Associated w/ hypercalcemia
- Tend to metastasize out of chest later
- Tend to have central necrosis
Squamous Cell Carcinoma
(Non-small cell)
Which cancer?
- epithelial neoplasm lacking both glandular and squamous differentiation
- Aggressive
- Rapid doubling times
- Usually peripheral w/ prominent necrosis (but can be central)
Large Cell Carcinoma
(Non-small)
Which cancer?
- Begins central, infiltrating submucosally to cause narrowing of bronchus w/o a discrete luminal mass
- Agressive (poor prognosis)
- Median untreated survival is 6 to 18 wks
Small Cell Lung Cancer
Besides non-small and small cell lung cancers, what is the 3rd category?
Carcinoid Tumors
Is central or peripheral more symptomatic?
Central, bc/ it causes obstruction.
What is the most common “intrathoracic effect” of lung cancer on clinical presentation?
Cough (50-75%)
The “intrathoracic effect” cough is most common in which 2 cancers?
- Squamous Cell Carcinoma
- Small Cell Lung Cancer
What are the 4 most common “intrathoracic effects” of lung cancer?
- Cough (SCC & Small Cell)
- Hemoptysis
- Dyspnea
- Pain (younger pts)
Superior Vena Cava Syndrome is a bulky upper lobe tumor causing sensation of fullness in the head and dyspnea. What cancer is it most common in?
Small Cell
3 PE findings of Superior Vena Cava Syndrome
- Dilated neck veins
- Facial edema
- Plethoric appearance
- A prominent venous patter on chest
- Facial edema
- Plethoric appearance
Superior Vena Cava Syndrome from SVC obstruction from lung cancer
2 x-ray findings of pt w/ Superior Vena Cava Syndrome
- Widening of mediastinum
- Right hilar mass
- Most common in squamous non-small cell
- shoulder pain
- Horner’s syndrome
Pancoast Syndrome
4 most common areas of extrathoracic metastases of lung cancer
- Liver
- Bone
- Adrenal
- Brain
(LABB)
SIADH (Syndrome of inappropriate ADH) secretion is a type of paraneoplastic syndrome which is frequently caused by _______ and results in ______.
- Small Cell Lung Cancer
- Hyponatremia
Anemia, leukocytosis, thrombocytosis, eosinophilia, and hypercoagulable disorders are types of what?
Paraneoplastic Syndromes / Extrathoracic Effects of lung cancers
How do you treat paraneoplastic syndromes?
Treat the cancer, and the syndromes should resolve
Cushing Syndrome (a paraneoplastic syndrome) is most common in which 2 cancers?
- Small Cell Lung Cancer
- Carcinoid Tumors
- At the minimum, what 2 imaging studies do you need to order for lung cancers?
- What is the 3rd most common thing you’ll likely order?
- CXR
- CT scan
- PET scan
Which imaging study is used to make lung cancer diagnosis?
None. You need biopsy to diagnose.
