Neoplastic Dzs Flashcards
Another name for Solitary pulmonary nodule
coin lesion
Describe a SPN
- well-circumscribed
- isolated
- round opacity
- completely surrounded by nl lung
- not a/w infiltrate, atelectasis or adenotpathy
- < 3cm
Most common causes of SPN?
- bronchogenic carcinoma
- metastatic lesion
- infectious granuloma
- calcification
Are SPNs usually symptomatic or asymptomatic? How are they usually found?
- usually asymptotic
- found incidentally on CXR
Why do you compare imaging of a SPN to old films?
compare to old rims for doubling time (rate of growth)
When looking at a CXR, what do you need to look at in the SPN?
- size
- well-circumscribed
- cavitation (cavitary w/ thick walls= higher change malignancy)
- Calcification (benign= dense calcification; malignant= less calcification)
What are features seen in a CT that are concerning for malignancy?
- spiculated margins
- peripheral halo
- density on CT scan
What is seen on imaging of a Hamartoma? (SPN)
Popcorn calcifications!
What are the percentages for low, intermediate, and high risk of malignancy? What is considered low risk?
low < 5%
intermediate 5-60%
high >60%
Low:
- age < 30
- stable lesion > 2 yrs
- characteristic benign calcification pattern
If you pt is low risk, what do you do?
Watchful waiting
-serial imaging
If you pt is intermediate risk, what do you do?
- diagnostic biopsy
- PET
If you pt is high risk, what do you do?
resection
Most common lung cancers? (2)
adenocarcinoma or squamous cell
Out of the 2 main groups of lung CA, what kind is most common?
Non-small cell lung CA (80-85%)
Epidemiology facts about lung CA
- 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
Risk factors for Lung CA? (which is more common)
Tobacco (80%) radiation exposure asbestos other carcinogens air pollution Arsenic in drinking water beta carotene
What types are included in the Non-small cell lung CA category?
adenocarcinoma
adenosquamous carcinoma
squamous cell carcinoma
large cell carcinoma
What is the most common type of Lung CA in non smokers?
adenocarcinoma
What type of cells are adenocarcinomas? How are they characterized (location, rate of growth)?
mucus glands or any epithelial cell within or distal to the terminal bronchioles
- usually peripheral nodules
- usually slow growing
What are adenosquamous carcinomas composed of?
> 10% malignant glandular and squamous components
What type of cells do Squamous cell carcinomas come from?
How are they characterized (location, mets?, necrosis)?
from bronchial epithelium
- a/w hypercalcemia
- metastasize out of the chest later
- tend to have central necrosis
What is a large cell carcinoma? Characteristics?
epithelial neoplasm lacking both glandular and squamous differentiation
- agressive, rapid doubling rate
- usually large, peripheral mass w/ prominent necrosis
What do small cell carcinomas originate?
characteristics?
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
What are Bronchial carcinoid tumors?
pedunculate or sessile growths in central bronchi
derived from neuroendocrine cells
grow slowly, rarely metastasize
how do patients with bronchial carcinoid tumors present?
hemoptysis, cough, focal wheezing, recurrent PNA
What is Carcinoid syndrome?
Rare
-flushing, diarrhea, wheezing, hypotension
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
In bronchial carcinoid tumors, what is Octeotifde scintigraphy used for?
localization of tumor
How do you dx/treat bronchial carcinoid tumors?
biopsy
surgical excision w/ mediastinal lymph node sampling or dissection
most resistant to radiation/chemo
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
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
What is Pancoast syndrome? (most common in/sx)
- common in squamous NSCLC
- Shoulder pain
- Horner’s syndrome
Where do extrathoracic metastases occur? Most common in what types of lung CA?
liver
bone
adrenal
brain
SCLC and squamous cell
What are some Paraneoplastic syndromes/ extrathoracic effects?
- hypercalcemia
- SIADH secretion- (in SCLC)
- paraneoplastic syndromes- (typically a/w SCLC)
- anemia, leukocytosis, thrombocytosis
What tests can be done to dx lung CA?
- sputum cytology
- FNA or cytology
- tissue biopsy
- spirometry (post-op)
What is the gold standard for mediastinal staging?
Mediastinoscopy
What is the most common site of NSCLC distant mets?
brain
What is used to stage Lung CA? what are the components?
TMN staging
primary tumor, node involvement, mets
Tx in early stage NSCLA?
Pulmonary resection w/ complete MLN evaluation
chemo- consult thoracic oncologist
What are potential post-op complications s/p resection?
arrhythmias prolonged post leads PNA resp failure wound infection AMS
What stages of pts have the best prognosis?
just know trend
1a, 1b, 11a, 11b
higher stage= worse prognosis
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
How do you treat limited vs extensive SCLC?
limited- chemo and radiation
extensive- chemo alone as initial tx
Side effects of chemoradiation
- N/V, fatigue, anorexia, weight loss
- anemia, neutropenia
- nephrotoxicity
- neurotoxicity
- rash
- visual disturbances
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
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
What is mesothelioma?
primary tumor arising from the surface linking of the pleura
linked to asbestos exposure (ship yard worker, construction)
Typical clinical findings in a pt w/ mesothelioma
- insidious onset SOB
- nonpleuritic CP
- weight loss
- dullness to percussion
- diminished breath sounds
- digital clubbing
How do you treat Mesothelioma?
Chemotherapy
How can you evaluate for mesothelioma?
- pleural fluid
- cytology
- VATS biopsy
- imaging
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
