Pulmonary Neoplasia Witwer FINAL Flashcards
What is the risk of aggressive malignant therapy?
Increased risk of morbidity/mortality
On pulm imaging if it is under 3 cm called a ____, over 3 cm termed a ____.
nodule
mass
You have a pt with area of suspicion on pulmonary imaging. What do you want to ask the patient if they have from past?
Older imaging to compare to new imaging for growth
What imaging is done for workup of pulmonary suspicious nodule/mass?
CXR
CT
possible PET scan
For a solitary pulmonary mass over 5 cm means there is a ___% chance of malignancy.
95%
Pulmonary nodules/masses change over ____. If there is no change over a ____ OR if it doubles in size in 465+ days this suggests _____.
months
year
benignity
What are factors suggestive of malignancy of pulmonary nodules/masses?
little or no calcification (if calcified it is sparse & stippled
- indistinct margins i.e. shaggy, lobulated, spiculated
- cavitary lesions
- age over 30, especially over 50
- Hx smoking
Overall there is a ___% chance of malignancy in a solitary pulmonary nodule found. But if patient is over 50 w/ new solitary NON calcified nodule and COPD then increases to __%
40%
80%
Solitary pulmonary nodule found on pt < 35 yrs has chance of malignancy of < __%.
1%
Patients that are over 50 and present with hemoptysis and no other indicative cause causes high suspicion for ____.
Malignancy
Pulmonary nodules with dense calcification centrally and/or laminated is almost always ____.
Benign
PET scans have a sensitivity for malignancy of ___%
and a specificity of ___%
95%
85%
In PET scans what structures would expect to normally take up FDG showing activity?
Heart
Kidneys
ureters
bladder
A superposition of PET scan and CT scans is done for what reason?
PET scan will show where to look generally, CT performed at same time will show precise location/involvment
What percentage do NSCLC make up of total?
These are further categorized into which types?
80%
Squamous cell - 30% of lung cancers
Large cell
Adenocarcinoma - 30% of lung cancers
Bronchoalveolar carcinomas
*These types are relatively INSENSITIVE to chemo
SCLC account for __% of lung cancers and are also known as ___ ____ carcinoma.
20%
oat cell
*These types ARE SENSITIVE to chemo, but aggressive and worse prognosis due to small population of malignant cells surviving chemo.
**Strongly associated w/ smoking
In NSCLC one study showed that __% were smokers and __% were non-smokers
77%
23%
*but if they did smoke = worse prognosis
Where does lung cancer tend to spread?
Local and centrally to
- hilar areas
- mediastinum
- and also distant sites i.e. brain
What type of lung CA presents as a peripheral nodule/mass arising from peripheral lung tissue?
Adenocarcinoma
What is bronchoalveolar a subclassification of and who is it most common in?
adenocarcinoma
females who never smoked
What lung CA type tends to present more centrally, arising in the bronchi?
What does this do to the bronchi?
Squamous cell carcinoma (SCC)
causes bronchial obstruction can cause obstructive pneumonitis and/or atelectasis (drowned lung)
Pneumonitis means the lung has a consolidation, is this from infection?
Not necessarily, but can be
What type of lung CA tends to be peripheral AND rapidly growing?
Large cell carcinoma
What type of lung CA tends to be more central, agressive often with central spread and distant metastasis when first discovered?
Small cell lung CA (SCLC) and Oat cell carcinoma
Which lung CA can be associated with endocrince/paraneoplastic syndromes such as Cushing’s syndrome and inappropriate ADH secretion?
SCLC and Oat Cell Carcinoma
What is it called when a mass obstructs the superior vena cava?
superior vena cava syndrome (that was a tuffy)
Where is a Pancoast tumor found?
Apex or superior sulcus of the lung
What structures can a Pancoast tumor encroach on?
Brachiocephalic v.
Subclavian a.
phrenic n.
Vagus n.
recurrent laryngeal n.
brachial plexus
cervicothoracic (stellate) sympathetic ganglion
A Pancoast tumor encroaching on the cervicothoracic (stellate) sympathetic ganglion can cause which syndrome?
Horner syndrome (ptosis, miosis, anhidrosis)
*can also encroach on superior vena cava
A Pancoast tumor is monst commonly which type of lung CA?
95% are NSCLC
*further breakdown of subclasses =
SCC (50%)
Adenocarcinoma (25%)
Large cell tumors (25%)
In case Witty gives you a plain film to look at and guess the cancer where would you be looking for a Pancoast tumor?
behind and above the clavicles
*figured since he knows this dude there will be at least one or more questions on it
What type of lesions cavitate?
Both infectious and malignant
When do clinical findings occur from asbestos and what is found on imaging?
20 years after exposure
diffuse pulmonary fibrosis and pleural plaques that have calcified
What is the malignancy associated with asbestosis and how does this present on imaging?
Mesothelioma
presents as mass and/or pleural effusion
What are the primary tumors that metastasize to the lung?
- Colorectal
- Renal cell
- Breast
- malignant melanoma
- sarcomas
- endometrial/cervical/ovarian
- head and neck cancers
Some charts for your leisurely viewing (check answer for additional image)
