NMS Thoracic Flashcards
what are chances that coin lesion on CXR is malignant
50% at 50. under 50 chances decrease, over 50 chances increase
what do benign lesions look like vs. malignant
benign has smooth surfaces, malignant has irregular or spiculated surfaces
what are other benign lesions
Bulls’ eyes, hamartomas which have popcorn appearance on CXR
which area of U.S. are coin lesions common
SW U.S. where coccidiomycosis is common and mid-Atlantic and OH valley where Histo occurs
most common mets to the lung are from
colorectal, breast, liver
if a lung lesion looks malignant what do you do
get a CT to characterize lesions and to look for enlarged lymph nodes in mediastinum, then do CT-guided needle bx
what do you do for a lesion with cough and hemoptysis and mediastinal enlarged lymph node
bronchoscopy for tissue diagnosis and to determine location of lesion and mediastinoscopy to determine state of mediastinal LNs
what do you do if needle bx shows malignant or indeterminate (lung)?
resection
what doubling time favors benign status vs. malignant status
if doubling time is 465 days then it favors benign. if doubling time is 5 wks to 280 days, favors malignant
what type of lung cancer usually presents late and not amenable to resection
small cell carcinoma
cure rate for Stage I lung tumors w resection
70%
Stage II lung cancer 5y survival
40-50%
surgical options for metastatic lesion involving mainstem bronchus
pneumonectomy (easier) or sleeve lobectomy (safer). sleeves not feasible if mainstem pulmonary artery involved
perioperative death rate from pneumonectomy
5-10% especially in those over 70 and those with cardiac or obstructive airway dz
at what stages can lung tumors be resected
stages I and II
at what stages are chemo and radiation the only treatments
stages III and IV
ipsilateral hilar lymph nodes are what stage
stage II
mediastinal lymph nodes are what stage
stage III
can a tumor undergo chemo and be downstaged and resected (lung)
yes
imaging modality good for detecting lung cancer mets
PET scan
symptoms of Pancoast tumor
Horner’s syndrome, pain in ulnar area of elbow and wrist
how to verify superior sulcus tumor
CT, bronchoscopy, mediastinoscopy, needle bx
what are 5y survivals for stage II, IIIa, and IIIb lung cancer
stage II 44%
stage IIIA 22%
stage IIIB <10%
tx of pancoast tumor
- irradiation over course of 6 wks then
2. surgical resection of chest wall and lung