Neoplastic Pulmonary Disease Flashcards
What is the leading cause of cancer death in men and women?
lung cancer
What is the typical peak age range for lung cancer?
55-65 year olds
What are the 4 major types of lung cancer?
Squamous or epidermoid carcinoma
Small cell (also called oat cell) carcinoma
Adenocarcinoma
Large cell carcinoma
What is the number one risk factor for lung disease?
Smoking is the #1 risk factor
What percentage of all patients with lung cancer of all histological varieties are current smokers or have a history of smoking?
85%
The most common form of lung cancer is what type?
Adenocarcinoma
Lung cancer is often referred as?
Bronchogenic Carcinoma
Bronchogenic carcinoma classified in what 2 main categories?
Non-small cell lung cancer ~80%
Small cell lung cancer ~20%
Which types of lung cancer are the peripheral tumors?
Adenocarcinoma
Large cell carcinoma
Which types of lung cancer are the central tumors?
Squamous cell carcinoma
Small cell carcinoma
Which type of lung cancer is described below?
Central masses
Tends to originate in proximal bronchial epithelium/central bronchi as intraluminal growth
Tends to be a slower growing tumor
Squamous Cell Carcinoma
Which type of lung cancer is described below?
Most common form
Arise from mucus glands, can arise from any epithelial cell within or
distal to terminal bronchioles
Usually present as more peripheral in location, often as peripheral nodules or masses
Most common in patients with underlying lung disease
Adenocarcinoma
Which type of lung cancer is described below?
AKA “oat cell carcinoma”
Part of family of neuroendocrine tumors arising throughout body
Also occurs centrally and tends to narrow or obstruct bronchus
Widespread metastases is common (spreads quickly)
Poor prognosis
Small Cell Carcinoma
Which type of lung cancer is described below?
Heterogenous group of poorly differentiated tumors that don’t have
features of other tumor types
Present as peripheral or central masses
Rapid doubling time and aggressive clinical course – very aggressive
Large Cell Carcinoma
What is the Large Cell Carcinoma’s claim to fame?
Rapid doubling time
Lung CA (adenocarcinomas and small cells) accounts for 70% of
symptomatic what?
brain metastases
Examples of Paraneoplastic syndromes from lung cancer include:
Cushing’s syndrome
SIADH
Hypercalcemia
gynecomastia
What location is most common for lung cancer metastasis?
brain
A tumor of the superior sulcus at the extreme apex of the lung
Either a large cell or adenocarcinoma
Pancoast Tumors
What method is the definitive diagnosis of lung cancer?
Cytology
What is the modality as well as the guidelines for screening for lung cancer?
Use low-dose chest CT
Recommended for patients 55-74 years who have smoked ≥30 pack years and either continue to smoke or have quit within past 15 years
Which type of lung cancer has the best outcome/prognosis?
Squamous cell
Which type of lung cancer has the worst outcome/prognosis?
Small cell
A single round or oval shaped circumscribed isolated pulmonary lesion, up to <3cm, surrounded by normal lung tissue
Historically called “coin lesions”
Not associated with infiltrate, atelectasis, or adenopathy
Solitary Pulmonary Nodule
Based on ACCP guidelines, assessment of a solitary pulmonary nodule should be based primarily on two factors:
Patient’s risk of cancer (age, smoking history, etc)
Nodule size
What size of solitary pulmonary nodule should you start to get concerned/look into further?
Anything >8mm : 8mm is where the malignancy risk starts to increase
Most solitary pulmonary nodules are what?
infectious granulomas (80%) - TB, endemic fungi (ex. Histoplasmosis)
If multiple pulmonary nodules present, consider what?
metastatic disease
What are some risk factors to ask about/consider when evaluating a solitary pulmonary nodule?
Age
Smoking history
Environmental/work exposures (ex. Asbestos)
Prior history of CA
Coexisting lung disease
Travel or residence in endemic fungal areas (ex. Histoplasmosis)
A pulmonary nodule with the morphology of spiculated margins or a peripheral halo should raise your suspicion of what?
That the nodule is malignant (not benign)
What are the two most common benign lung neoplasms?
bronchial adenomas and hamartomas (90% of the total)
The majority of bronchial adenomas are what type?
80-90% of them are carcinoids
A neuroendocrine tumor is called what?
Carcinoid
Rare group of pulmonary tumors characterized by neuroendocrine differentiation and relatively indolent clinical behavior (rarely metastasize)
Carcinoid tumors
Carcinoid syndrome triad
Flushing
Diarrhea
Hypotension
What is the mainstay treatment of Carcinoid tumor and why?
Surgical removal only real treatment - mainstay
Resistant to radiation and chemotherapy
Generally considered a benign tumor in middle age patients that grows slowly over years
Think of it as a hunk of lung tissue that grows abnormally
Believed to arise as outgrowth from normal mesenchymal and epithelial lung elements
Contain mixture of cartilage, fat, smooth muscle, bone, and respiratory epithelium
Hamartoma
Appear as lobulated lesions with “popcorn” calcification
Hamartoma
What caution should you exercise with Hamartomas and why?
Hypervascular and they bleed profusely so caution used in surgery
