Pulmonary Neoplasia Witwer FINAL

Question 1

What is the risk of aggressive malignant therapy?

Answer 1

Increased risk of morbidity/mortality

Question 2

On pulm imaging if it is under 3 cm called a ____, over 3 cm termed a ____.

Answer 2

nodule

mass

Question 3

You have a pt with area of suspicion on pulmonary imaging. What do you want to ask the patient if they have from past?

Answer 3

Older imaging to compare to new imaging for growth

Question 4

What imaging is done for workup of pulmonary suspicious nodule/mass?

Answer 4

CXR

CT

possible PET scan

Question 5

For a solitary pulmonary mass over 5 cm means there is a ___% chance of malignancy.

Answer 5

95%

Question 6

Pulmonary nodules/masses change over ____. If there is no change over a ____ OR if it doubles in size in 465+ days this suggests _____.

Answer 6

months

year

benignity

Question 7

What are factors suggestive of malignancy of pulmonary nodules/masses?

Answer 7

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

Question 8

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 __%

Answer 8

40%

80%

Question 9

Solitary pulmonary nodule found on pt < 35 yrs has chance of malignancy of < __%.

Answer 9

1%

Question 10

Patients that are over 50 and present with hemoptysis and no other indicative cause causes high suspicion for ____.

Answer 10

Malignancy

Question 11

Pulmonary nodules with dense calcification centrally and/or laminated is almost always ____.

Answer 11

Benign

Question 12

PET scans have a sensitivity for malignancy of ___%

and a specificity of ___%

Answer 12

95%

85%

Question 13

In PET scans what structures would expect to normally take up FDG showing activity?

Answer 13

Heart

Kidneys

ureters

bladder

Question 14

A superposition of PET scan and CT scans is done for what reason?

Answer 14

PET scan will show where to look generally, CT performed at same time will show precise location/involvment

Question 15

What percentage do NSCLC make up of total?

These are further categorized into which types?

Answer 15

80%

Squamous cell - 30% of lung cancers

Large cell

Adenocarcinoma - 30% of lung cancers

Bronchoalveolar carcinomas

*These types are relatively INSENSITIVE to chemo

Question 16

SCLC account for __% of lung cancers and are also known as ___ ____ carcinoma.

Answer 16

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

Question 17

In NSCLC one study showed that __% were smokers and __% were non-smokers

Answer 17

77%

23%

*but if they did smoke = worse prognosis

Question 18

Where does lung cancer tend to spread?

Answer 18

Local and centrally to

• hilar areas
• mediastinum
• and also distant sites i.e. brain

Question 19

What type of lung CA presents as a peripheral nodule/mass arising from peripheral lung tissue?

Answer 19

Adenocarcinoma

Question 20

What is bronchoalveolar a subclassification of and who is it most common in?

Answer 20

adenocarcinoma

females who never smoked

Question 21

What lung CA type tends to present more centrally, arising in the bronchi?

What does this do to the bronchi?

Answer 21

Squamous cell carcinoma (SCC)

causes bronchial obstruction can cause obstructive pneumonitis and/or atelectasis (drowned lung)

Question 22

Pneumonitis means the lung has a consolidation, is this from infection?

Answer 22

Not necessarily, but can be

Question 23

What type of lung CA tends to be peripheral AND rapidly growing?

Answer 23

Large cell carcinoma

Question 24

What type of lung CA tends to be more central, agressive often with central spread and distant metastasis when first discovered?

Answer 24

Small cell lung CA (SCLC) and Oat cell carcinoma

Question 25

Which lung CA can be associated with endocrince/paraneoplastic syndromes such as Cushing’s syndrome and inappropriate ADH secretion?

Answer 25

SCLC and Oat Cell Carcinoma

Question 26

What is it called when a mass obstructs the superior vena cava?

Answer 26

superior vena cava syndrome (that was a tuffy)

Question 27

Where is a Pancoast tumor found?

Answer 27

Apex or superior sulcus of the lung

Question 28

What structures can a Pancoast tumor encroach on?

Answer 28

Brachiocephalic v.

Subclavian a.

phrenic n.

Vagus n.

recurrent laryngeal n.

brachial plexus

cervicothoracic (stellate) sympathetic ganglion

Question 29

A Pancoast tumor encroaching on the cervicothoracic (stellate) sympathetic ganglion can cause which syndrome?

Answer 29

Horner syndrome (ptosis, miosis, anhidrosis)

*can also encroach on superior vena cava

Question 30

A Pancoast tumor is monst commonly which type of lung CA?

Answer 30

95% are NSCLC

*further breakdown of subclasses =

SCC (50%)

Adenocarcinoma (25%)

Large cell tumors (25%)

Question 31

In case Witty gives you a plain film to look at and guess the cancer where would you be looking for a Pancoast tumor?

Answer 31

behind and above the clavicles

*figured since he knows this dude there will be at least one or more questions on it

Question 32

What type of lesions cavitate?

Answer 32

Both infectious and malignant

Question 33

When do clinical findings occur from asbestos and what is found on imaging?

Answer 33

20 years after exposure

diffuse pulmonary fibrosis and pleural plaques that have calcified

Question 34

What is the malignancy associated with asbestosis and how does this present on imaging?

Answer 34

Mesothelioma

presents as mass and/or pleural effusion

Question 35

What are the primary tumors that metastasize to the lung?

Answer 35

• Colorectal
• Renal cell
• Breast
• malignant melanoma
• sarcomas
• endometrial/cervical/ovarian
• head and neck cancers

Question 36

Some charts for your leisurely viewing (check answer for additional image)

Answer 36