Pulm: Lung Cancer Flashcards
95% of all cancers are classified as this:
bronchiogenic carcinoma
Bronchiogenic carcinoma are malignancies that originate where?
airways or parenchyma
This is a small, well defined lesion surrounded by pulmonary parenchyma
Solitary Pulmonary Nodule
An SPN is less than ____ cm
3 cm
What is the most common type of SPN?
infectious granuloma
if a lesion is > 3 cm it is called…
mass
nodules or masses are considered ______ until proven otherwise
cancer
Benign or malignant cause of an SPN?
infectious
hamartoma
vascular
inflammatory
benign
What are three common causes of infectious SPNs?
TB
Cocci
Pulm. Abscess
60% of SPNs in AZ are caused by ______. This tells you that what factor should be considered when taking a hx for SPN
cocci
residence/travel
What three characteristics should be assessed when approaching SPN imaging?
calcification
Shape
Size
Benign or malignant?
no calcification
malignant
Benign or malignant?
smooth, well-defined edges
benign
Benign or malignant?
5+ cm
malignant
What is the preferred imaging study to assess an SPN?
Helical Chest CT
What 4 factors does helical chest CT assess?
size
growth
lobar location
borders
A solid nodule > 8mm with a low probability of malignancy is noted. A CT should be ordered when?
CT at 3 months
After getting a CT of a solid nodule > 8mm with low probability, if no growth is noted, when should the next CTs take place?
9-12 mo
18-24 mo
What tests should be ordered for intermediate probability SPN > 8mm?
FDG PET/CT
A high probability SPN > 8mm requires what diagnostic?
biopsy or excision
An SPN 6-8mm should be followed with a CT at what time?
6-12 mo
An SPN less than 6mm (does/doesn’t) require follow-up.
doesn’t
A lesion with the following characteristics requires what?
new/enlarging not stable not calcified not rounded > 3cm
referral
What are the four primary cell types in lung cancer?
small cell
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
What are the non-small cell types?
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
What is the subtype of small cell carcinoma?
oat cell carcinoma
What is the most common type of lung cancer?
adenosarcoma
What type of lung cancer?
- arises in central airway
- highly aggressive, 70% mets
- 6-18 week survival
Oat cell/small cell
A patient presents with:
- large hilar mass
- bulky mediastinal adenopathy
- Extrinsic compression of airway
- cough, dyspnea, weight loss, debility
Oat cell/small cell
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
adenocarcinoma
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
squamous cell carcinoma
what type of cancer…
detectable by sputum cytology
more likely to cause hemoptysis
can cavitate
mets to regional lymph noedes
squamous cell carcinoma
What type of cancer?
- central or peripheral mass
- mets to distant organs
- relatively undifferentiated
- aggressive
large cell carcinoma
Which type of Cancer?
- rapid doubling, early mets
- arises centrally
- hilar/mediastinal LAD
- strong association with smoking
small cell
Which type of cancer is associated with:
- SVC syndrome
- paraneoplastic syndromes like SIADH, Cushings, Eaton-Lambert
small cell
What type of cancer?
- arises peripherally
- associated with thrombophlebitis, clubbing
- most cases due to smoking
adenocarcinoma
What type of cancer?
- arises in central bronchi
- associated with hemoptysis, PTH
- extends to hilum/mediastinum
- slower growing, late mets
- may cavitate
Squamous cell
What type of cancer?
- fast growing
- primarily dx of exclusion
large cell
What is the cause of the following sxs?
pleural effusion pericardial effusion hoarseness SVC Syndrome Pancost syndrome
intrathoracic spread
What 5 sxs should be concerning for primary lesions?
cough weight loss dyspnea CP hemoptysis
What is the MC cause of hemoptysis?
bronchitis
Cough most frequently occurs with what types of cancer?
squamous and small cell
dyspnea occurs in lung cancer due to what three pathologic conditions>
airway obstruction
pneumonitis
Pleural/pericardial effusion
What are 4 sxs of intrathoracic spread?
pleural effusion
pericardial effusion
hoarseness
svc syndrome
What sx of intrathoracic spread?
-indicates direct pleural extension, mediastinal node involvement, lymphatic obstruction
pleural effusion
What sx of intrathoracic spread?
indicates extension into pericardium
pericardial effusion
What sx of intrathoracic spread?
compression of recurrent laryngeal nerve
associated with left sided tumors
hoarseness
What is the most common cause of SVC syndrome?
Non-small cell
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
SVC syndrome
What 4 diagnostics can be used to identify SVC syndrome?
CXR
Duplex US
Contrast CT
Superior Vena Cavogram
In evaluating SVC syndrome, which diagnostic should be used for:
-initial study with indwelling devices and arm swelling
duplex US
In evaluating SVC syndrome, which diagnostic should be used for:
assessing level and extent of blockage
identify collateral pathways
identify underlying cause
Contrast CT
In evaluating SVC syndrome, which diagnostic should be used for:
identification of obstruction
assess extent of thrombus formation
Gold standard
Superior vena cavogram
What treatment option is often used to treat SVC syndrome?
emergency radiation therapy
Which treatment is indicated in SVC syndrome with the following sxs?
stridor or laryngeal edema
coma from cerebral edema
emergency radiation therapy
This is a tumor involving the superior sulcus (apical chest) which compresses the brachial plexus and cervical sympathetic nerves.
Pancoast syndrome
Compression of the cervical sympathetic nerves in pancoast syndrome results in ipsilateral pain in what pattern?
descending: right shoulder > right forearm, scapula, fingers
What results from an injury of sympathetic nerves of the face, leading to:
miosis
anhidrosis (lack of sweating)
ptosis
Horner’s syndrome
What type of NSCLC can cause pancoast syndrome?
squamous cell
A patient presents with the following symptoms, concerning for…
ipsilateral sxs
rib destruction
atrophy of hand muscles
pain C8, T1, T2 roots
Pancoast syndrome
This is a rare disorder triggered by an altered immune response to a neoplasm
paraneoplastic syndrome
What three organ systems are commonly affected by paraneoplastic syndrome?
hematologic
endocrine
neuro
This disorder is a constellation of:
anorexia
weight loss leading to cachexia
suppressed immunity
Paraneoplastic syndromes
What five hematologic manifestations can occur in paraneoplastic syndromes?
- hypercalcemia
- anemia
- luekocytosis
- thrombocytosis
- hypercoagulability
What are two manifestations of the endocrine system in paraneoplastic syndromes?
PTH-like substance secretion
Excess HCG production
The following endocrine manifestations of paraneoplastic syndromes are a result of…
Gynecomastia
Milky nipple discharge
Associated with large cell lung cancer
Excess HCG Production
The following endocrine manifestations of paraneoplastic syndromes are a result of…
Hypercalcemia
related to squamous cell carcinoma
PTH-like substance secretion
The following endocrine manifestations of paraneoplastic syndromes are a result of…
Hyponatremia
assoc. with small cell
SIADH
The following endocrine manifestations of paraneoplastic syndromes are a result of…
ectopic ACTH
Bad prognosis
Assoc. w/ small cell
cushings
A patient presents with the following sxs, you should be concerned for…
muscle weakness weight loss HTN hirsutism osteoporosis
cushings
A patient presents with the following sxs, you should be concerned for…
irritability restlessness personality changes confusion coma seizure respiratory arrest
SIADH
A patient presents with the following neurologic sxs. What paraneoplastic syndrome is this concerning for?
muscle weakness
decreased DTRs
assoc. w/ small cell
Eaton-Lambert Syndrome
This paraneoplastic syndrome is caused by antibodies at NMJ leading to defective ACh release.
Eaton-Lambert Syndrome
What is the most common site of distant mets in lung CA?
liver
What 4 sites are common for mets in lung cancer?
liver, bone, adrenal, brain
Brain mets are associated with…
small cell
What are the two reasons you need tissue biopsy in diagnosing lung cancer?
r/o non-malignant
r/o mets from another tumor
How is small cell staged?
limited vs extensive disease
How is non-small cell staged?
TNM staging
TNM stands for…
T: primary tumor
N: nodal involvement
M: distant mets
When is a sputum culture useful in lung cancer dx?
central lesions
A patient has SCLC. the tumor is limited to ipsilateral hemithorax.
What stage?
limited disease
A patient has SCLC. The tumor extends beyond hemithorax and includes pleural effusions.
What stage?
Extensive disease
Extensive disease presents in _____% of SCLC while limited disease presents in _______%
Extensive: 60-65%
Limited: 35-40%
Performance status is useful in assessing…
ability to perform ADLs
What performance status?
fully active, no restrictions
0
What performance status?
strenuous physical activity restricted.
fully ambulatory
able to carry out light work
1
What performance status?
capable of all self-care
unable to carry out work activity
up and about 50% of waking hours
2
What performance status?
capable of only limited self-care
confined to bed or chair
confined to bed or chain in > 50% of waking hours
3
What performance status?
completely disabled
cannot carry out any self-care
totally bed or chair confined
4
Performance status is on an ascending scale of no restriction to disability from _____ to ____
0-4
An FEV1 < 60% of predicted is the strongest indicator of…
post-op complications
What imaging modality is used to aid in diagnosis and staging?
PET
What are the two limitations of PET?
doesnt detect all CA
infx may be positive
the FDG used in PET scan has the tendency to accumulate in what normal tissues? (3)
Kidneys
Heart
Bladder
SCLC is treated with _____, which has an 80% response rate
chemotherapy
For what percent of patients is surgery an option for treating SCLC?
5%, small primary, no mets
NSCLC is treated with…
surgical resection
Stage I-IIIA NSCLC with adequate pulm function can proceed with with tx?
surgery
Stage IIIB to IV NSCLC is treated with…
palliative radiation or combo chemo
What is treated with thoracentesis, pleurx catheters and pleurodesis?
malignant effusion
The following are side effects of what treatment for lung cancer?
anemia, neutropenia nephrotoxicity cutaneous toxicity NV weight loss fatigue brain fog
cytotoxic chemo
Rank the NSCLC stages from best prognosis to worst…
Stage 1»_space;> Stage 2 > Stage 3> Stage 4
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
LDCT
What drugs can be used to help in a smoking cessation program?
wellbutrin
chantix
