Neoplastic Diseases Flashcards
pulmonary nodule info
Definition: ≤ 3 cm isolated, rounded opacity on chest xray
- Commonly: Incidental finding with no clinical symptom
- ⅓ of all nodule findings are noted on CT scans ordered for other things
-Not associated with infiltrate, atelectasis, or adenopathy
-Most benign nodules = infectious granulomas
-Importance: pulmonary nodles carries a significant risk of malignancy
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Most benign nodules =_______ granulomas
infectious granulomas
what do we do about a pulmonary nodule benign vs malignant
Malignant Tumors: Resection if indicated
- Nodules with a high index of suspicion for malignancy may warrant resection
-CT is indicated in any suspicious solitary pulmonary nodule!
Benign Tumors: Avoid invasive procedures
lung cancer screening: Fleischner Society guidlines
Annual screening = LOW DOSE computed tomography (LDCT):
- adults aged 50 to 80 years AND
- have a 20 pack-year smoking history or quit smoking within 15 years
-dont screen if they have have a health problem that lowers life expectancy
-Change in criteria expanded eligible population ->
detecting large numbers of lung nodules (majority benign)
2022 “State of Lung Cancer” report: only 5.8% of eligible Americans have been screened for lung cancer
Risk factors for nodule malignancy
Age:
- < 30, malignant tumors are rare
- Risk ↑ with age
Smokers:
- Likelihood of malignancy ↑↑↑ with pack-years (20+ yrs)
Hx of Malignancy:
- Hx ↑ likelihood of further malignancy
Evaluation of Malignant Tumors: size of nodule
Mild: 2-5 mm = 1% Malignancy
Moderate: 6-10 mm = 24% Malignancy
Significant: 11-20 mm = 33% Malignancy
Severe: 21-45 mm = 80% Malignancy
Evaluation of Malignant Tumors: what factors
Factors that make nodules more likely malignant:
-Doubling time: rapid progression
-Size: large size
-Borders: ill defined margins, lobular, spiculated margins, peripheral halo
-Calcification: NO calcifications or sparse -> dense calcifications indicate prior inflammation
- cavitation: can be infectious or malignant
Evaluation of Malignant Tumors: borders of nodule
Benign: Smooth, well-defined edge
Malignant:
- Ill-defined margins or lobular appearance
- Spiculated margins and peripheral halo
Lobulated: malignancy
Cavitary: could be infectious or malignancy
Spiculated BAC: hazy
Smooth Granuloma: Beningn
Evaluation of Malignant Tumors: Doubling Time
Rapid progression (< 30 days) is suggestive of infectious process
Long term stability (> 500 days) suggests benignity
Evaluation of Malignant Tumors: calcifications
Benign lesions: Dense calcification
- calcification suggests prior inflammation
Malignant lesions: Sparser calcification
nodule tx: Low probability of malignancy (<5%)
Features of low probability:
-Age under 30
-Characteristic pattern of benign calcification: small, not growing, dense, well defined borders, etc
Tx = Watchful waiting!!!! + serial CTs at routine intervals
-Serial CT scans: with growth would suggest malignancy
Is this calcified vs not
Calcified nodule! incidental finding on chest xray
nodule tx: high probability (>60%) of malignancy
Resect nodule if no contraindications
if its large, spiculated + peripheral halo = high probability
nodule tx: intermediate probability of malignancy (5-60%)
5-60% = intermediate
Bx:
- transthoracic needle aspiration (TTNA)
- bronchoscopy
PET/CT: shows metabolic activity - + test could be infection or inflammation
Sputum cytology:
- highly specific but useless unless central lesion
Video-assisted thoracoscopic surgery (VATS):
- aggressive approach to dx
carcinoid tumors: definition + location
Definition:
- Low grade malignant neoplasm with a slow growth rate and rare metastasis chance
- “Cancer-ish”: Does not behave like regular lung cancer
- Typically < 60 years old patients-> YOUNGER
Location:
- Central Bronchi (MC): Sessile or Pedunculated growths
- Peripherally Located: Asymptomatic solitary pulmonary nodule (rare)
“CARcinoid tumor = only people under 60 should drive a car -> younger age because they are the CENTRAL part of society
Cars = SPEed -> SEssile or PEdunculated”
carcinoid tumors: S&S
-Hemoptysis
-Cough
-Focal wheezing
-Recurrent pneumonia
CARCinoid Syndrome: rare
- Cutatneous Flushing
- Asthmatic Wheezing
- Rapid HR/Hypotension
- Cramping/Diarrhea
- Due to the substances that the carcinoid secretes
carcinoid tumor dx
Bronchoscopy:
-PINK or PURPLE tumor in a central airway
CT scanning:
- localizes the lesion
- use to follow growth over time
Octreotide Scintigraphy, Dotatate PET/CT Scan:
- Localize region of metastasis
carcinoid tumor tx + complications
Surgical excision*
Bronchoscopic removal if:
- entirely endoluminal
- poor surgical candidate
Prognosis is generally favorable
Complication:
- Bleeding and airway obstruction
bronchogenic carcinoma description
Lung cancer: #1 cause of cancer deaths in men and women!!!
-Cigarette smoking causes > 85% of cases of lung ca
-Mean age at diagnosis 70
- Unusual under the age 40
bronchogenic carcinoma risk factors
-Tobacco smoke**
-Radon gas
-Asbestos
-Metals
-Industrial carcinogens
-Family Hx
-Medical conditions
-Previous primary lung cancer
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bronchogenic carcinoma: 4 histologic types
- Squamous cell carcinoma (20%)
- Adenocarcinoma (38% - MC) -> Bronchoalveolar cell carcinoma (2%)
- Large cell carcinoma (5%)
-Small cell carcinoma (13%)
For staging purposes, classifications are split into Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC)
paraneoplastic syndromes
Carcinoid tumors may oftentimes secrete substances to cause Paraneoplastic Syndromes
Hypercalcemia = SCC
Endocrine issues = Small cell
Neuromuscular issues = small cell
Cardiovascular = adenocarcinoma
Hematological = all
Gynecomastia = large cell
superior vena cava syndrome
-tumor obstructing SVC
-facial edema and plethora
-venous distension distal to obstruction
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horner’s syndrome
Problem with sympathetic nerve supple to one side of face:
- tumor invades sympathetic trunk -> unilateral sx
Sx:
-miosis- constriction
-ptosis- droopy eyelid
-anhidrosis- failure to sweat
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Staging of Non Small Cell Lung Cancers
Stages are 1-4; with 4 being the worst
Stage is determined by looking at 3 separate components
T= Tumor size
N= Lymph Node involvement
M= Absence or presence of metastastis
new tx for NSCLC: immunotherapy
Definition: Use of medicines to help a Pt’s immune system recognize and destroy cancer cells
- Functions by blocking PD-1 or PDL-1 = T cells can now recognize tumor cells -> increases immune response = slows tumor progression
- Immunotherapy greatly helps recognize cancer as foreign
Specific blocking sites:
-PD-1 Blockers:
-PDL-1 Blockers:
Tumor marker: PDL1!!
metastatic lung cancer imaging
CT = most sensitive *
Chest radiographs:
- multiple spherical densities with sharp margins
-MC: lower lung zones
Image: endotracheal metastases (growth in trachea)
what type of cancer is this?
Metastatic lung cancer with MULTIPLE round lesions
- CANNONBALL LESIONS
- multiple spherical densities with sharp margins
- usually at the bases
- CT more sensitive than x-ray
this is very progressed ds -> pt would be symptomatic
“cannonballs need to land bc of gravity so they are in the bases/lower lung zones”
What is the first step in the treatment protocol for potentially resectable NSCLC?
Initial evaluation to determine the clinical stage of the cancer.
