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Clinical Medicine II > Pulm: Lung Cancer > Flashcards

Pulm: Lung Cancer Flashcards

1
Q

95% of all cancers are classified as this:

A

bronchiogenic carcinoma

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2
Q

Bronchiogenic carcinoma are malignancies that originate where?

A

airways or parenchyma

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3
Q

This is a small, well defined lesion surrounded by pulmonary parenchyma

A

Solitary Pulmonary Nodule

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4
Q

An SPN is less than ____ cm

A

3 cm

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5
Q

What is the most common type of SPN?

A

infectious granuloma

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6
Q

if a lesion is > 3 cm it is called…

A

mass

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7
Q

nodules or masses are considered ______ until proven otherwise

A

cancer

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8
Q

Benign or malignant cause of an SPN?

infectious
hamartoma
vascular
inflammatory

A

benign

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9
Q

What are three common causes of infectious SPNs?

A

TB
Cocci
Pulm. Abscess

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10
Q

60% of SPNs in AZ are caused by ______. This tells you that what factor should be considered when taking a hx for SPN

A

cocci

residence/travel

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11
Q

What three characteristics should be assessed when approaching SPN imaging?

A

calcification

Shape

Size

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12
Q

Benign or malignant?

no calcification

A

malignant

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13
Q

Benign or malignant?

smooth, well-defined edges

A

benign

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14
Q

Benign or malignant?

5+ cm

A

malignant

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15
Q

What is the preferred imaging study to assess an SPN?

A

Helical Chest CT

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16
Q

What 4 factors does helical chest CT assess?

A

size

growth

lobar location

borders

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17
Q

A solid nodule > 8mm with a low probability of malignancy is noted. A CT should be ordered when?

A

CT at 3 months

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18
Q

After getting a CT of a solid nodule > 8mm with low probability, if no growth is noted, when should the next CTs take place?

A

9-12 mo

18-24 mo

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19
Q

What tests should be ordered for intermediate probability SPN > 8mm?

A

FDG PET/CT

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20
Q

A high probability SPN > 8mm requires what diagnostic?

A

biopsy or excision

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21
Q

An SPN 6-8mm should be followed with a CT at what time?

A

6-12 mo

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22
Q

An SPN less than 6mm (does/doesn’t) require follow-up.

A

doesn’t

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23
Q

A lesion with the following characteristics requires what?

new/enlarging
not stable
not calcified
not rounded
> 3cm
A

referral

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24
Q

What are the four primary cell types in lung cancer?

A

small cell
adenocarcinoma
squamous cell carcinoma
large cell carcinoma

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25
Q

What are the non-small cell types?

A

adenocarcinoma
squamous cell carcinoma
large cell carcinoma

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26
Q

What is the subtype of small cell carcinoma?

A

oat cell carcinoma

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27
Q

What is the most common type of lung cancer?

A

adenosarcoma

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28
Q

What type of lung cancer?

  • arises in central airway
  • highly aggressive, 70% mets
  • 6-18 week survival
A

Oat cell/small cell

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29
Q

A patient presents with:

  • large hilar mass
  • bulky mediastinal adenopathy
  • Extrinsic compression of airway
  • cough, dyspnea, weight loss, debility
A

Oat cell/small cell

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30
Q

What type of cancer has the following characteristics?

  • presents as peripheral nodules/masses
  • arises from mucous glands, epithelial cells
  • can be in or distal to terminal bronchioles
  • mets to distant organs
A

adenocarcinoma

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31
Q

What type of cancer has the following characteristics?

  • occurs centrally or in main bronchus
  • arises from bronchial epithelium
  • can be seen as intraluminal growth in bronchi
A

squamous cell carcinoma

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32
Q

what type of cancer…

detectable by sputum cytology

more likely to cause hemoptysis

can cavitate

mets to regional lymph noedes

A

squamous cell carcinoma

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33
Q

What type of cancer?

  • central or peripheral mass
  • mets to distant organs
  • relatively undifferentiated
  • aggressive
A

large cell carcinoma

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34
Q

Which type of Cancer?

  • rapid doubling, early mets
  • arises centrally
  • hilar/mediastinal LAD
  • strong association with smoking
A

small cell

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35
Q

Which type of cancer is associated with:

  • SVC syndrome
  • paraneoplastic syndromes like SIADH, Cushings, Eaton-Lambert
A

small cell

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36
Q

What type of cancer?

  • arises peripherally
  • associated with thrombophlebitis, clubbing
  • most cases due to smoking
A

adenocarcinoma

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37
Q

What type of cancer?

  • arises in central bronchi
  • associated with hemoptysis, PTH
  • extends to hilum/mediastinum
  • slower growing, late mets
  • may cavitate
A

Squamous cell

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38
Q

What type of cancer?

  • fast growing
  • primarily dx of exclusion
A

large cell

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39
Q

What is the cause of the following sxs?

pleural effusion
pericardial effusion
hoarseness
SVC Syndrome
Pancost syndrome
A

intrathoracic spread

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40
Q

What 5 sxs should be concerning for primary lesions?

A 
cough
weight loss
dyspnea
CP
hemoptysis
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41
Q

What is the MC cause of hemoptysis?

A

bronchitis

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42
Q

Cough most frequently occurs with what types of cancer?

A

squamous and small cell

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43
Q

dyspnea occurs in lung cancer due to what three pathologic conditions>

A

airway obstruction
pneumonitis
Pleural/pericardial effusion

44
Q

What are 4 sxs of intrathoracic spread?

A

pleural effusion
pericardial effusion
hoarseness
svc syndrome

45
Q

What sx of intrathoracic spread?

-indicates direct pleural extension, mediastinal node involvement, lymphatic obstruction

A

pleural effusion

46
Q

What sx of intrathoracic spread?

indicates extension into pericardium

A

pericardial effusion

47
Q

What sx of intrathoracic spread?

compression of recurrent laryngeal nerve

associated with left sided tumors

A

hoarseness

48
Q

What is the most common cause of SVC syndrome?

A

Non-small cell

49
Q

A patient presents with the following, making you concerned for what complication?

  • dyspnea
  • facial swelling/head fullness worse bending forward or laying down
  • dilated neck veins
  • prominent venous pattern on chest
  • arm swelling
  • Hx of NSCLC
A

SVC syndrome

50
Q

What 4 diagnostics can be used to identify SVC syndrome?

A

CXR
Duplex US
Contrast CT
Superior Vena Cavogram

51
Q

In evaluating SVC syndrome, which diagnostic should be used for:

-initial study with indwelling devices and arm swelling

A

duplex US

52
Q

In evaluating SVC syndrome, which diagnostic should be used for:

assessing level and extent of blockage

identify collateral pathways

identify underlying cause

A

Contrast CT

53
Q

In evaluating SVC syndrome, which diagnostic should be used for:

identification of obstruction

assess extent of thrombus formation

Gold standard

A

Superior vena cavogram

54
Q

What treatment option is often used to treat SVC syndrome?

A

emergency radiation therapy

55
Q

Which treatment is indicated in SVC syndrome with the following sxs?

stridor or laryngeal edema

coma from cerebral edema

A

emergency radiation therapy

56
Q

This is a tumor involving the superior sulcus (apical chest) which compresses the brachial plexus and cervical sympathetic nerves.

A

Pancoast syndrome

57
Q

Compression of the cervical sympathetic nerves in pancoast syndrome results in ipsilateral pain in what pattern?

A

descending: right shoulder > right forearm, scapula, fingers

58
Q

What results from an injury of sympathetic nerves of the face, leading to:

miosis
anhidrosis (lack of sweating)
ptosis

A

Horner’s syndrome

59
Q

What type of NSCLC can cause pancoast syndrome?

A

squamous cell

60
Q

A patient presents with the following symptoms, concerning for…

ipsilateral sxs
rib destruction
atrophy of hand muscles
pain C8, T1, T2 roots

A

Pancoast syndrome

61
Q

This is a rare disorder triggered by an altered immune response to a neoplasm

A

paraneoplastic syndrome

62
Q

What three organ systems are commonly affected by paraneoplastic syndrome?

A

hematologic

endocrine

neuro

63
Q

This disorder is a constellation of:

anorexia

weight loss leading to cachexia

suppressed immunity

A

Paraneoplastic syndromes

64
Q

What five hematologic manifestations can occur in paraneoplastic syndromes?

A
  1. hypercalcemia
  2. anemia
  3. luekocytosis
  4. thrombocytosis
  5. hypercoagulability
65
Q

What are two manifestations of the endocrine system in paraneoplastic syndromes?

A

PTH-like substance secretion

Excess HCG production

66
Q

The following endocrine manifestations of paraneoplastic syndromes are a result of…

Gynecomastia

Milky nipple discharge

Associated with large cell lung cancer

A

Excess HCG Production

67
Q

The following endocrine manifestations of paraneoplastic syndromes are a result of…

Hypercalcemia

related to squamous cell carcinoma

A

PTH-like substance secretion

68
Q

The following endocrine manifestations of paraneoplastic syndromes are a result of…

Hyponatremia
assoc. with small cell

A

SIADH

69
Q

The following endocrine manifestations of paraneoplastic syndromes are a result of…

ectopic ACTH
Bad prognosis
Assoc. w/ small cell

A

cushings

70
Q

A patient presents with the following sxs, you should be concerned for…

muscle weakness
weight loss
HTN
hirsutism
osteoporosis
A

cushings

71
Q

A patient presents with the following sxs, you should be concerned for…

irritability
restlessness
personality changes
confusion
coma
seizure
respiratory arrest
A

SIADH

72
Q

A patient presents with the following neurologic sxs. What paraneoplastic syndrome is this concerning for?

muscle weakness
decreased DTRs
assoc. w/ small cell

A

Eaton-Lambert Syndrome

73
Q

This paraneoplastic syndrome is caused by antibodies at NMJ leading to defective ACh release.

A

Eaton-Lambert Syndrome

74
Q

What is the most common site of distant mets in lung CA?

A

liver

75
Q

What 4 sites are common for mets in lung cancer?

A

liver, bone, adrenal, brain

76
Q

Brain mets are associated with…

A

small cell

77
Q

What are the two reasons you need tissue biopsy in diagnosing lung cancer?

A

r/o non-malignant

r/o mets from another tumor

78
Q

How is small cell staged?

A

limited vs extensive disease

79
Q

How is non-small cell staged?

A

TNM staging

80
Q

TNM stands for…

A

T: primary tumor

N: nodal involvement

M: distant mets

81
Q

When is a sputum culture useful in lung cancer dx?

A

central lesions

82
Q

A patient has SCLC. the tumor is limited to ipsilateral hemithorax.

What stage?

A

limited disease

83
Q

A patient has SCLC. The tumor extends beyond hemithorax and includes pleural effusions.

What stage?

A

Extensive disease

84
Q

Extensive disease presents in _____% of SCLC while limited disease presents in _______%

A

Extensive: 60-65%

Limited: 35-40%

85
Q

Performance status is useful in assessing…

A

ability to perform ADLs

86
Q

What performance status?

fully active, no restrictions

A

0

87
Q

What performance status?

strenuous physical activity restricted.

fully ambulatory

able to carry out light work

A

1

88
Q

What performance status?

capable of all self-care

unable to carry out work activity

up and about 50% of waking hours

A

2

89
Q

What performance status?

capable of only limited self-care

confined to bed or chair

confined to bed or chain in > 50% of waking hours

A

3

90
Q

What performance status?

completely disabled

cannot carry out any self-care

totally bed or chair confined

A

4

91
Q

Performance status is on an ascending scale of no restriction to disability from _____ to ____

A

0-4

92
Q

An FEV1 < 60% of predicted is the strongest indicator of…

A

post-op complications

93
Q

What imaging modality is used to aid in diagnosis and staging?

A

PET

94
Q

What are the two limitations of PET?

A

doesnt detect all CA

infx may be positive

95
Q

the FDG used in PET scan has the tendency to accumulate in what normal tissues? (3)

A

Kidneys
Heart
Bladder

96
Q

SCLC is treated with _____, which has an 80% response rate

A

chemotherapy

97
Q

For what percent of patients is surgery an option for treating SCLC?

A

5%, small primary, no mets

98
Q

NSCLC is treated with…

A

surgical resection

99
Q

Stage I-IIIA NSCLC with adequate pulm function can proceed with with tx?

A

surgery

100
Q

Stage IIIB to IV NSCLC is treated with…

A

palliative radiation or combo chemo

101
Q

What is treated with thoracentesis, pleurx catheters and pleurodesis?

A

malignant effusion

102
Q

The following are side effects of what treatment for lung cancer?

anemia, neutropenia
nephrotoxicity
cutaneous toxicity
NV
weight loss
fatigue
brain fog
A

cytotoxic chemo

103
Q

Rank the NSCLC stages from best prognosis to worst…

A

Stage 1&raquo_space;> Stage 2 > Stage 3> Stage 4

104
Q

The following populations are indicated to have what screening test?

smokers age 55-74 with 30 pack year hx

quit within 15 years

20 pack year hx with one additional risk factor

A

LDCT

105
Q

What drugs can be used to help in a smoking cessation program?

A

wellbutrin

chantix

Clinical Medicine II (31 decks)

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