Pulmonary Neoplasms Flashcards
Solitary pulmonary nodule definition
- Well-circumscribed
- Isolated
- Round opacity
- Completely surrounded by normal lung
- Not associated with infiltrate, atelectasis or adenopathy
- ≤ 3 cm
Most common SPN etiology
- Bronchogenic carcinoma
- Metastatic lesion
- Infectious granuloma
- Histoplasmosis
- Coccidioidomycosis
- Tuberculosis
- Other fungal - Calcification
Solitary pulmonary nodule clinical presentation
- Usually asymptomatic
2. Found incidentally on CXR
What increases the risk of a SPN being cancerous?
Increasing age
What does cavitation with thick walls (>16 mm) findings on a CXR indicate?
Higher change of malignancy
What does dense calcification indicate on a CXR? Less calcification?
Benign = dense calcification -(central or laminated pattern) Malignant = less calcification (stippled or eccentric pattern)
CT concerning features for malignancy
- Spiculated margins
- Peripheral halo
- Density on CT scan
Harmartoma
“popcorn calcification” on CXR= Benign
What is low risk assessment of SPN?
- Age < 30
- Stable lesion x ≥ 2 years
- Characteristic benign calcification pattern
Management of low risk SPN
- Watchful waiting
- Serial imaging (CXR or CT)
Management of intermediate risk SPN
- Diagnostic biopsy (transthoracic needle aspiration or bronchoscopy)
- PET
Management of high risk SPN
Resection
Lung cancer definition
Malignant neoplasm of the lung arising from respiratory epithelium:
- Bronchi
- Bronchioles
- Alveoli
What are the two main groupings of lung cancer
- Non–small cell lung cancer (NSCLC) = most common (80-85%)
2. Small cell lung cancer (SCLC)
What are the two most common types of lung cancer?
- Adenocarcinoma
2. Squamous cell carcinoma
what is the greatest risk factor for lung cancer? how many lung cancers does the compose of?
Tobacco smoke
=about 80% of lung cancers
Duration and quantity increase risk
What cancer is least associated with lung cancer
Adenocarcinoma
Location of adenocarcinomas
Peripheral nodules or masses
Squamous cell carcinoma location
Arise from the bronchial epithelium–>centrally located, large airways
What cancer tends to metastasize later?
Squamous cell carcinoma
Large cell carcinoma characteristic
Usually a large, peripheral mass with prominent necrosis
Small cell carcinoma location
Centrally
Small cell carcinoma survival
6-18 weeks
Regional or distant metastasis @ time of dx
Bronchial carcinoid tumors
Pedunculated or sessile growths in central bronchi
What cells are Bronchial carcinoid tumors derived from?
neuroendocrine cells
Bronchial carcinoid tumors clinical presentation
- Hemoptysis
- Cough
- Focal wheezing
- Recurrent pneumonia
- Peripherally located: asymptomatic SPNs
Carcinoid syndrome
- Flushing
- Diarrhea
- Wheezing
- Hypotension
* rare
What are the most common signs/sx’s of lung cancer?
- Cough
- Hemoptysis
- Dyspnea
- Pain
Superior vena cava syndrome sx’s
- Bulky upper lobe tumor
- Sensation of fullness in the head
- Dyspnea
Superior vena cava syndrome PEx’s
Dilated neck veins
Facial edema
Plethoric appearance
Superior vena cava syndrome CXR findings
Widening of mediastinum
R hilar mass
What lung cancer is Superior vena cava syndrome most common in?
Small cell carcinoma
Pancoast syndrome
Shoulder pain
Horner’s syndrome: Ptosis, Miotic (constricted pupil)
What cancer is Pancoast syndrome most common in?
non-small cell carcinoma
What are the 4 most common extrathoracic metastases
- Liver
- Bone-Use. vertebral bodies
- Adrenal-usu. asymptomatic
- Brain
Paraneoplastic syndromes / Extrathoracic effects definition
- Effects of tumor that are not related to direct invasion, obstruction, or metastasis
- Common in small cell carcinoma and squamous cell
Lung cancer diagnosis
Tissue biopsy
Define limited small cell carcinoma staging
Disease limited to the unilateral hemithorax
Define extensive small cell carcinoma staging
Tumor extends beyond the hemothorax
limited small cell carcinoma treatment
chemo & radiation
extensive small cell carcinoma treatment
chemo alone as initial treatment
How often should pt’s receive a chest CT post-treatment?
every 6 months x 2 years, and then annually
Chemotherapy sequelae
- Neuropathy
- Hearing loss
- Neurocognitive changes
Radiation sequelae
- Skin changes
- Radiation pneumonitis
- Esophagitis
- Cardiovascular disease
Mesothelioma definition
Primary tumor arising from the surface lining of the pleura=80% of cases
What is Mesothelioma linked to?
asbestos exposure!!
How long is the latent period of Mesothelioma
20-40 years
Mesothelioma treatment
Chemotherapy
What is the 5-yr survival rate of mesothelioma?
10%
Poor prognosis
What is the gold standard for mediastinal staging?
Mediastinoscopy
For advanced stages of lung cancer, what imaging do you want to use?
Bone scan and brain imaging
What is the most common site of non-small cell lung cancer mets?
Brain
