Pulmonary Neoplasms Flashcards
Lung and bronchus cancer is the ____ cause of all new cancer cases in men and women (2017 estimates)?
2nd
Lung and bronchus cancer is the ______ cause of death in men and women (2017 estimates)?
leading
What are the major risk factors for lung cancer?
smoking (bet you knew that one)
2nd hand smoke
certain occupational exposures - asbestos is an important example
radiation
air pollution
Among cigarette smokers what factors determine risk of developing lung cancer?
of cigarettes smoked
years smoked
early age of smoking initiation
unfiltered or high tar cigarettes
What percentage of heavy smokers develop lung cancer?
11%
What are other (besides smoking) epidemiologic risks for lung cancer?
women > men
family history of early lung cancer (<60 2x risk)
HIV
recently, more non-smokers with certain mutations (EFGR, ALK) on the rise
What % of men and women who develop lung cancer are never smokers?
15% men
53% women
What are the WHO classifications of lung cancer?
small cell lung cancer (SCLC)
Non small cell lung cancer (NSCLC)
Unclassified/Undifferentiated
What are the sub-types of NSCLC?
Adenocarcinoma
squamous cell carcinoma
large cell carcinoma
What is the most common sub-type of lung cancer?
adenocarcinoma
What type of lung cancer are you most likely to see in a never smoker?
adenocarcinoma
Which lung cancer has a higher predilection for distant metastasis?
adenocarcinoma
What is a subtype of adenocarcinoma that is more often seen in female non-smokers?
Bronchoaveolar cell carcinoma (BAC)
What are the characteristics of BAC (bronchoalveolar cell carcinoma)?
slow growing with late matastases
may cause bronchorrhea
less likely to be PET +
staged and treated as an adenocarcinoma
What subtype of cancer is the most likely to cause paraneoplastic syndromes?
Squamous cell carcinoma
What is NSCLC has a 3-4% prevalence and is aggressive, with a poor prognosis?
Large cell cancer
(strongly associated with smoking)
What are some characteristics of SCLC (small cell lung cancer)
incidence is declining, largely due to reduced cigarette smoking
early metastatic dissemination with regional nodes
originates in major bronchi
What are the major symptoms of lung cancer?
dry cough
chest pain
dyspnea
infection
fever
hemoptysis
bronchial obstruction with wheezing
If a tumor has intrathoracic extrapulmonary extension, what symptoms might you see?
chest pain
hoarseness
SVC obstruction
dysphagia
cardiac symptoms
what are some systemic symptoms one might see with lung cancer (without metastasis)?
anorexia
weight loss
weakness
paraneoplastic syndromes
What hormone is excreted by large cell carcinoma?
HCG (same as pregnancy)
What are the major radiographic features of lung cancer on chest Xray?
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
What are the Mayo Clinic’s six independent predictors of a malignant solitary pulmonary nodule (SPN)?
- Patient Age
- Smoking Status
- History of extrathoracic malignancy
- nodule diameter
- nodule spiculation
- location in upper lobe
What size SPN is correlated with a greater risk of malignancy?
6-10 mm (24%)
What border types are correlated with a greater risk of malignancy for SPN?
spiculated (high risk)
corona radiata (very high risk)
What patterns of calcification are correlated with a higher risk of malignancy for a SPN?
stippled and eccentric
What should you do if the pre-test probability of cancer for a SPN is high (>60%)?
excisional biopsy with frozen section
what should you do with a SPN with an intermediate (5-60%) chance of malignancy?
consider PET, bronchoscopy
What should you do if the pre-test probability of cancer is low for SPN?
serial CT’s
Wht is a common method for diagnosing lung cancer?
bronchoscopy
can add a brush or wash to try and reach spaces where the scope cannot go
What is another common method of diagnosing lung cancer?
CT-guided FNA
*needle can cause pneumothorax or hemothorax
patient may require chest tube
If there is a pleural effusion and suspected lung cancer, how might you make a diagnosis?
thoracentesis
*if negative after two taps and risk of malignancy is high, go to VATS or pleuroscopy
if you suspect lung cancer, where might you look for metastasis?
supraclavicular nodes
liver lesions
adrenal englargement
What characterizes a T3 tumor?
large 5-7cm
invades something other than the lung
or have a second tumor in the same lobe
What are the characteristics of a T4 tumor?
> 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
What does the N component of tumor staging tell you in lung cancer?
N0 = no adenopathy
N1= intrapulmonary or hilar adenopathy
N2 = ipsilateral mediastinal adenopathy
N3=contralateral or supraclavicular adenopathy
What does the M component of lung tumor staging reflect?
M1a=contralateral nodules or pleural dissemination
M1b=single metastasis in a single organ
M1c = multiple metastases in a single organ or in several organs
What stage cancers are generally considered resectable?
I or II
rarely, III
What are contraindications to lung tumor resection?
FEV1<40%
predicted post-op FEV1<30%
very low DLCO
What is the epidemiology for mesothelioma?
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
what is the epidemiology of carcinoid tumors?
rare (1-2%)
neuroendocrine tumor from Kulchitsky cells in bronchial epithelium
typically better prognosis
NOT smoking related
2x in females
patients < 40 years
What percentage of lung cancer pts. have mets?
20-50%
What is a pancoast tumor?
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)
What is the newest advancement in lung cancer treatment?
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
