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Clin Med - Pulmonary > Pulmonary Neoplasms > Flashcards

Pulmonary Neoplasms Flashcards

1
Q

Lung and bronchus cancer is the ____ cause of all new cancer cases in men and women (2017 estimates)?

A

2nd

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2
Q

Lung and bronchus cancer is the ______ cause of death in men and women (2017 estimates)?

A

leading

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3
Q

What are the major risk factors for lung cancer?

A

smoking (bet you knew that one)

2nd hand smoke

certain occupational exposures - asbestos is an important example

radiation

air pollution

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4
Q

Among cigarette smokers what factors determine risk of developing lung cancer?

A

of cigarettes smoked

years smoked

early age of smoking initiation

unfiltered or high tar cigarettes

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5
Q

What percentage of heavy smokers develop lung cancer?

A

11%

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6
Q

What are other (besides smoking) epidemiologic risks for lung cancer?

A

women > men

family history of early lung cancer (<60 2x risk)

HIV

recently, more non-smokers with certain mutations (EFGR, ALK) on the rise

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7
Q

What % of men and women who develop lung cancer are never smokers?

A

15% men

53% women

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8
Q

What are the WHO classifications of lung cancer?

A

small cell lung cancer (SCLC)

Non small cell lung cancer (NSCLC)

Unclassified/Undifferentiated

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9
Q

What are the sub-types of NSCLC?

A

Adenocarcinoma

squamous cell carcinoma

large cell carcinoma

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10
Q

What is the most common sub-type of lung cancer?

A

adenocarcinoma

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11
Q

What type of lung cancer are you most likely to see in a never smoker?

A

adenocarcinoma

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12
Q

Which lung cancer has a higher predilection for distant metastasis?

A

adenocarcinoma

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13
Q

What is a subtype of adenocarcinoma that is more often seen in female non-smokers?

A

Bronchoaveolar cell carcinoma (BAC)

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14
Q

What are the characteristics of BAC (bronchoalveolar cell carcinoma)?

A

slow growing with late matastases

may cause bronchorrhea

less likely to be PET +

staged and treated as an adenocarcinoma

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15
Q

What subtype of cancer is the most likely to cause paraneoplastic syndromes?

A

Squamous cell carcinoma

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16
Q

What is NSCLC has a 3-4% prevalence and is aggressive, with a poor prognosis?

A

Large cell cancer

(strongly associated with smoking)

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17
Q

What are some characteristics of SCLC (small cell lung cancer)

A

incidence is declining, largely due to reduced cigarette smoking

early metastatic dissemination with regional nodes

originates in major bronchi

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18
Q

What are the major symptoms of lung cancer?

A

dry cough

chest pain

dyspnea

infection

fever

hemoptysis

bronchial obstruction with wheezing

19
Q

If a tumor has intrathoracic extrapulmonary extension, what symptoms might you see?

A

chest pain

hoarseness

SVC obstruction

dysphagia

cardiac symptoms

20
Q

what are some systemic symptoms one might see with lung cancer (without metastasis)?

A

anorexia

weight loss

weakness

paraneoplastic syndromes

21
Q

What hormone is excreted by large cell carcinoma?

A

HCG (same as pregnancy)

22
Q

What are the major radiographic features of lung cancer on chest Xray?

A

hilar prominence

hilar or peri-hilar mass

localized air trapping

bronchial obstruction with atelectasis or consolidation

chest wall abnormality

mediastinal mass or widening

pleural effusion

elevation of hemidiaphragm

23
Q

What are the Mayo Clinic’s six independent predictors of a malignant solitary pulmonary nodule (SPN)?

A
  1. Patient Age
  2. Smoking Status
  3. History of extrathoracic malignancy
  4. nodule diameter
  5. nodule spiculation
  6. location in upper lobe
24
Q

What size SPN is correlated with a greater risk of malignancy?

A

6-10 mm (24%)

25
Q

What border types are correlated with a greater risk of malignancy for SPN?

A

spiculated (high risk)

corona radiata (very high risk)

26
Q

What patterns of calcification are correlated with a higher risk of malignancy for a SPN?

A

stippled and eccentric

27
Q

What should you do if the pre-test probability of cancer for a SPN is high (>60%)?

A

excisional biopsy with frozen section

28
Q

what should you do with a SPN with an intermediate (5-60%) chance of malignancy?

A

consider PET, bronchoscopy

29
Q

What should you do if the pre-test probability of cancer is low for SPN?

A

serial CT’s

30
Q

Wht is a common method for diagnosing lung cancer?

A

bronchoscopy

can add a brush or wash to try and reach spaces where the scope cannot go

31
Q

What is another common method of diagnosing lung cancer?

A

CT-guided FNA

*needle can cause pneumothorax or hemothorax

patient may require chest tube

32
Q

If there is a pleural effusion and suspected lung cancer, how might you make a diagnosis?

A

thoracentesis

*if negative after two taps and risk of malignancy is high, go to VATS or pleuroscopy

33
Q

if you suspect lung cancer, where might you look for metastasis?

A

supraclavicular nodes

liver lesions

adrenal englargement

34
Q

What characterizes a T3 tumor?

A

large 5-7cm

invades something other than the lung

or have a second tumor in the same lobe

35
Q

What are the characteristics of a T4 tumor?

A

> 7 cm

invade something that surgeons can’t (or don’t want to) remove

or

get a second tumor in the ipsilateral lung in different lobe

36
Q

What does the N component of tumor staging tell you in lung cancer?

A

N0 = no adenopathy

N1= intrapulmonary or hilar adenopathy

N2 = ipsilateral mediastinal adenopathy

N3=contralateral or supraclavicular adenopathy

37
Q

What does the M component of lung tumor staging reflect?

A

M1a=contralateral nodules or pleural dissemination

M1b=single metastasis in a single organ

M1c = multiple metastases in a single organ or in several organs

38
Q

What stage cancers are generally considered resectable?

A

I or II

rarely, III

39
Q

What are contraindications to lung tumor resection?

A

FEV1<40%

predicted post-op FEV1<30%

very low DLCO

40
Q

What is the epidemiology for mesothelioma?

A

asbsestos expsoure (30-35 years after exposure)

50-70 years of age

male:female is 5:1

median survival less than 12 months from diagnosis

41
Q

what is the epidemiology of carcinoid tumors?

A

rare (1-2%)

neuroendocrine tumor from Kulchitsky cells in bronchial epithelium

typically better prognosis

NOT smoking related

2x in females

patients < 40 years

42
Q

What percentage of lung cancer pts. have mets?

A

20-50%

43
Q

What is a pancoast tumor?

A

tumor in the apex of the lung that may invade contiguous structures

in particular, brachial plexus with pain down the medial aspect of the arm

can have Horner’s syndrome (unilateral ptosis, miosis, ipsilateral anhydrosis)

44
Q

What is the newest advancement in lung cancer treatment?

A

immunotherapy PD-L1 blocks T-cell activity. If you inhibit tumor PD-L1 interaction with PD-1 on T cells, you can allow the T-cells to attack the tumor

Clin Med - Pulmonary (13 decks)

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