OnlineMedEd: Pulmonology - "Lung Cancer" Flashcards
Why might you be suspicious of tuberculosis in a patient with lung cancer?
Similar symptom profile: fever, weight loss, and hemoptysis
Describe the diagnostic workup of suspected lung cancer.
•First, for patients with fever, hemoptysis, and weight loss, order an x-ray.
•Second, interpret the x-ray:
- If there’s a nodule, then do a CT and biopsy.
- If the XR is negative and they don’t have a paraneoplastic syndrome, then stop; if they do have a paraneoplastic syndrome, then do a CT and biopsy.
- If the XR shows effusion, then do a tap of the effusion and look for malignant cells. If positive then CT.
Describe the newer bronchoscopic technique.
Called EBUS (endobronchoscopic ultrasound), it involves doing a bronchoscopy with an ultrasound so that you can see any masses on the other side of the airway.
Peripheral lesions can be sampled with _________. Central lesions can be sampled with ___________.
CT-assisted biopsy; video-assisted sampling (VATS)
If a centrally located lesion looks highly suspicious for lung cancer, then you can _______________.
diagnose with resection
How is lung cancer staging done?
PET-CT (then do PFTs to get a baseline)
Who should receive low-dose CTs screening for lung cancer?
Those who are 55-80 yo, who have smoked for more than 30 pack years, and who quit smoking less than 15 years ago.
What are the “good” characteristics in a lung nodule?
- Less than 8 mm in diameter (greater than 2 cm is bad)
- Smooth borders (spiculated is bad)
- No calcifications
- Person is younger than 45 and who didn’t smoke
How frequently should LDCTs be done?
Yearly
If a pulmonary nodule has not changed in _________, then it is considered to be stable and no follow-up is needed.
2 years
If a pulmonary nodule is changing, what should you do?
- For low-risk nodules (unclear criteria but I think it has to do with the nodule’s characteristics, mentioned in another card), do serial CTs.
- For high-risk nodules (ditto), biopsy.
Give a rundown on small cell carcinoma.
- Cannot do surgery, but usually sensitive to chemotherapy and radiation
- Paraneoplastic syndromes: SIADH, Cushing’s, anti-cerebellar antibodies, LEMS
- Smoking highly causative
What is the pathophysiology of hypercalcemia in squamous cell carcinoma?
PTH-rp (related-peptide) is released by the tumor –not PTH.
(Remember the Sketchy with the PHd sneaking out of the SCC cell.)
Adenocarcinoma –which is more common in non-smokers –is related to what exposure?
Asbestos