Neoplasms of the Lung Flashcards
Lung nodules
Commonly found on CXR. History, physical and imaging features help guide treatment
Lung nodules history and physical
Often asymptomatic or patients may present with chronic cough, dyspnea, and SOB
Always inquire about smoking and exposure therapy
Dx of lung nodules
1) Serial CXR - to determine the nodule’s location, progression and extent
2) Chest CT - to determine the nature, extent, and infiltrating nature of the nodule
Clues based on history:
Recent immigrant - TB
From the SW USA - coccidio
From Ohio River Valley - Histo
Tx of lung nodules
1) Surgical resection - indicated when nodules at high risk for malignancy. Low risk nodules can be followed with CXR or CT every 3 months for 1 year and then every 6m for another year
2) An invasive diagnostic procedure is indicated if the size of the nodule increases
Characteristics of benign lung nodules
1) Age less than 35
2) Nonsmoker
3) No change from old films
4) Central, uniform, or popcorn calcification
5) Smooth margins
6) Size less than 2cm
Characteristics of malignant lung nodules
1) Age above 45-50
2) Smoker
3) New or enlarging lesions
4) Absent or irregular calcification
5) Irregular margins
6) Size greater than 2 cm
Lung cancer
Leading cause of cancer death in USA. Risk factors include tobacco smoke (except for bronchoalveolar carcinoma) and radon or asbestos exposure.
SCLC
1) Highly correlated with cigarette exposure
2) Has a central location
3) Neuroendocrine origin. Associated with paraneoplastic syndromes
4) Mets are often found on presentation in intrathoracic and extrathoracic sites such as brain, liver and bone
NSCLC
Represents a group of cancers with the most common types being adenocarcinoma, SCC and large cell carcinoma. These are all less likely than SCLC to metastasize at an early stage
1) Adenocarcinoma - Most common lung cancer. Peripheral location. Includes bronchoalveolar carcinoma, which is associated with multiple nodules, interstitial infiltration, and prolific sputum production but is NOT associated with smoking
2) SCC - central location. 98% are seen in smokers
3) LCC/neuroendocrine carcinomas - least common; associated with a poor prognosis
Common locations of lung cancer mets
LABB
Liver
Adrenals
Brain
Bone
History and physical for lung cancer
1) Presents with cough, hemoptysis, dyspnea, wheezing, pneumonia, chest pain, weight loss, possible abnormalities on respiratory exam (crackles, atelectasis)
2) Other findings -
Horner’s - miosis, ptosis, anhidrosis. In patients with Pancoast tumor at apex of lung
SVC syndrome - obstruction of SVC with supraclavicular venous engorgement and facial swelling
Hoarseness - secondary to recurrent laryngeal nerve involvement
Many paraneoplastic syndromes
Dx of lung cancer
1) CXR or chest CT
2) FNA (CT guided) for peripheral lesions. Bronchoscopy (biopsy or brushing) for central lesions
Tx of lung cancer
1) SCLC - Unresectable. Often responds to radiation and chemo initially but usually recurs. Low median survival rate
2) NSCLC - surgical resection in early stages. Supplement surgery with radiation or chemo (depending on stage). Palliative radiation and/or chemo is appropriate for symptomatic but unresectable disease
Endocrine paraneo
1) Cushing’s syndrome (ACTH) - SCLC
2) SIADH leading to hyponatremia - SCLC
3) Hypercalcemia (PTHrP) - SCC
4) Gynecomastia - LCC
Skeletal paraneo
1) Hypertrophic pulmonary osteoarthropathy - NSCLC
2) Digital clubbing - NSCLC
