Pulm neoplasms highlights Flashcards
1) Define coin lesion/ nodule
2) Define mass
3) What is often noted on lung cancer screening or as an incidental finding on CXR?
1) 30 mmor less = anodule (coin lesion)
2) > 30 mm cm = amass
3) PN (pulmonary nodule)
What is the most common malignant pulmonary neoplasm?
Adenocarcinoma
What is the most common kind of benign pulmonary nodule?
Healed infectious granuloma
What is the goal of initial imaging of a neoplasm?
Estimate the malignant potential of the nodule
You should repeat low dose chest CT for benign or probably benign nodules; screening interval depends on the ___________ and ___________ of the initial nodule
morphology and size
Additional imaging besides CXR, like HRCT or PET/CT or referral for biopsy for concerning nodules, should be done when?
Very suspicious large solid PN - 15 mm + or 8mm + that are new or growing
Describe what to do for a solitary incidental PN 6-8mm based on risk
1) Low risk: repeat CT @ 6-12 months, then consider @ 18–24 months
2) Moderate to high risk: repeat CT @ 6 -12 months, then repeat CT @ 1 –24 months
When is a PET-CT and biopsy always warranted?
If any PN is concerning for malignancy
True or false: pulmonary neoplasm does not mean cancer. Explain your answer.
True (but your patient will think cancer when you use it!!!!)
Lung cancer is the # 1 cause of ___________ deaths in WOMEN and MEN
cancer
Majority of lung cancers divided into what 2 histologic types? What % does each make up?
1) Non-small cell lung cancer (NSCLC; 85%)
2) Small cell lung cancer (SCLC; 15%)
What do Small cell lung cancer (SCLC) and NSCLC have in common?
Both assoc. w smoking
List the risk factors for lung cancer
1) Cigarette smoking
2) Prior radiation
3) COPD
4) Environmental exposure (radon, asbestos)
Lung cancer symptoms include what 3 things?
Hemoptysis, cough, dyspnea
1) If you have a pt with a puln nodule and their test comes back and says they have hyponatremia, what is the most likely cancer?
2) What if it was hypercalcemia instead?
1) Small cell carcinoma [causing SIADH]
2) SCC [hyper PTH]
True or false: adenocarcinoma is not associated with smoking and is more peripheral
True
True or false: even if a CXR is normal, that does not rule out cancer because the sensitivity is low
True
Is Non-small cell Squamous cell lung cancer more centrally or peripherally located?
Centrally
What is the primary concern of lung cancer Dx confirmation?
Tissue
Non-small cellcan be treated with what?
Surgery, then radiotherapy, CTX
Cigarette smokeis associated with what lung cancers?
1) Small cell (oat cell)
2) Some non-small cell cancers: SCC + large cell carcinoma
1) What is the most common lung cancer in non-smokers? What are 2 common causes?
2) Pancoast tumors are masses in the______ region of the lung, compress the nerves andblood vessels, & are most likely SCCor___________________
1) Adenocarcinoma; air pollution & radon common cause
2) upper; adenocarcinoma
What 3 things are Pancoast tumors assoc. with?
1) Shoulder pain
2) Horner’s syndrome
3) Bony destruction
Carcinoid syndrome (rare):
Specific to carcinoid tumors, causes the release of serotonin/vasoactiveresulting in what 3 things?
Flushing, diarrhea, and bronchoconstriction (asthma type lung Sx)
What is a treatment of non-small cell lung carcinoma after initial surgery?
Erlotinib
1) Lung cancer often found as incidental nodule on ________ or chest CT.
2) Large cell and carcinoid tumors (non-small cell types) can be found throughout the __________.
3) Small cell and Squamous cell found “S”entrally; both are associated with what?
1) CXR
2) lungs
3) Smoking
What is the mnemonic to remember what doesn’t cause adnocarcinoma?
Found peripherally, not associated with smoking (Ain’t Smoking)
What are the 2 types of Pancoast tumors?
Adenocarcinoma or squamous cell carcinoma
What is needed for definitive lung CA dx?
Biopsy/FNA
Carcinoid syndrome (rare, ~ 1-2%): What are the classic S/Sx?
Cutaneous flushing, diarrhea, itching, bronchoconstriction (wheezing), and hypotension
-S/S manifested when vasoactive substance(serotonin, histamine, & bradykinin) secreted into systemic circulation from liver or lung mets
1) What arise from neuroendocrine cells in GI (appendix most common), lungs, ovaries, and thymus?
2) What is the most common site of metastatic spread?
1) Carcinoid tumors
2) Liver
Increased Serotonin synthesis leads to what Sx? Why?
Pellagra due to decreased tryptophan + niacin/B3
What is the purpose of getting a urinalysis for a carcinoid tumor?
know this
Elevated 5-HIAA (5-hydroxyindoleacetic acid): main metabolite of serotonin and is used to determine serotonin levels in body
Who should be screened for lung cancer?
50-80 y/o, > 20 PYH smoking, either currently smoking or quit < 15 years
What are the 5 As of smoking cessation?
Ask all patients every visit about smoking
Advise patients to quit
Assess patient’s willingness to quit
Assist patient to quit with pharmacology – Chantix has best EB
Arrange follow up
