Pulmonary Neoplasms

Question 1

Which cancers have the worst prognosis? Best?

Answer 1

• small cell lung cancer and adenocarcinoma

- squamous cell

Question 2

What do you use for biopsy of central lesion? Peripheral?

Answer 2

central-bronchoscopy

peripheral- IR needle biopsy

Question 3

How do you treat Stage I and II of NSC? Stage III? Stage IV?

Answer 3

• Surgery (+chemo for stage II)
• chemo and RT
• chemo

Question 4

What order of testing would you go in? When/how do you decide if candidate for surgery?

Answer 4

1. CXR
2. CT/PET- don’t r/o at this point
3. Lung biopsy- need to check if truly metastatic or new tumor
   - FEV1>2L for pneumonectomy
   - FEV1>1.5L for lobectomy

Question 5

What are risk factors for lung cancer?

Answer 5

Smoking (esp small cell), asbestos, radon, pollution/diesel, RT, HIV, acquired lung disease, oncogene mutations (ras)

Question 6

What are the types of small cell? non-small cell?

Answer 6

• small: oat cell and combined small cell

- non: adenocarcinoma, squamous cell carcinoma, large cell carcinoma

Question 7

What are symptoms of lung cancer?

Answer 7

1. Lungs: hemoptysis, pleuritic CP, cough, wheezing, dyspnea
2. Anorexia, weight loss
   (Facial swelling, fever, hoarseness, dysphagia, weakness, bone pain)

Question 8

What is a pancoast tumor?

Answer 8

upper part of lung and invade apical chest wall and brachial plexus–> shoulder pain radiating down arm

Question 9

What is horner’s syndrome?

Answer 9

Miosis, Anhydrosis, Ptosis d/t erosion of cervical sympathetic chain

Question 10

What is SVC syndrome?

Answer 10

obstructive of SVC leading to facial swelling and UEs

Question 11

What are paraneoplastic syndromes?

Answer 11

Hyponatremia, hypercalcemia, cushing’s, thrombophlebitis

Question 12

What are PE findings? Xray?

Answer 12

wheezing, dull to percusion, dec breath sounds
palpable cervical or axillary LA
clubbing
Mass, effusion, PNA–> f/u CXR

Question 13

How do squamous cell carcinomas form?

Answer 13

columnar epithelium–>metaplastic change–> squamous epithelium

• CENTRAL– necrosis, cavity form
• slow growth and low metastasis

Question 14

Where are adenocarcinomas found? A/w? Prognosis>

Answer 14

PERIPHERY- most common
-pleural effusion
-Poor prognosis–> likely to distantly metastasis
(alveolar or bronchoalveolar in young and non-smokers)

Question 15

Where are large cell carcinomas found? A/w? 2 types?

Answer 15

PERIPHERY

• pneumonitis and hilar adenopathy
• Giant cell and clear cell

Question 16

Where does small cell start? A/w? prognosis?

Answer 16

• bronchi, perihilar region–> CENTRAL
• lymphadenopathy
• BAD–aggressive metatasize (paraneoplastic syndromes)

Question 17

If pt with sxs and abnl CXR/CT, what next?

Answer 17

lung biopsy

• central= bronchoscopy
• periphery= IR guided biopsy
• pleural effusion= thoracentesis

Question 18

What does an exudative thoracentesis indicate?

Answer 18

Malignant= distant metastasis=no resection

but needs to be done twice w/ benign

Question 19

Staging for small cell? Tx?

Answer 19

Limited= confined to 1 lung and may involve adjacent lymph nodes---> RT and chemo
Extensive= spread outside lung--> chemo

Question 20

Staging for non-small cell? How do you assess this?

Answer 20

T (0-4)
N (0-3)
M (0 or 1) *if M1 then stage IV
-Use CT (structure) + PET (metabolically active)

Question 21

What test do you use for staging with the brain? Bony metastasis? Pancoast tumors?

Answer 21

• CT or MRI
• Bone scan
• MRI

Question 22

What are the drugs used in tx in non-small cell?

Answer 22

bevacizumab- against vEGF

erlotinib- TK inhibitor

Question 23

What is SPN? How do you go about evaluating it? What would make you think it is malignant?

Answer 23

< or = 3 cm
1. consider age, RF, size
(Big size, irregular borders, calcifications=more likely malig)
2. Chest CT
3. PET if >8-10mm
4. F/u CT in 3 months
5. Tissue if only way to truly know what a nodule is!