Pulmonary neoplasm Flashcards
What is the age range that the USPSTF recommends having lung cancer screening
50-80 for those who have 20 pack year smoking history that is current or within that last 15 years
What are some benign characteristics for lung tumors
Size <3cm
Solid round nodules
Age<30
non-smoker
Dense central calcification
well defined borders, no halo
What are some characteristics of malignant lung nodules
Size>3cm
Sub-solid (ground glass)
Smokers
Age>30
Stripped/eccentric calcification
irregular margins
lobular
cavitary with thick walls
Which population is most effected by solitary pulmonary nodules
men
smoker, COPD, older
**if non-smoker = women higher risk
What constitutes a solitary pulmonary nodule
‘coin lesion’
Discrete, round, <3cm
*not fixed to pleura/ chest wall
*No lymphadenopathy, infiltrate, atelectasis
What is the most common benign solitary pulmonary nodule
Infectious granuloma
What is the most common malignant solitary pulmonary nodule
Adenocarcinoma
What is a definitive dx for solitary pulmonary nodules
Biopsy
Which patient population is at increased risk for developing a solitary pulmonary nodule
Any hx of smoking
+FH lung cancer
Carcinogen exposure
Upper lobe nodule
emphysema
pulmonary fibrosis
What is the Fleischner criteria used for
managing incidentally detected solid pulmonary nodules in adults
What is considered a traditional lung cancer
Bronchogenic carcinoma
What is the #1 cause of cancer deaths
bronchogenic carcinoma
What is the median age to be diagnosed with bronchogenic carcinoma
70
*rare prior to 40y/o
What is the survival range with bronchogenic carcinomas
5 years max
What is the highest risk factor for bronchogenic carcinomas
smoking
What are the types of bronchogenic carcinoma
small cell (oat cell)
non-small cell
What types of cancer are considered non-small cell carcinoma
Adenocarcinoma
squamous cell carcinoma
Large cell carcinoma (everything else)
Which type of bronchogenic carcinoma is less common
small cell
What type of cell make up small cell carcinoma
neuroendocrine cells
What type of cells make up squamous cell carcinoma
bronchial epithelial cells
What type of cells make up adenocarcinoma
Glandular (mucous) cells
What are large cell carcinomas made up of
Undifferentiated
Which population is at highest risk of developing small cell carcinoma
Males over 50 (avg age = 70)
Smoking history
caucasian
What is the presentation of small cell carcinoma
rapid onset of symptoms (8-12 wks)
Mets common
central (bronchial) masses
paraneoplastic syndromes (SIADH, cushings)
What are paraneoplastic syndromes
Things associated with malignant diseases
What is the most common type of lung cancer in NON-smokers
adenocarcinoma
Which population is at greater risk of developing adenocarcinoma
Males over 50 (avg age = 70)
What gene mutation is associated with adenocarcinoma
P53
What is the presentation of adenocarcinoma
Peripheral masses but mostly asymptomatic
What are gene therapy targets for adenocarcinoma
EGFR mutations
ALK mutations
What is the presentation os squamous cell carcinoma
Hemoptysis
central (bronchial) masses
What is the second most common lung cancer
Squamous cell carcinoma (strong association with smoking)
How do you diagnose large cell carcinoma
dx of exclusion
*may present with peripheral or central masses
What is the most common presentation of bronchogenic carcinomas
New or worsening cough or dyspnea
*Hemoptysis (2) and chest pain (3)
What are some associated symptoms with bronchogenic carcinomas
Dysphagia
SVC syndrome
Horners syndrome
Pancoast syndrome
Paraneoplastic syndrome
Digital clubbing
Sx from mets
What is Horners syndrome
miosis, ptosis, anhydrous
What is pan coast syndrome
Shoulder/UE pain, weakness and hand atrophy from invasion of brachial plexus
What is the workup for bronchogenic carcinomas
Imaging (CXR -> then CT)
Bronchoscopy is central lesion
CT FNA is peripheral
What is the staging for small cell carcinomas
limited disease = confined to hemithorax
Extensive disease = extends to other lung / outside lung
How are non-small cell lung cancers staged
via the TMN staging system
What is the mainstay treatment for small cell carcinoma
Chemo and radiation
*resection if localized
How do you treat stage 1&2 non-small cell carcinoma w/o nodes
Resection
How do you treat late stage 2 or stage 3 non-small cell carcinoma
Resection with chemotherapy
How do you treat stage 3 unresectable small cell carcinomas
Chemo +/- radiation
+/-adjunctive immunotherapy (-mads)
What type of tumor is carcinoid tumors
rare, malignant, neuroendocrine tumors (atypical or typical)
What are the risk factors for carcinoid tumors
Smoking (atypical ONLY)
+FH
Multiple endocrine neoplasia type 1 (MEN1 gene)
What is the #1 pulmonary tumor in kids
carcinoid tumors
How much later do atypical carcinoid tumors present after typical
roughly 10 years
Where are carcinoid tumors found in the lungs
central bronchial masses (typical)
Peripherally (atypical)
What is carcinoid syndrome
Facial flushing
SOB
HTN
Hirsutism
asthma
weight gain
What is the workup for a carcinoid tumor
Chest CT (test of choice)
*should be well defined, lobulated nodules +/- calcifications
What test allows to differentiate types of carcinoid tumors
PET
What is a tumor marker for neuroendocrine tumors
plasma chromogranin (CgA)
How do you test for endocrine dysfunction
5-HIAA (seretonin byproduct)
Serum /urine cortisol
ACTH levels
GHRH & IGF
What test gives a definitive diagnosis for carcinoid tumors
Bronchoscopy and biopsy
What is the treatment for carcinoid tumors
Resection preferred
+/- chemo and/or radiation
Possible hormonal control
What can be used for hormonal control with carcinoid tumors
octreotide
What is the second most common form of lung cancer
Pulmonary metastasis
What is the second most frequent site of cancer metastasis
Pulmonary system (primarily via pulmonary artery)
Which cancers typically metastasize to the lungs
Colorectal
head/neck
urologic (Kidney, prostate, testicular)
GI cancers
Breast cancer
melanoma
gynecologic tumor
Where does primary lung cancer metastasize to
Liver
Bones
Brain
Lymph nodes
Adrenal glands
What is the most common initial test for pulmonary metastasis
CXR
What is the best test for pulmonary metastasis
Helical chest CT
What is the most common finding on imaging with pulmonary metastasis
multiple, bilateral nodules. Spherical, fairly well defined, varying sizes
How can you ID the primary tumor if not already known
Look for tumor markers
Biopsy results
What is the treatment for multiple pulmonary nodules, multiple met sites, and unreachable nodules
Palliative care (radiation +/- chemo)
What is the criteria to be able to resect a pulmonary nodule
Have primary tumor under control
Sufficient cardiopulmonary status
Ability to remove all mets
All non-operative options exhausted
What is the prognosis for pulmonary metastasis
5 year survival = 36%
10 year survival = 26%
What causes mesothelioma
Asbestos exposure
What is the presentation of mesothelioma
Dyspnea
non-pleuritic chest pain
unilateral pleural effusion
What is the workup for mesothelioma
CXR
CT for further differentiation
Thoracentesis
Pleural bx
CT,MRI,PET for staging
What is the treatment for mesothelioma
Resection, +/- chemo, +/- radiation
What is the average survival of mesothelioma
9-12 months
