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

Neoplastic Dzs Flashcards

(51 cards)

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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)?

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
A

pedunculate or sessile growths in central bronchi

derived from neuroendocrine cells

grow slowly, rarely metastasize

25
how do patients with bronchial carcinoid tumors present?
hemoptysis, cough, focal wheezing, recurrent PNA
26
What is Carcinoid syndrome?
Rare | -flushing, diarrhea, wheezing, hypotension
27
On CXR of a pt w/ a bronchial carcinoid tumor, what might you see centrally vs peripherally?
central: pneumonitis, atelectasis, bronchiectasis, collapse peripheral: solitary pulmonary nodule - <4cm - slightly lobulated - +/- calcifications
28
In bronchial carcinoid tumors, what is Octeotifde scintigraphy used for?
localization of tumor
29
How do you dx/treat bronchial carcinoid tumors?
biopsy | surgical excision w/ mediastinal lymph node sampling or dissection most resistant to radiation/chemo
30
What is the most common sx in lung CA? Others?
- Cough (50-75%, usually in squamous cell and small cell) - hemoptysis - dyspnea - pain - weight loss - hoarsness
31
What is Superior vena cava syndrome? | what type of CA is it most common in
- 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
What is Pancoast syndrome? (most common in/sx)
- common in squamous NSCLC - Shoulder pain - Horner's syndrome
33
Where do extrathoracic metastases occur? Most common in what types of lung CA?
liver bone adrenal brain SCLC and squamous cell
34
What are some Paraneoplastic syndromes/ extrathoracic effects?
- hypercalcemia - SIADH secretion- (in SCLC) - paraneoplastic syndromes- (typically a/w SCLC) - anemia, leukocytosis, thrombocytosis
35
What tests can be done to dx lung CA?
- sputum cytology - FNA or cytology - tissue biopsy - spirometry (post-op)
36
What is the gold standard for mediastinal staging?
Mediastinoscopy
37
What is the most common site of NSCLC distant mets?
brain
38
What is used to stage Lung CA? what are the components?
TMN staging | primary tumor, node involvement, mets
39
Tx in early stage NSCLA?
Pulmonary resection w/ complete MLN evaluation chemo- consult thoracic oncologist
40
What are potential post-op complications s/p resection?
``` arrhythmias prolonged post leads PNA resp failure wound infection AMS ```
41
What stages of pts have the best prognosis? | just know trend
1a, 1b, 11a, 11b higher stage= worse prognosis
42
In staging SCLC, when is it considered limited vs extensive?
limited ~30% -dz limited to the unilateral hemithorax extensive ~ 70% -tumor extends beyond the hemothorax
43
How do you treat limited vs extensive SCLC?
limited- chemo and radiation extensive- chemo alone as initial tx
44
Side effects of chemoradiation
- N/V, fatigue, anorexia, weight loss - anemia, neutropenia - nephrotoxicity - neurotoxicity - rash - visual disturbances
45
Where do the majority of recurrences of Lung CA occur? | what do you need to do?
recurrences at distant sites chest CT every 6 months x 2 years and annually after that
46
As a primary care provider, what might your patients complain of post-treatment of Lung CA?
- chronic pain, dyspnea, fatigue, impaired sleep, distressed mood - chemo sequelae-neuropathy, hearing loss - skin changes, esophagitis
47
What is mesothelioma?
primary tumor arising from the surface linking of the pleura linked to asbestos exposure (ship yard worker, construction)
48
Typical clinical findings in a pt w/ mesothelioma
- insidious onset SOB - nonpleuritic CP - weight loss - dullness to percussion - diminished breath sounds - digital clubbing
49
How do you treat Mesothelioma?
Chemotherapy
50
How can you evaluate for mesothelioma?
- pleural fluid - cytology - VATS biopsy - imaging
51
Screening with Low-dose CT is what grade level recommendation by USPSTF? For who?
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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