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F2 E3 Shea > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q
  • What does SPN stand for?
  • What is another name for it?
A
  • Solitary Pulmonary Nodule
  • “coin lesion”
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2
Q

Describe a SPN (6 things)

A
  • Well circumscribed
  • Isolated
  • Round opacity
  • Completely surrounded by normal lung
  • NOT associated w/ infiltrate, atelectasis, or adenopathy
  • 3 cm or less

“WIRCN’ till 3”

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3
Q

4 most common etiologies of SPN

A
  • Bronchogenic carcinoma
  • Metastatic lesion
  • Infectious granuloma
    • histo
    • cocci
    • TB
    • fungal
  • Calcification
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4
Q
  • Why are SPNs important?
  • What is the goal of evaluating a SPN?
A
  • 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
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5
Q

Clinical presentation of SPN (2 things)

A
  • Usually asymptomatic
  • Found incidentally on CXR
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6
Q
  • What are the 2 most important things for evaluating pt w/ SPN?
  • What is the most important risk factor?
A
  • Getting a thorough history
  • Getting a thorough physical exam
  • Age (as age increases, chances of malignancy increase. 60+ there is 50% chance of malignancy)
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7
Q

What is part of the evaluation process of a SPN which is not always available but should be utilized when it is?

A

Review and compare to old imaging studies

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8
Q
  • 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
A

SPN concerning for malignancy

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9
Q
  • Hamartoma
  • Doubles in size in short duration (1 month)
  • Dense calcification of central or laminated pattern
  • Smooth/well circumscribed
A

SPN which is not likley malignant

  • Hamartoma: popcorn calcification (benign connective tissue)
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10
Q

When evaluation the probability of malignancy (risk assessment), what are 3 things which would make a patient “low risk” <5%?

A
  • 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”)

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11
Q

If a patient has a “low risk” SPN, what is the next step in management?

A

Watchful waiting (serial imaging w/ CXR or CT)

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12
Q

If a patient has an “intermediate risk” SPN what is the next step in management?

A
  • Diagnositc biopsy (transthoracic needle aspiration or bronchoscopy)
  • PET scan
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13
Q

If a patient has a “high risk” SPN, what is the next step in management?

A

Resection

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14
Q

What is an important part of management of SPNs?

A
  • Pt education
  • Shared discussion w/ pt (some pts are conservative and are okay w/ watchful waiting, while others want immediate resection or biopsy)
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15
Q

After _____ , if the nodule is unchanged / stable, there is no need for further follow up (benign lesion)

A

24 months

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16
Q

The ____ the nodule, the more aggressive the monitoring needs to be. (earlier imaging / more frequent imaging)

A

Larger

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17
Q

Another name for lung cancer

A

Bronchogenic carcinoma

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18
Q

Lung cancer is a malignant neoplasm of the lung arising from the ___ ____.

A

Respiratory epithelium (bronchi, bronchioles, alveoli)

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19
Q

What are the 2 most common types of lung cancers?

A
  • Adenocarcinoma
  • Squamous Cell Carcinoma (SCC)
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20
Q

What are the 2 main groupings of lung cancer?

A
  • Non-small cell lung cancer (NSCLC)
  • Small cell lung cancer (SCLC)
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21
Q

Is “non-small” or “small” more common?

A

Non-small cell lung cancer (NSCLC)

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22
Q

What is the 2nd most common cancer among men/women?

A

Lung Cancer

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23
Q

What is the leading cause of cancer death among both men / women?

A

Lung Cancer

24
Q

Most people diagnosed w/ lung cancer

  • Over the age of ___
  • Average age of dx is ____
  • Unusual under the age of ____
A
  • 65+
  • avg: 70
  • Under: 40
25
Q

Is lung cancer more common in men or women?

A

Men

(1 in 15 for men)

(1 in 17 for women)

26
Q

Are white men or black men more prone to lung cancer?

By what %?

A

Black men are 20% more likely

27
Q

Are white women or black women more prone to lung cancer?

By what %?

A

White women

Black women are 10% less likely

28
Q

Tobacco smoke causes what % of lung cancers?

A

80%

29
Q

What are the top 3 causes of lung cancer?

A
  1. Tobacco smoke (includes cigar, pipe, low tar, “light cigarette,” & menthol)
  2. Radon exposure
  3. Asbestos exposure (mesothelioma)
30
Q

Genetics is a risk factor for lung cancer. What chromosome is affected?

A

6

31
Q

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?
A
  • Adenocarcinoma
  • Adenosquamous carcinoma
  • Squamous cell carcinoma
  • Large cell carcinoma
32
Q

What is the most common non-small cell lung cancer?

A

Adenocarcinoma

33
Q

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
A

Adenocarcinoma

(Non-small cell)

34
Q

Is adenocarcinoma:

  • Central or peripheral nodules/masses?
  • Slow or fast growing?
A
  • Peripheral
  • slow growing
35
Q

Which cancer?

  • composed of >10% malignant glandular & squamous components
A

Adenosquamous carcinoma

(Non-small cell)

36
Q

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
A

Squamous Cell Carcinoma

(Non-small cell)

37
Q

Which cancer?

  • epithelial neoplasm lacking both glandular and squamous differentiation
  • Aggressive
  • Rapid doubling times
  • Usually peripheral w/ prominent necrosis (but can be central)
A

Large Cell Carcinoma

(Non-small)

38
Q

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
A

Small Cell Lung Cancer

39
Q

Besides non-small and small cell lung cancers, what is the 3rd category?

A

Carcinoid Tumors

40
Q

Is central or peripheral more symptomatic?

A

Central, bc/ it causes obstruction.

41
Q

What is the most common “intrathoracic effect” of lung cancer on clinical presentation?

A

Cough (50-75%)

42
Q

The “intrathoracic effect” cough is most common in which 2 cancers?

A
  • Squamous Cell Carcinoma
  • Small Cell Lung Cancer
43
Q

What are the 4 most common “intrathoracic effects” of lung cancer?

A
  1. Cough (SCC & Small Cell)
  2. Hemoptysis
  3. Dyspnea
  4. Pain (younger pts)
44
Q

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?

A

Small Cell

45
Q

3 PE findings of Superior Vena Cava Syndrome

A
  • Dilated neck veins
  • Facial edema
  • Plethoric appearance
46
Q
  • A prominent venous patter on chest
  • Facial edema
  • Plethoric appearance
A

Superior Vena Cava Syndrome from SVC obstruction from lung cancer

47
Q

2 x-ray findings of pt w/ Superior Vena Cava Syndrome

A
  • Widening of mediastinum
  • Right hilar mass
48
Q
  • Most common in squamous non-small cell
  • shoulder pain
  • Horner’s syndrome
A

Pancoast Syndrome

49
Q

4 most common areas of extrathoracic metastases of lung cancer

A
  • Liver
  • Bone
  • Adrenal
  • Brain

(LABB)

50
Q

SIADH (Syndrome of inappropriate ADH) secretion is a type of paraneoplastic syndrome which is frequently caused by _______ and results in ______.

A
  • Small Cell Lung Cancer
  • Hyponatremia
51
Q

Anemia, leukocytosis, thrombocytosis, eosinophilia, and hypercoagulable disorders are types of what?

A

Paraneoplastic Syndromes / Extrathoracic Effects of lung cancers

52
Q

How do you treat paraneoplastic syndromes?

A

Treat the cancer, and the syndromes should resolve

53
Q

Cushing Syndrome (a paraneoplastic syndrome) is most common in which 2 cancers?

A
  • Small Cell Lung Cancer
  • Carcinoid Tumors
54
Q
  • 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?
A
  • CXR
  • CT scan
  • PET scan
55
Q

Which imaging study is used to make lung cancer diagnosis?

A

None. You need biopsy to diagnose.

F2 E3 Shea (16 decks)

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