Pulm Neoplasms Flashcards
Coin lesions
< 3 cm
Surrounded by nml lung tissue
Solitary pulm nodule (SPN)
Etiology (SPN)
1) Benign
Infx granulomas (80%); TB, fungi - histoplas
Hamartoma (15%); slow growing, mult tissue (cartilage, fat, muscle, bone, etc), popcorn calc
2) Malignant (5%)
Bronchogenic carcinoma, bronchial carcinoid, mets tumors (multiple SPNs)
RFs (SPNs)
AGE (malignancy inc proportionately)
SMOKING
Environment/Work exposure (asbestos)
H/o cancer
Other lung dz
Travel (endemic fungal areas)
Dx (SPNs)
Review old films (comparison)
CT or PET
(Smooth, well-defined = likely benign)
(Lobular, spiculated / corona radiata, peripheral halo = often malignant)
Biopsy by pulm
#1 cancer-related death Older age (usually) Smoking hx (usually)
Bronchogenic carcinoma
RFs (Bronchogenic carcinoma)
SMOKING
Asbestos, radon gas, formaldehyde, metals
Radiation
HIV
Screening (Bronchogenic carcinoma)
Currently not recommended
Low-dose CT
Classification (Bronchogenic carcinoma)
1) Non-Small cell (NSCLC - 80%)
AC, SCC, Large cell
2) Small cell (SCLC - 20%)
Much worse
30-40% NSCLC
Usually peripheral (mid-clavicular or lateral)
Nodule or mass
Usually underlying lung dz
Adenocarcinoma (NSCLC)
20-30% NSCLC
Usually central, endobronchial mass (marble)
Persistent cough, hemoptysis, recurrent PNA
Sputum cytology
SCC (NSCLC)
10% (NSCLC)
Poorly differentiated
Usually peripheral mass
Can look like AC
Large cell carcinoma (NSCLC)
Neuroendocrine tumor "Oat cell" subtype Bronchial origin, starts central Narrows/obstructs bronchi Hilar mass on imaging
Small cell (SCLC)
H A SS L E
A & L are outer / peripheral
(Adenocarcinoma, Large cell)
S & S are inner / central
(SCC, Small cell)
Clinical signs/sxs (Bronchogenic Ca)
Primary lesion
Cough - chronic Dyspnea Chest pain - "fullness" Hemoptysis "B" signs: Fever, Night sweats, Weight loss
Clinical signs/sxs (Bronchogenic Ca)
Intrathoracic spread
Pleural effusion
Hoarseness (compress of recurr laryng n.)
**Superior vena cava synd (esp SCC); crimp SVC, venous backup/plethora, edema nipples up (neck/face), hoarse, hemoptysis
**Pancoast tumor/syndrome (apical lung); assoc c Horner’s syndrome (ptosis, miosis, anhidrosis), rib destruc, brachial plexopathy
Clinical signs/sxs (Bronchogenic Ca)
Extrathoracic spread
Mets to:
Bone (pain, fx)
Liver (poor px)
Brain (HA, N/V, seizure, focal deficits)
Dx (Bronchogenic Ca)
Confirm & stage
CXR, CT, ??? bone scan, PET, brain MRI
Tissue sampling (sputum cytology, thoracent, bronchoscopy, needle bx, VATS)
TNM stage
Tx (Bronchogenic Ca)
NSCLC - surgery if caught early
Adjuvant chemo/rad
SCLC - Chemo; poor px
Primary tumor of pleural surface lining
M»_space; F; > 60 yrs
Occupational exposure
Mesothelioma
Clinical presentation (Mesothelioma)
Slow onset dyspnea (2/2 pleural effusion)
Non-pleuritic chest pain
Weight loss
Dx (Mesothelioma)
CXR, CT, thoracentesis, pleural bx, VATS
Tx (Mesothelioma)
Surgery, radiation, chemo
Poor px
Neuroendocrine tumor
Synth/store/secrete neuroamine/peptides
Slow-growing, rarely mets, but arise thru-out body (GI»_space; lung»_space; thymus & ovary)
Young adults, usually male
Carcinoid tumor
Carcinoid tumor
Signs/sxs
Dx
Tx
Hemoptysis, cough, recurrent PNA Carcinoid syndrome rare (syst release serotonin - FLUSHING, DIARRHEA, BRONCHOSPASM - wheezing) Paraneoplastic - SIADH CT, bronchoscopy, bx Surgical excision
Associated Findings (Paraneoplastic) NSCLC
Hypercalcemia
Hypophosphatemia
Hypoglycemia
Migratory thrombophlebitis
Associated Findings (Paraneoplastic) SCLC
Acanthosis nigracans SIADH Dermatomyositis Cushing's Syndrome Nephrotic Syndrome
