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Pulmonology 2 > Pulmonary Neoplasms > Flashcards

Pulmonary Neoplasms Flashcards

1
Q

Risk factors for lung cancer

A
  • smoking & secondhand smoke
  • asbestos (mesothelioma)
  • Radon (uranium mining)
  • FHX of smoking re-lated cancers
  • air pollution
  • prior lung diseases (COPD, TB)
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2
Q

WHat is the common age rage for the development of lung cancer?

A

40-80yrs

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3
Q

What cancer is the most common cause of cancer deaths?

A

lung cancer.

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4
Q

Smoking cessation is beneficial in individuals even with an established dx of lung cancer, True or False?

A

True

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5
Q

Smoking Cessation Tx

A
  • Zyban (Buproprion/wellbutrin)
  • chantix (varenicline)
  • nicotine replacement therapy
  • clonidine and nortriptyline are recommended as second-line txs
  • hypnosis can work for some motivated smokers
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6
Q

Benign neoplasms aka?

Malignant neoplasms?

A
  • tumors

- cancer

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7
Q

Benign Pulmonary Neoplasms

  • describe cellular growth
  • types
A

-cells grow in fairly orderly manner, stick together, dont migrate, seem to be encapsulated, smooth borders.

Types:

  • Hamartomas: local tissues growing in disorganized manner
  • Granulomas: chronic inflamm lesions with mfs.
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8
Q

Malignant Tumors

-cell growth?

A
  • rapid, even continuous division, show de-differentiation (look less and less like parent cells/tissue; lose some or all of their normal cell functions)
  • masses have irregular, invasive borders
  • travel in search for new lands to conquer
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9
Q

Metastatic Lung Cancer

-routes of spread

A

Transcoelomic: along the surface of an organ (mesothelioma)

Lymphatic: most common route for carcinomas

Hematogenous: most common route for sarcoma.

Iatrogenic: transplantation or implantations

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10
Q

Most lethal of all cancers?

A

-Bronchogenic carcinoma

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11
Q

Bronchogenic carcinoma

-what are the two main families of this cancer and their subtypes

A
  1. Small cell lung cancer:
    - primitive neuroendocrine cells
  2. Non-small cell lung cancers
    a. )adenocarcinoma
    b. ) squamous cell carcinoma of the lung
    c. ) large cell lung carcinoma
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12
Q

List some common types of lung cancer

A
  • carcinoid
  • Kaposi’s sarcoma
  • melanoma
  • lymphoma
  • head and neck
  • mesothelioma
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13
Q

Small Cell Lung Carcinoma

  • aka
  • where is this typically found?
  • arises from which cells?
  • rapid or slow growing?
  • metastases?
A
  • aka: “oat cell” lung cancer
  • typically a central mass with endobronchial growth.
  • arises from primitive small neuroendocrine cells
  • very aggressive, rapidly fatal
  • Yes, metastases. 90% of patients with SCLC develop brain metastases
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14
Q

Small Cell Lung Cancer

-what peptide hormones does this secrete?

A

Secretes:

  • ACTH
  • AVP (Arginine Vasopressin)
  • ANF (Atrial natriuretic factor)
  • Gastrin-releasing peptide (GRP)
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15
Q

Among women and young adults

A
  • Adenocarcinoma

- Adenocarcinoma!!!

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16
Q

Non-small cell Lung Carcinoma (NSCLC)- ADENOCARCINOMA:

  • where on the lung does this arise?
  • greatest cause
A
  • found on peripheral lung locations

- smoking

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17
Q

What is the most common type of lung cancer occurring in never somkers?

A

-Adenocarcinoma

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18
Q

NSCLC: BRONCHOALVEOLAR ADENOCARCINOMA

  • subtype of which subtype?
  • growth
  • occurs when in life?
  • commonly mistaken for?
  • metastases?
  • found where on the lungs?
  • appearance on CXR and CT
A
  • its a subtype of the Adenocarcinoma subtype of NSCLC.
  • Growth: rapidly progressive, solitary or multicentric nodules
  • occurs during 2nd decade of life
  • commonly mistaken for non-resolving focal or bilateral “pneumonia”
  • metastases? distant spread uncommon
  • tends to be more peripheral and grows along the alveoli.

CXR: single mass, diffuse multinodular lesion, fluffy infiltrate.

CT: “groud-glass” opacity

19
Q 
NSCLC: Squamous Cell Carcinoma 
-found where on the lungs?
-metastases?
-CT findings
-
A
  • found in the proximal bronchi, occur centrally
  • tend to remain localized and cavitate(nest of tumor cells with central necrosis resulting in cavitation)–metastasize late.
  • CT: ground glass opacity
20
Q 
NSCLC: LARE CELL CARCINOMA: 
-dx
-growth 
-found where on the lungs?
-
A
  • dx of exclusion
  • growth: large poor differentiated cell, prominent necrosis.
  • found peripherally, sheets of large malignant cells often associated with necrosis.
21
Q

General Clinical Presentation of Lung Cancer

A
  • asymptomatic
  • Central lesions:
  • -cough
  • -hemoptysis
  • -wheeze
  • -stridor
  • -SOB
  • -collapse of lung
  • -post obstructive pna (think bronchogenic CA when pna not responding to tx)
  • Peripheral Lesions:
  • -pain d/t plueral or chest wall invasion
  • Metastases:
  • -bone pain, back pain
  • -diff breathing, chest wall pain
  • -HA, sz, speech diff
  • -weakness, weight loss, loss of appetite
22
Q

Lung cancers kill their host by spreading throughout the body,

  1. ) local spread is via?
  2. ) distal spread is via?
A
  • local spread in chest is through the lymphatics of simple invasion
  • distal spread is via blood
23
Q

Lung Cancer Metastases:

-most common sites?

A
  • Adrenals 50%
  • Liver 30-50%
  • Brain 20%
  • Bone 20%
24
Q

Clinical findings suggestive of metastatic dz?

A
  • weight loss greater than 10lbs
  • focal skeletal pain
  • HA, syncope, sz
  • Lymphadenopathy
  • Hoarseness
  • Hepatomegaly
  • Papilledema
  • Superior vena cava syndrome
  • HCT less than 40% men and 35% women
25
Q

Horners syndrome:

  • what is this?
  • sx
A
  • a disrupted nerve pathway on one side from the brain to the face and eye.
  • Miosis (smaller pupil), drooping of the eyelid with loss of sweating to that side of the face.
26
Q

Pancoast Syndrome

  • what is this?
  • sx
A
  • extension of a tumor at the apex of the lung involving C8, T1, T2 nerves and possible destruction of ribs
    sx: shoulder pain radiating in the ulnar distribution
27
Q

Superior vena cava syndrome

  • cause
  • signs
  • sx
A

caused 90% of the time due to bronchogenic cancer.

signs:
- swelling of face, neck, arms - venous dilation

sx:
- SOB, cough, chest pain suggesting upper airway obstruction
- hoarseness, tongue swelling, nasal congestion
- HA, syncope, lethagry d/t cerbral edema.

28
Q

What causes hoarseness secondary to Superior Vena Cava Syndrome?

A

-irritation to the left recurrent laryngeal nerve.

29
Q

Paraneoplastic Syndromes:

  • what are they?
  • tx
  • examples
A
  • what are they: disease or sx d/t presence of cancer in the body.
  • tx: treat the cancer

examples:
- Cachexia: only in NSCLC

  • Hypercalcemia: squamous cell cancer
  • Hypertrophic pulmonary osteoarthropathy(adenocarcinomas)
  • skeletal manifestations: clubbing(NSCLC)
  • Cutaneous manifestations: dermatomyositis and acanthosis nigricans
  • Neurologic manifestations: Myasthenic Eaton-Lambert syndrome and retinal blindness (SCLC)
  • -peripheral neuropathy
  • -subacute cerebellar degenerations
  • -cortical degenerations
  • -polymyositis
  • Hematologic manifestations:
  • -migratory venous thrombophlebitis (Trousseaus’s)
  • -nonbacterial thrombotic endocarditis with arterial emboli
  • -DIC
  • Renal Manifestations:
  • -nephrotic syndrome
  • -glomerulonephritis
30
Q

Eaton-Lambert Syndrome

  • what is this?
  • tx
A

What: autoimmune response, proximal muscle weakness. Usually in lower extremities. Depressed deep tendon reflexes

  • strength improves with serial effort.
    tx: chemotheraphy is initial tx of choice!
31
Q

screening of lung cancer

-what size nodule is cancerous?

A

low dose noncontrast thin slice helical or spiral chest CT

nodules less than 5mm are unlikely to be cancerous

noduels 5-10mm in diameter are of uncertain significance.

32
Q

Characteristics of benign solitary pulmonary nodule?

Malignant?

Tx of solitary pulmonary nodule

A

Benign:
-younger patient, smooth edges, not growing, calcification, less than 5mm

Malignant:
-older pt, smoker, growing, rough edges, greater than 5mm

Tx:
-low probability of malignancy you should follow with serial CTs for at least 2 years

-high probability of malignancy you should get tissue/resect.

33
Q

A lesion larger than ____cm is almost always malignant?

A

-3

34
Q

Multiple Pulmonary Nodules

  • what size is usually malignant? Benign?
  • Nodule patterns
A
  • greater than 1 cm usually malignant
  • less than 5 mm usually benign, granulomas, lymph nodes, scars

Patterns:

  • nodular: multiple round opacities, usually 1mm to 1cm
  • reticular: overlapping, irregular linear opacities
  • reticulonodular: combines nodular and reticular effects.
35
Q

Dx and Work up of Lung Cancer

A
  • History and Physical
  • CXR
  • Labs: CBC, CMP
  • Possible tissue for histology
  • stage of cancer (CT, PET, Bone scan, MRI)
  • thoracentesis for plueral effusion
36
Q

When would you do a fine needle biopsy? How does this work? May have what complications?

A
  • peripheral lesions
  • 22gauge needle, image guidance via flouroscopy, CT, or ultrasound.

Complications:

  • pneumothorax
  • hemoptysis
37
Q

Staging Cancer

-TNM Classification

A

T (primary tumor, where and size)
N (regional lymph nodes metastasis)
M (distant metastasis)

38
Q

Staging Cancer:

  • Small cell lung cancer
  • tx
A
  • limited: confined to a single hemithorax; chemo & radiation
  • extensive:intrathoracic malignant pleural effusion or metastatic disease; chemo only.

*cranial spread is frequently seen, prophylactic radiation recommended.

39
Q

Non-small Cell lung cancer staging & tx for each stage

A
    1. confined to the lung; surgical resection, radiation or chemo
    1. lymph node involvement in lung; resection of tumor and lymph nodes, chemo and occasionally radiation.
    1. spread to mediastinal nodes.
      a. ) same side as tumor: radiation + chemo + ?resection
      b. ) wide spread in mediastinum; chemo + ? radiation
    1. other lobes or distal metastases; treated witch chemo
40
Q

nearly half of lung cancers have ______ involvement on dx.

A

mediastinal

41
Q

Mediastinoscopy is good at showing _____?

A

-may show spread into lymph nodes

42
Q

Cancer Tx Options

A
  • Surgery: resection of tumor and nearby lymph nodes. (Video Assisted thorascopic surgery)
  • Chemo
  • Radiation (high energy x-rays to destroy cancer cells)
  • Targeted: stops action of abnormal proteins that promote growth (Avastin; prevents new blood vessel growth, Tarceva: helps in NSCLC)
  • Adjuvnt: tx before/after surgery to decrease recurrence.
43
Q

Types of lung cancer surgeries

A
  • lobectomry or pneumonectomy

* used to be lateral thoracotomy now VATS!

Pulmonology 2 (8 decks)

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