Pulmonary Neoplasms Flashcards
Which cancers have the worst prognosis? Best?
- small cell lung cancer and adenocarcinoma
- squamous cell
What do you use for biopsy of central lesion? Peripheral?
central-bronchoscopy
peripheral- IR needle biopsy
How do you treat Stage I and II of NSC? Stage III? Stage IV?
- Surgery (+chemo for stage II)
- chemo and RT
- chemo
What order of testing would you go in? When/how do you decide if candidate for surgery?
- CXR
- CT/PET- don’t r/o at this point
- Lung biopsy- need to check if truly metastatic or new tumor
- FEV1>2L for pneumonectomy
- FEV1>1.5L for lobectomy
What are risk factors for lung cancer?
Smoking (esp small cell), asbestos, radon, pollution/diesel, RT, HIV, acquired lung disease, oncogene mutations (ras)
What are the types of small cell? non-small cell?
- small: oat cell and combined small cell
- non: adenocarcinoma, squamous cell carcinoma, large cell carcinoma
What are symptoms of lung cancer?
- Lungs: hemoptysis, pleuritic CP, cough, wheezing, dyspnea
- Anorexia, weight loss
(Facial swelling, fever, hoarseness, dysphagia, weakness, bone pain)
What is a pancoast tumor?
upper part of lung and invade apical chest wall and brachial plexus–> shoulder pain radiating down arm
What is horner’s syndrome?
Miosis, Anhydrosis, Ptosis d/t erosion of cervical sympathetic chain
What is SVC syndrome?
obstructive of SVC leading to facial swelling and UEs
What are paraneoplastic syndromes?
Hyponatremia, hypercalcemia, cushing’s, thrombophlebitis
What are PE findings? Xray?
wheezing, dull to percusion, dec breath sounds
palpable cervical or axillary LA
clubbing
Mass, effusion, PNA–> f/u CXR
How do squamous cell carcinomas form?
columnar epithelium–>metaplastic change–> squamous epithelium
- CENTRAL– necrosis, cavity form
- slow growth and low metastasis
Where are adenocarcinomas found? A/w? Prognosis>
PERIPHERY- most common
-pleural effusion
-Poor prognosis–> likely to distantly metastasis
(alveolar or bronchoalveolar in young and non-smokers)
Where are large cell carcinomas found? A/w? 2 types?
PERIPHERY
- pneumonitis and hilar adenopathy
- Giant cell and clear cell
Where does small cell start? A/w? prognosis?
- bronchi, perihilar region–> CENTRAL
- lymphadenopathy
- BAD–aggressive metatasize (paraneoplastic syndromes)
If pt with sxs and abnl CXR/CT, what next?
lung biopsy
- central= bronchoscopy
- periphery= IR guided biopsy
- pleural effusion= thoracentesis
What does an exudative thoracentesis indicate?
Malignant= distant metastasis=no resection
but needs to be done twice w/ benign
Staging for small cell? Tx?
Limited= confined to 1 lung and may involve adjacent lymph nodes---> RT and chemo Extensive= spread outside lung--> chemo
Staging for non-small cell? How do you assess this?
T (0-4)
N (0-3)
M (0 or 1) *if M1 then stage IV
-Use CT (structure) + PET (metabolically active)
What test do you use for staging with the brain? Bony metastasis? Pancoast tumors?
- CT or MRI
- Bone scan
- MRI
What are the drugs used in tx in non-small cell?
bevacizumab- against vEGF
erlotinib- TK inhibitor
What is SPN? How do you go about evaluating it? What would make you think it is malignant?
< 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!
