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Foundations II (Cholley) > Pulmonary neoplasms > Flashcards

Pulmonary neoplasms Flashcards

1
Q

Characteristics of SPN

A
  • Well circumscribed
  • Isolated
  • Round opacity
  • Surrounded by normal lung
  • ≤ 3 cm
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2
Q

What are the most common causes of SPN?

A
  • Bronchogenic carcinoma
  • Metastatic lesion
  • Granuloma
  • Calcification
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3
Q

What is the clinical presentation of SPN?

A

Usually asx

Found incidentally on CXR

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4
Q

What are RFs for SPN?

A
  • Older age
  • Smoking
  • Recent travel
  • Recreational activities
  • Occupational
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5
Q

How do you evaluate imaging for SPN?

A

Compare to old films, looking for rate of growth

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6
Q

What can be seen on CXR?

A
  • Cavitation
  • Calcification (dense calcification = benign, less calcification = malignancy)
  • Hamartoma = “popcorn”
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7
Q

What are concerning features for malignancy on CT?

A
  • Spiculated margins
  • Peripheral halo
  • Density
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8
Q

What type of people are considered low risk for malignancy?

A
  • Age < 30
  • Stable lesion ≥ 2 years
  • Benign calcification pattern
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9
Q

SPN: How do you manage low risk pts?

A

Watchful waiting

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10
Q

SPN: How do you manage intermediate risk pts?

A
  • Biopsy

- PET

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11
Q

SPN: How do you manage high risk pts?

A

Resection

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12
Q

What are the most common types of lung CA?

A
  • Adenocarcinoma

- Squamous cell carcinoma

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13
Q

What are the 2 main groups of lung CA?

A
  1. Non-small cell

2. Small cell

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14
Q

What are RFs for lung CA?

A
  • Tobacco smoke #1
  • Exposure to radon, asbestos, or other carcinogens
  • Pollution
  • Arsenic drinking H2O
  • Previous radiation to chest
  • Personal or family hx
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15
Q

What group of cancer is most common?

A

Non-small cell

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16
Q

What categories does non-small cell cancer include?

A
  • Adenocarcinoma (most common)
  • Adenosquamous
  • Squamous cell
  • Large cell
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17
Q

What are characteristics of adenocarcinoma?

A
  • Associated w/ smoking, but most common type in non-smokers
  • Mucus gland origin
  • Located peripherally
  • Slow growing
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18
Q

What are characteristics of squamous cell?

A
  • Bronchial epithelium origin
  • Associated w/ hypercalcemia
  • Metastasize later on
  • Central necrosis
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19
Q

What are characteristics of large cell?

A
  • Agressive, rapid

- Peripheral w/ prominent necrosis (but can be central)

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20
Q

What are characteristics of small cell?

A
  • Bronchial origin
  • Begin centrally, infiltrate submucosally –> narrowing of bronchus
  • Aggressive, poor px
  • Distant metastasis at time of dx
21
Q

Describe bronchial carcinoid tumors

A

Pedunculated or sessile growths in central bronchi

22
Q

What are bronchial carcinoid tumors derived from?

A

Neuroendocrine cells

23
Q

What is the clinical presentation of bronchial carcinoid tumors?

A
  • Hemoptysis, cough, focal wheezing, recurrent pneumonia

- Grow slowly & rarely metastasize

24
Q

What sx indicate carcinoid syndrome?

A

Flushing, diarrhea, wheezing, hypotension

25
What imaging is used for bronchial carcinoid tumors?
- CXR - CT - Octeotide scintigraphy
26
What is definitive dx of bronchial carcinoid tumors?
Biopsy
27
How do you tx bronchial carcinoid tumors?
Excision w/ mediastinal lymph node sampling
28
What are 2 complications of bronchial carcinoid tumors?
- Bleeding | - Airway obstruction
29
What are characteristics/sx of superior vena cava syndrome?
- Most common SCLC - Bulky upper lobe tumor - Fullness in head - Dyspnea
30
What are PE findings in SVC syndrome?
- JVD - Facial edema - Plethoric appearance
31
What do you see on CXR in SVC syndrome?
- Widening of mediastinum | - R hilar mass
32
What are characteristics/sx of Pancoast syndrome?
- Common in squamous NSCLC - Shoulder pain - Horner's syndrome
33
What labs can you use to dx lung CA?
- CBC - Electrolytes - Ca2+ - Creatinine - Liver - LDH - Albumin
34
What imaging can you use to dx lung CA?
- CXR - CT scan - PET - CT-PET combined - MRI brain
35
What other tests can you use to dx lung CA?
- Sputum - FNA or cytology - Biopsy - Spirometry
36
What system do oncologists use to stage cancer?
TNM staging
37
How do you tx early stage pts w/ NSCLC?
- Resection w/ MLN eval - Standard therapy for 1a & 1b - Consult oncology
38
How do you tx nonsurgical candidates for NSCLC?
- Chemoradiation | - Stereotactic radiation
39
How do you classify SCLC?
- Limited: up to unilateral hemithorax | - Extensive: beyond hemothorax
40
How do you tx limited vs extensive SCLC?
- Limited: chemo & radiation | - Extensive: chemo alone
41
What are side effects of chemo?
- N/V, anorexia, wt loss - Fatigue - Hematologic - Nephrotoxicity - Neurotoxicity - Rash - Visual disturbances
42
What are complications of lung CA?
- Pancoast - Horner - Recurrent laryngeal nerve compression - Pleural effusion - SVC syndrome - Endocrine dz (carcinoid syndrome)
43
How do you continue to monitor pts who were treated for lung CA?
- H&P, chest CT every 6 mos for 2 yrs. Annual thereafter | - Annual LDCT ≥ 5 years
44
What are complications that can be seen after tx for lung CA?
- Chronic pain, dyspnea, fatigue, impaired sleep, sexual dysfunction - Chemotherapy sequelae - Radiation sequelae
45
Describe: mesothelioma. What is it linked to?
Primary tumor arising from surface lining of pleura | - Linked to asbestos
46
What are clinical findings of mesotheliomas?
- Insidious onset SOB - Nonpleuritic CP - Wt loss - Dullness to percussion - Diminished breath sounds - Clubbing
47
How do you evaluate mesotheliomas?
- Pleural fluid: exudative, hemorrhagic - Cytology - VATS biopsy - Imaging (CT, PET-CT): unilateral thickening & pleural effusion
48
How do you tx mesotheliomas?
Chemo
49
What are USPSTF guidelines regarding lung CA screening?
Annual LDCT screening in: - Age 55-74: current/former smoker w/ ≥ 30-pack-yr hx

Foundations II (Cholley) (25 decks)

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