Pulm. Cancer Flashcards
Screening. what 2 criteria?
recommended for patients that fullfill 2 criteria:
1. >20 pack years smoking history
- Currently smoking or quit smoking within the past 15 years. (if stopped >= 15 years, do not needed to be screened)
Screening. what recommended test?
low dose CT scan of the chest
Screening. Recommended interval?
Yearly
Screening. age?
50-80 years
Screening. termination of screening? 2
Patient successfully quit smoking for >= 15 years
OR
Patient has medical conditions that significantly limit life expectancy
Adenocarcinoma. Incidence?
40-50 proc.
Adenocarcinoma. location?
treatment?
peripheral (involves pleura)
Stage
Chemoradiation
Resection
Adenocarcinoma. clinical associations? 2
Clubbing
Hyperthrophic osteoarthropathy
Squamous cell carcinoma. incidence?
20-25 proc.
Squamous cell carcinoma. location?
treatment?
Central
Necrosis and cavitation
Stage
Chemoradiation
Resection
Squamous cell carcinoma. clinical assoc?
Hypercalcemia (PTH-rp)
Small cell carcinoma. incidence?
10-15 proc.
Small cell carcinoma. location?
Treatment?
Central
Chemoradiation
Small cell carcinoma. clinical assoc?
Cushing syndrome (ACTH)
SIADH (ADH)
Lambert-Eaton syndrome
Large cell carcinoma. incidence?
5-10 proc.
Large cell carcinoma. location?
Peripheral
Large cell carcinoma. clinical assoc?
Gynecomastia
Galactorrhea
Secretes b-hcg
Solitary pulmonary nodule. definition?
It is defined by the features of round opacity, up to 3 cm in diameter, and surrounded by
pulmonary parenchyma
+ no assoc LN enlargement
Solitary pulmonary nodule.
by convention is must not be assoc. with what?
pleural effusion, adenopathy, or atelectasis
Solitary pulmonary nodule.
Most nodules are benign (eg, infectious granuloma, hamartoma)
.
Solitary pulmonary nodule. causes.
Primary lung cancer?
Squamous cell, adenocarcinoma , small cell, large cell & carcinoid [can be first in lung then go to intestine]
Solitary pulmonary nodule. causes. metastatic?
Melanoma , breast, head & neck, renal cell, colon, germ cell & sarcoma
Solitary pulmonary nodule. causes. benign infectious granulomas?
Tuberculosis , histoplasmosis , atypical mycobacteria , granulomas coccidioidomycosis , Cryptococcus & blastomycosis
Solitary pulmonary nodule. causes. benign neoplasmas?
Lipoma , hamartoma & fibroma
Solitary pulmonary nodule. causes. vascular?
Arteriovenous malformations
Solitary pulmonary nodule. findings that favour carcinoma? CT findings
CT scan findings
i. Large nodule size > 3
ii. Low density
iii. Spiculated borders
iv. Eccentric calcifications
Solitary pulmonary nodule. findings that favour carcinoma? clinical findings
Clinical findings:
i. Age >40
ii. History of smoking
iii. Weight loss
iv. Previous malignancy
Solitary pulmonary nodule. Management based on CT.
Bening features –>?
Serial CT scans for 2-3 years
Solitary pulmonary nodule. Management based on CT.
Ground glass appearance –>?
Yearly assessment (even with stable appearance and size)
Solitary pulmonary nodule. Management based on CT.
Intermediate features –>?
Further investigation with biopsy or PET
Solitary pulmonary nodule. Management based on CT.
Highly malignant features–>?
Surgical excision
Solitary pulmonary nodule. yra algoritmas faile, is esmes kortose parasyta ka daryti pagal CT findings
.
Assessment of malignancy risk for solitary pulmonary nodule. Low risk. size?
<0,8 cm
Assessment of malignancy risk for solitary pulmonary nodule. immediate risk. size?
0,8 - 2 cm
Assessment of malignancy risk for solitary pulmonary nodule. high risk. size?
> = 2 cm
Assessment of malignancy risk for solitary pulmonary nodule. Low risk. age?
< 40
Assessment of malignancy risk for solitary pulmonary nodule. intermediate risk. age?
40-60
Assessment of malignancy risk for solitary pulmonary nodule. high risk. age?
> 60
Assessment of malignancy risk for solitary pulmonary nodule. Low risk. smoking status?
Never smoked
Assessment of malignancy risk for solitary pulmonary nodule. Intermediate risk. smoking status?
current
Assessment of malignancy risk for solitary pulmonary nodule. High risk. smoking status?
current
Assessment of malignancy risk for solitary pulmonary nodule. Low risk. smoking cessation?
> 15 years
Assessment of malignancy risk for solitary pulmonary nodule. Intermediate risk. smoking cessation?
5-15 years
Assessment of malignancy risk for solitary pulmonary nodule. High risk. smoking cessation?
<5 years
Assessment of malignancy risk for solitary pulmonary nodule. Low risk. Nodule margin characteristics?
Smooth
Assessment of malignancy risk for solitary pulmonary nodule. Intermediate risk. Nodule margin characteristics?
Scalloped
Assessment of malignancy risk for solitary pulmonary nodule. High risk. Nodule margin characteristics?
Corona radiate or spiculated
Cancer. clinical presentation?
● Fever.
● Weight loss.
● Hemoptysis.
Cancer. diagnosis. Xray. Nothing ->
Check for paraneoplastic syndrome.
Positive –> cancer
Negative –> no cancer
Cancer. diagnosis. Xray. Effusion –>?
Do troracenthesis
Malignant cells –> cancer (stage 4 - metastatic disease)
No malignant cells –> no cancer
Cancer. diagnosis. Xray. Cancer (gali tipo tiesiog matytis). –> Do CT
.
Cancer. diagnosis. CT scan.
Find in the large airway –>?
bronchoscopy and biopsy.
Cancer. diagnosis. CT scan.
Found outside the lung –>?
Endobronchial US
Cancer. diagnosis. CT scan.
Periphery ->?
CT guided percutaneous biopsy
Cancer. diagnosis. CT scan.
Middle –>?
Video assisted thoracoscopic surgery
Cancer. diagnosis. CT scan.
Thoracenthesis with effusion –>?
–> positive malignant cells –> stage 4 lung cancer.
Cancer. diagnosis. what for staging?
PET CT for staging
Cancer. diagnosis. What test to do if candidate of surgery?
PFT
Cancer. diagnosis. treatment?
Treatment either chemotherapy, radiation, or surgery.
▪ Lobectomy if FEV1>1.5L and DLCO>60%.
Cancer: Primary prevention?
Quit smoking and secondhand smoking.
Infectious granulomas are the MCC of benign pulmonary nodules; multiple
rather than single, and associated with active disease (fever, cough, weight
loss).
.
Solitary pulmonary nodules. Factors increasing malignant probability?
Large size (> 2 cm), agvanced age, female, active or previous smoking, family/personal history of cancer, upper lobe location, spiculated radiograph appearance
Solitary pulmonary nodule. Algo.
High risk malignancy –>?
Surgical excision
Solitary pulmonary nodule. Algo.
Low-intermediate risk malignancy –>?
Evaluate nodule size
Solitary pulmonary nodule. Algo.
Low-intermediate risk malignancy –> size >= 8 mm –> what tests to do?
FDG-PET or biopsy
Solitary pulmonary nodule. Algo.
Low-intermediate risk malignancy –> size >= 8 mm –>FDG-PET or biopsy –> suspicious for malignancy –>?
Surgical excision
Solitary pulmonary nodule. Algo.
Low-intermediate risk malignancy –> size >= 8 mm –>FDG-PET or biopsy –> NO suspicious for malignancy –>?
Serial CT scans
Solitary pulmonary nodule. Algo.
Low-intermediate risk malignancy –> size < 8 mm –> if nodule 5-7 mm?–>?
Serial CT scans
Solitary pulmonary nodule. Algo.
Low-intermediate risk malignancy –> size < 8 mm –> if nodule =< 4?–>?
Evaluate malignancy risk:
If low –> no follow up
If intermediate –> Serial CT scans
Bronchoalveolar carcinoma.
Peripheral location (pneumonia-alike on xray)
Treatment: stage, chemoradiation, resection
.