Pulmonary Cancer

Question 1

Location of following tumors:
Adenocarcinoma
SCC
Small cell carcinoma
Large cell carcinoma

Answer 1

Peripheral
Central (cavitations/necrotic)
Central
Peripheral

Question 2

2 Clinical associations of Adenocarcinoma:

Answer 2

Clubbing

Hypertrophic Osteoarthropathy

Question 3

1 Clinical association of SCC:

Answer 3

PTHrP (Hypercalcemia of malignancy)

(Stones, Bones, Groans, Thrones, Psych overtones)

Management:
Severe/symptomatic →  
1. Rapidly lower lvls w/ IV 0.9% NaCl
2. Start calcitonin or bisphosphonates (Alendronate)
3. Consider HD if life-threatening
4. Avoid thiazides & lithium

Question 4

3 Clinical associations of Small cell carcinoma:

Answer 4

1. Cushing Syndrome
2. SIADH (Euvolemic, hyponatremic, salty pee)
3. Lambert Eaton Syndrome

(autoantibodies against presynaptic calcium channels → impaired Ach release in the NMJ)

Proximal muscle weakness (improves w/use)
Reduced or absent reflexes
Dry mouth/ Constipation

Question 5

2 Clinical associations of Large cell carcinoma:

Answer 5

Gynecomastia

Galactorrhea

Question 6

Most common type of primary lung cancer

More common in women and nonsmokers

Answer 6

Adenocarcinoma

+ mucin staining

Question 7

Lung cancer associated with
Intercellular bridges (desmosomes)
Keratin pearls
smoking

Answer 7

SCC

Question 8

Lung cancer associated with
smoking
Poor response to chemotherapy
Early metastases
Poor prognosis

Answer 8

Large Cell Carcinoma

Largely fucked

Question 9

Most common primary lung cancer in children & adolescents
Good prognosis with slow course 
Carcinoid syndrome (flushing, diarrhea)

Answer 9

Bronchial carcinoid tumor

Question 10

An apical lung carcinoma
Symptoms 2/2 mass effect of the tumor:
Horner syndrome (ipsilateral miosis, ptosis, & anhidrosis)
Brachial plexus
Localized pain in the axilla and shoulder
Upper limb motor and sensory deficits
Hoarseness
Facial swelling
Phrenic nerve: paralysis of the hemidiaphragm (visible as elevated hemidiaphragm on chest x-ray)

Answer 10

Pancoast tumor

superior sulcus tumor

Question 11

Recurrent respiratory infections (pneumonia) in the same pulmonary region in patients ≥ 40 years old should always raise suspicion for

Answer 11

lung cancer

Question 12

The most common sites of metastasis from lung cancer are the (4)

Answer 12

Brain, Liver, Adrenals, and Bones

BLAB

Question 13

Lung imaging:
CXR → indicated as first-line imaging

CT chest (if cxr has suspicious findings) 
Nodules/masses:
- [location]
- No \_\_\_\_
- \_\_\_  margins 
-Large size (> 2 cm or 8mm)

Answer 13

• In the upper lobe
• No calcifications
• Irregular (scalloped or spiculated)

Question 14

Cavitating lesion with air-fluid levels on CXR is characteristic of which lung cancer?

Answer 14

squamous cell carcinoma

Question 15

All metabolically active (pet +) lung lesions suspicious for malignancy should undergo __ or __ for diagnostic confirmation.

Answer 15

biopsy or excision

Question 16

Preoperative PFTs are required prior to lung resection surgery
A preoperative FEV1 < __ L and DLCO < __% predicts a poor outcome after lobectomy.

Answer 16

1.5L
60%
(Can do wedge resection instead?)

*Patients with a preop FEV1 and DLCO that are both ≥80 are considered low risk and can tolerate lobectomy or pneumonectomy. If not calculate predicted postop (PPO) FEV1 and DLCO. If both PPO FEV1 and PPO DLCO ≥60 can tolerate lobectomy or pneumonectomy.

Question 17

A ___ identified on CXR in a patient with high-risk features ( age 60+, smoking hx, 8+mm, upper lobe) should be evaluated by CT thin to rule out malignancy.

Answer 17

solitary pulmonary nodule

Question 18

Initial assessment of Solitary pulmonary nodule on imaging

Answer 18

Review any previous CXR imaging

for changes in size/shape

Question 19

Annual screening with a low-dose CT scan in patients ___ years of age with ≥ __ pack-year smoking history who have smoked within the past __ years

Answer 19

50–80
20
15

Question 20

Solitary pulmonary nodule is seen on CXR. No past imaging is available in patient’s chart. What is the next best step in management?

Answer 20

Obtain a thin-slice CT chest