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Foundations II Exam 3 (Jess) > Neoplastic Dzs > Flashcards

Neoplastic Dzs Flashcards

1
Q

Another name for Solitary pulmonary nodule

A

coin lesion

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2
Q

Describe a SPN

A
  • well-circumscribed
  • isolated
  • round opacity
  • completely surrounded by nl lung
  • not a/w infiltrate, atelectasis or adenotpathy
  • < 3cm
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3
Q

Most common causes of SPN?

A
  • bronchogenic carcinoma
  • metastatic lesion
  • infectious granuloma
  • calcification
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4
Q

Are SPNs usually symptomatic or asymptomatic? How are they usually found?

A
  • usually asymptotic

- found incidentally on CXR

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5
Q

Why do you compare imaging of a SPN to old films?

A

compare to old rims for doubling time (rate of growth)

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6
Q

When looking at a CXR, what do you need to look at in the SPN?

A
  • size
  • well-circumscribed
  • cavitation (cavitary w/ thick walls= higher change malignancy)
  • Calcification (benign= dense calcification; malignant= less calcification)
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7
Q

What are features seen in a CT that are concerning for malignancy?

A
  • spiculated margins
  • peripheral halo
  • density on CT scan
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8
Q

What is seen on imaging of a Hamartoma? (SPN)

A

Popcorn calcifications!

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9
Q

What are the percentages for low, intermediate, and high risk of malignancy? What is considered low risk?

A

low < 5%
intermediate 5-60%
high >60%

Low:

  • age < 30
  • stable lesion > 2 yrs
  • characteristic benign calcification pattern
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10
Q

If you pt is low risk, what do you do?

A

Watchful waiting

-serial imaging

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11
Q

If you pt is intermediate risk, what do you do?

A
  • diagnostic biopsy

- PET

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12
Q

If you pt is high risk, what do you do?

A

resection

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13
Q

Most common lung cancers? (2)

A

adenocarcinoma or squamous cell

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14
Q

Out of the 2 main groups of lung CA, what kind is most common?

A

Non-small cell lung CA (80-85%)

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15
Q

Epidemiology facts about lung CA

A
  • 2nd most common CA in both sexes
  • leading cause of CA death
  • more people die yearly than colon, breast, and prostate combined
  • most 65+
  • black men 20% more likely
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16
Q

Risk factors for Lung CA? (which is more common)

A 
Tobacco (80%)
radiation exposure
asbestos
other carcinogens
air pollution
Arsenic in drinking water
beta carotene
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17
Q

What types are included in the Non-small cell lung CA category?

A

adenocarcinoma
adenosquamous carcinoma
squamous cell carcinoma
large cell carcinoma

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18
Q

What is the most common type of Lung CA in non smokers?

A

adenocarcinoma

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19
Q

What type of cells are adenocarcinomas? How are they characterized (location, rate of growth)?

A

mucus glands or any epithelial cell within or distal to the terminal bronchioles

  • usually peripheral nodules
  • usually slow growing
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20
Q

What are adenosquamous carcinomas composed of?

A

> 10% malignant glandular and squamous components

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21
Q

What type of cells do Squamous cell carcinomas come from?

How are they characterized (location, mets?, necrosis)?

A

from bronchial epithelium

  • a/w hypercalcemia
  • metastasize out of the chest later
  • tend to have central necrosis
22
Q

What is a large cell carcinoma? Characteristics?

A

epithelial neoplasm lacking both glandular and squamous differentiation

  • agressive, rapid doubling rate
  • usually large, peripheral mass w/ prominent necrosis
23
Q

What do small cell carcinomas originate?

characteristics?

A

bronchial origin

-begin centrally, infiltrating submucosally to cause narrowing of the bronchus w/o a discrete luminal mass

  • aggressive, poor prognosis
  • 6-18 week survival untreated
24
Q

What are Bronchial carcinoid tumors?

A

pedunculate or sessile growths in central bronchi

derived from neuroendocrine cells

grow slowly, rarely metastasize

25
Q

how do patients with bronchial carcinoid tumors present?

A

hemoptysis, cough, focal wheezing, recurrent PNA

26
Q

What is Carcinoid syndrome?

A

Rare

-flushing, diarrhea, wheezing, hypotension

27
Q

On CXR of a pt w/ a bronchial carcinoid tumor, what might you see centrally vs peripherally?

A

central: pneumonitis, atelectasis, bronchiectasis, collapse

peripheral: solitary pulmonary nodule
- <4cm
- slightly lobulated
- +/- calcifications

28
Q

In bronchial carcinoid tumors, what is Octeotifde scintigraphy used for?

A

localization of tumor

29
Q

How do you dx/treat bronchial carcinoid tumors?

A

biopsy

surgical excision w/ mediastinal lymph node sampling or dissection
most resistant to radiation/chemo

30
Q

What is the most common sx in lung CA? Others?

A
  • Cough (50-75%, usually in squamous cell and small cell)
  • hemoptysis
  • dyspnea
  • pain
  • weight loss
  • hoarsness
31
Q

What is Superior vena cava syndrome?

what type of CA is it most common in

A
  • most common in SCLC
  • bulky upper lobe tumore
  • sensation of fullness in head
  • dyspnea
  • PE: distended neck veins, facial edema
  • CXR: widening of mediastinum, R hilar mass
32
Q

What is Pancoast syndrome? (most common in/sx)

A
  • common in squamous NSCLC
  • Shoulder pain
  • Horner’s syndrome
33
Q

Where do extrathoracic metastases occur? Most common in what types of lung CA?

A

liver
bone
adrenal
brain

SCLC and squamous cell

34
Q

What are some Paraneoplastic syndromes/ extrathoracic effects?

A
  • hypercalcemia
  • SIADH secretion- (in SCLC)
  • paraneoplastic syndromes- (typically a/w SCLC)
  • anemia, leukocytosis, thrombocytosis
35
Q

What tests can be done to dx lung CA?

A
  • sputum cytology
  • FNA or cytology
  • tissue biopsy
  • spirometry (post-op)
36
Q

What is the gold standard for mediastinal staging?

A

Mediastinoscopy

37
Q

What is the most common site of NSCLC distant mets?

A

brain

38
Q

What is used to stage Lung CA? what are the components?

A

TMN staging

primary tumor, node involvement, mets

39
Q

Tx in early stage NSCLA?

A

Pulmonary resection w/ complete MLN evaluation

chemo- consult thoracic oncologist

40
Q

What are potential post-op complications s/p resection?

A 
arrhythmias
prolonged post leads
PNA
resp failure
wound infection
AMS
41
Q

What stages of pts have the best prognosis?

just know trend

A

1a, 1b, 11a, 11b

higher stage= worse prognosis

42
Q

In staging SCLC, when is it considered limited vs extensive?

A

limited ~30%
-dz limited to the unilateral hemithorax

extensive ~ 70%
-tumor extends beyond the hemothorax

43
Q

How do you treat limited vs extensive SCLC?

A

limited- chemo and radiation

extensive- chemo alone as initial tx

44
Q

Side effects of chemoradiation

A
  • N/V, fatigue, anorexia, weight loss
  • anemia, neutropenia
  • nephrotoxicity
  • neurotoxicity
  • rash
  • visual disturbances
45
Q

Where do the majority of recurrences of Lung CA occur?

what do you need to do?

A

recurrences at distant sites

chest CT every 6 months x 2 years and annually after that

46
Q

As a primary care provider, what might your patients complain of post-treatment of Lung CA?

A
  • chronic pain, dyspnea, fatigue, impaired sleep, distressed mood
  • chemo sequelae-neuropathy, hearing loss
  • skin changes, esophagitis
47
Q

What is mesothelioma?

A

primary tumor arising from the surface linking of the pleura

linked to asbestos exposure (ship yard worker, construction)

48
Q

Typical clinical findings in a pt w/ mesothelioma

A
  • insidious onset SOB
  • nonpleuritic CP
  • weight loss
  • dullness to percussion
  • diminished breath sounds
  • digital clubbing
49
Q

How do you treat Mesothelioma?

A

Chemotherapy

50
Q

How can you evaluate for mesothelioma?

A
  • pleural fluid
  • cytology
  • VATS biopsy
  • imaging
51
Q

Screening with Low-dose CT is what grade level recommendation by USPSTF? For who?

A

Grade B

Annual LDCT for:
-age 55-74: current smoker or former within 15 yrs w/ > 30 pack hx

Foundations II Exam 3 (Jess) (6 decks)

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