Pulmonary Neoplasms

Question 1

What is a Pulmonary Nodule​?

Answer 1

• A lesion that is both within and surrounded by pulmonary parenchyma. (also called ‘coin’ lesion)​
• Less than 3 cm in size and not associated with atelectasis or lymphadenopathy.​

Question 2

What are the disadvantages of Chest X-Ray-PA/Lateral?

Answer 2

-Can miss small nodules​

Question 3

What is a PET/CT​? What is the sensitivity/specificity? Wht is it used for?

Answer 3

• Positron Emission Tomography​
• FDG – Fluorodeoxyglucose​
• PET-CT scans have a 95% sensitivity, but a lesser specificity of only 81%.​
• Can be used for diagnosis, staging, and monitoring treatment of cancers.​

Question 4

What is the significance of size of lesions on Radiograph?

Answer 4

Larger lesions are more likely to be malignant than smaller lesions.​

Question 5

What are the radiographic features of a malignant pulmonary nodule compared to benign nodule?

Answer 5

Malignant lesions will have a more irregular or spiculated border. Benign lesions will have a smooth and discrete border.​

Question 6

What is the expected rate of growth of a malignant pulmonary lesion?

Answer 6

-Lesions that are malignant tend to have an interval increase in size between 4-6 months. Therefore, nodules that grow very rapidly are more likely benign.​

Question 7

What’s the most common Pathology​ of Lung Cancer?

Answer 7

• 90% of all epithelial lung cancers are comprised of adenocarcinoma (most common overall), squamous cell carcinoma, large cell carcinoma and small cell carcinoma.​
• The remaining 10% include undifferentiated carcinomas, carcinoid, and rarer tumor types.​

Question 8

What is Large Cell Carcinoma​?

Answer 8

• Malignant epithelial neoplasm lacking glandular or squamous differentiation.​
• Usually a diagnosis of exclusion, to include all poorly differentiated NSCLCa that are not further classifiable.​
• Usually presents as large peripheral mass with prominent necrosis.​

Question 9

What type of lung cancer is most common in non-smoker (1) vs smoker (2)

Answer 9

Adenocarcinoma-Most common type of lung cancer, especially in never smokers.​
Squamous cell and NSCLC are most common in smokers

Question 10

What are the Clinical Presentations of lung cancer? (name 3)

Answer 10

• Cough (dry or productive)​
• Dyspnea​
• Hemoptysis​
• Recurrent pneumonias​
• Weight loss (unexplained)​
• Chest pain​

Question 11

What are the Signs and Symptoms of a more extensive disease of lung cancer? (name 3)

Answer 11

• Bone pain​
• Dysphagia​
• Hoarseness​
• Neurologic abnormalities (HA, syncope, cognitive impairment)​
• Horner’s Syndrome (ptosis, anhidrosis, miosis)​
• Superior vena cava syndrome​

Question 12

How is lung cancer Diagnosed?

Answer 12

• CT guided needle biopsy​
• Bronchoscopy +/- Lavage​
• Endobronchial Ultrasound biopsy (EBUS)​
• Video-assisted Thoracoscopic Surgery (VATs) biopsy​
• Thoracentesis

Question 13

What is Lung Cancer Staging of TNM?

Answer 13

-Staging is the assessment of the extent of tumor in a particular patient.​
Local (T = tumor)​
Regional (N = nodes)​
Distant (M = Metastasis)​
-It allows the grouping of patient with similar disease for prognostic, analytic and therapeutic purposes.​

Question 14

What is the metastatic work when lung cancer tends to spread?

Answer 14

-Lung cancers tend to spread via three main routes:​
Blood​
Lymphatics​
Direct Invasion​

Question 15

What is the metastatic work when lung cancer commonly metastasize?

Answer 15

-Lung cancers commonly metastasize to these areas:​
Brain​
Bone​
Liver​
Adrenal glands

Question 16

What is Carcinoid Tumor?​

Answer 16

• Comprise 1-2% of all lung malignancies.​
• Characterized by neuroendocrine differentiation and relatively indolent clinical behavior.​
• They are made up of peptide and amine producing cells.​
• They can arise at a number of sites throughout the body: GI tract, Thymus, lung, and ovaries.​
• They are the most common primary lung neoplasm in children.​

Question 17

Carcinoid Tumor is comprised of what two main cell types?

Answer 17

• Typical carcinoid have an excellent prognosis and are about 4 x more common than atypical.​
• Atypical carcinoid have a greater tendency to metastasize​

Question 18

Treatment​ for Carcinoid Tumor?

Answer 18

• En bloc surgical resection is the treatment of choice.​
• For patients that are not surgical candidates, intraluminal, bronchoscopic resection may be an alternative as well as radiation therapy.​
• For metastatic carcinoid, the role of chemotherapy and radiation therapy is limited.​

Question 19

What is Pancoast Tumor?​

Answer 19

• Also known as superior sulcus tumors as they are located in the pulmonary apex, adjacent to the subclavian vessels.​
• Given its location, they typically spread to the ribs, vertebrae, subclavian vessels, and brachial plexus.​
• Can also involve the recurrent laryngeal nerve, vagus nerve, and sympathetic ganglion.

Question 20

What is the Pathology of Pancoast Tumor?​

Answer 20

• A majority of these tumors are squamous cell carcinomas.​
• However, studies have shown that adenocarcinomas, small cell carcinomas, mesothelioma, lymphomas can all arise in this area.​
• Therefore, a histologic diagnosis is mandatory prior to definitive treatment.​

Question 21

What are Clinical Presentation’s of Pancoast Tumor?​

Answer 21

• Shoulder pain 44-96%​
• Horner’s Syndrome 14-50%​
  
  • Miosis (Constriction of pupils)​
  • Enophthalmos (sunken eyes)​
  • Anhidrosis (lack of sweating)​
  • Ptosis (drooping of the eyelid)​

Question 22

What are the Cancers that spread to the lungs?

Answer 22

-Malignant melanoma​
-Sarcomas​
-Carcinomas of the:​
Breast​
Kidney​
Bladder​
Colon​
Prostate​