Pulmonary neoplasm Flashcards by Melissa Ring

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

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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

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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

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Which population is most effected by solitary pulmonary nodules

men
smoker, COPD, older
**if non-smoker = women higher risk

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What constitutes a solitary pulmonary nodule

‘coin lesion’
Discrete, round, <3cm

*not fixed to pleura/ chest wall
*No lymphadenopathy, infiltrate, atelectasis

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What is the most common benign solitary pulmonary nodule

Infectious granuloma

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What is the most common malignant solitary pulmonary nodule

Adenocarcinoma

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What is a definitive dx for solitary pulmonary nodules

Biopsy

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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

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What is the Fleischner criteria used for

managing incidentally detected solid pulmonary nodules in adults

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What is considered a traditional lung cancer

Bronchogenic carcinoma

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What is the #1 cause of cancer deaths

bronchogenic carcinoma

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What is the median age to be diagnosed with bronchogenic carcinoma

*rare prior to 40y/o

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What is the survival range with bronchogenic carcinomas

5 years max

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What is the highest risk factor for bronchogenic carcinomas

smoking

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What are the types of bronchogenic carcinoma

small cell (oat cell)
non-small cell

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What types of cancer are considered non-small cell carcinoma

Adenocarcinoma
squamous cell carcinoma
Large cell carcinoma (everything else)

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Which type of bronchogenic carcinoma is less common

small cell

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What type of cell make up small cell carcinoma

neuroendocrine cells

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What type of cells make up squamous cell carcinoma

bronchial epithelial cells

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What type of cells make up adenocarcinoma

Glandular (mucous) cells

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What are large cell carcinomas made up of

Undifferentiated

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Which population is at highest risk of developing small cell carcinoma

Males over 50 (avg age = 70)
Smoking history
caucasian

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What is the presentation of small cell carcinoma

rapid onset of symptoms (8-12 wks)
Mets common
central (bronchial) masses
paraneoplastic syndromes (SIADH, cushings)

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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