Pulmonary Neoplasms

Question 1

METASTATIC LUNG CANCER routes of spread

Answer 1

Tramscoelomic: along the surface of an organ - mesothelioma
Lymphatic: most common route for carcinomas
Hematogenous: most common route for sarcomas
Iatrogenic: transplantation or implantation

Question 2

BRONCHOGENIC CARCINOMA – two main families

Answer 2

small cell lung cancer – primitive neuroendocrine cells...BAD lots of metastases 
Non-small cell lung cancer:
Adenocarcinoma
Squamous cell carcinoma of the lung
Large cell lung carcinoma
Bronchoalveolar carcinoma

Question 3

SCREENING FOR LUNG CANCER

Answer 3

Patients with 30+ pack years even if they quit within the last 15 years

Question 4

PANCOAST’S SYNDROME

Answer 4

Extension of tumor at apex of the lung involving C8, T1, T2 nerves and possible destruction of ribs
Shoulder pain radiating in the ulnar distribution

Question 5

SOLITARY PULMONARY NODULE

Answer 5

Common clinical finding, often incidental
Lung Ca – Metastatic Ca – Granuloma (most common)
More likely to be benign if:
Younger patient, smooth edges, not growing, calcification, 5mm

Question 6

MULTIPLE PULMONARY NODULES

Answer 6

May be malignant or benign
> 1 cm, usually malignant
< 5 mm, usually benign, granulomas, lymph nodes, scars
Benign:
Infections: septic emboli, fungi, TB, parasites
Wegner’s, AV malformations, pneumoconioses
Malignant:
Usually metastatic
Pattern – nodular, reticular, or combined