Pulmonary Neoplastic Deck Flashcards by Sarah Moore

What conditions are included in pulmonary neoplastic disease?

Bronchogenic Carcinoma
Solitary pulmonary nodule
Carcinoid tumors

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What is the epidemiolgy of Bronchogenic Carcinoma?

Second most common cause of cancer in men and women

Overall 5 year survival rate is 15%

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What types of cancer are included in Bronchogenic carcinoma?

Divided into 2 categories based on staging and treatment options:
A. Small Cell Lung Cancer (SCLC)
B. Non-SCLC (NSCLC)

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What are the characteristics of small cell lung cancer?

More likely to spread early in disease
Rarely amenable to surgery
Mean survival 6-18 weeks
Poor prognosis

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What are the characteristics of non small cell lung cancer?

Grows slower with ‘better’ prognosis

A. Depends on cytology & timing of diagnosis

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What is the pathophys of bronchogenic cancer?

Lung cancer commonly results from repeated tissue trauma from inhalation of irritants or carcinogens

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Where in the lungs do most cancers originate?

Almost all lung cancers begin in epithelial cells of lungs
A. In normal lungs, epithelium lines and protects tissue below it
B. When exposed to carcinogens, epithelium constantly replaces itself until cells develop chromosomal changes and become dysplastic

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What are the 3 types of Non small cell lung cancer?

Squamous Cell Carcinoma (SCC)
Adenocarcinoma
Large cell carcinoma

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What is the percentage of Squamous Cell CA in all lung cancer cases?

Represents 25-35% of lung cancer cases

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Where does squamous cell carcinoma originate? Where does it go?

Originates in central bronchi and metastasizes to regional lymph nodes
Prone to early mets with aggressive course

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What are the sxs of squamous cell carcinoma?

Cough
Hemoptysis
Later sxs:
Chest Pain
Weight loss
Dyspnea
Usually Hx of smoking

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What are the CXR results in Squamous cell carcinoma?

Hilar masses
Peripheral masses
Atelectasis: precursor to pneumonia
Infiltrates
Pleural Effusion

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What are the histologic diagnoses in Squamous cell carcinoma?

Sputum cytology
Bronchoscopy
Pleural fluid analysis
Tissue biopsy

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What is the treatment of choice for squamous cell carcinoma? What is the 5 yr survival rate?

Surgery
Treatment of choice
5 year survival rate after resection is 35-40%
Only if mets no present

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What are the other treatment options in squamous cell carcinoma?

Radiation Therapy

Chemotherapy

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What is the most common type of bronchogenic carcinoma?

Adenocarcinoma

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What is the percentage of adenocarcinoma in all lung cancer cases?

35-40%

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True/false: adenocarcinoma typically does not metastasize.

Typically metastasize to distant organs

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What is the pathophys of adenocarcinoma?

Tumors arise from mucus glands

Most located in periphery of lung
Few tumors are bronchoalveolar

Not amenable to early detection through sputum analysis

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What are the sxs of adenocarcinoma?

Cough
Lymphadenopathy
Hepatomegaly
Weight loss
Hx smoking

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What are the CXR results in adenocarcinoma?

CXR (PA & Lat)

Reveal small peripheral masses

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What are the Carcinoembryonic antigen results in adenocarcinoma?

Positive, but not diagnostic

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How is adenocarcinoma treated?

Disease often metastatic when diagnosed
Symptomatic lung cancer is usually advanced
A. Usually not amenable to surgery
If amenable to surgery, bronchoalveolar tumor has most favorable prognosis

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How is adenocarcinoma diagnosed?

Cytology from a biopsy

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What is the time frame between development of adenocarcinoma and presentation of sxs?

Interval between development of lung cancer and clinical presentation of disease estimated at 5-10 years

Define large cell carcinoma?

1. Heterogenous group of undifferentiated types that do not fit elsewhere

What is the percentage of large cell carcinoma in all lung cancer cases?

3-5% of lung cancers

What are the characteristics of large cell carcinoma?

1. Cytology usually reveals large cells 2. May be central or peripheral masses 3. Tends to grow and spread quickly in comparison to other NSCLC

What percentage of all lung cancers is small cell carcinoma?

10-15% of lung cancers

True/false: small cell carcinoma is the most aggressive cancer.

1. Most aggressive type 2. Small cells that metastasize early Lymphatic and hematogenous spread

What is the pathophys of small cell carcinoma?

1. Tumor of bronchial origin that usually begins centrally, causing narrowing or obstruction of bronchus 2. Hilar & mediastinal abnormalities are common

What are the sxs of small cell carcinoma?

1. Anorexia 2. Weight loss 3. New cough or change in chronic cough 4. +/- hemoptysis 5. +/- atelectasis 6. Significant polyuria 7. Syndrome of Inappropriate ADH (SIADH) A. 10-15% of pts with SCLC can develop this syndrome B. Paraneoplastic syndrome

What are the most important sxs of small cell carcinoma?

1. Significant polyuria 2. Syndrome of Inappropriate ADH (SIADH) A. 10-15% of pts with SCLC can develop this syndrome B. Paraneoplastic syndrome

What are the paraneoplastic syndromes in small cell carcinoma?

Incompletely understood patterns of organ dysfunction related to immune mediated or secretory effects of tumor

What systems are included in paraneoplastic syndromes?

``` Endocrine Neuromuscular Cardiovascular Hematologic Cutaneous ```

What are the CXR results in small cell carcinoma?

Hilar adenopathy and mediastinal widening

What is the treatment of small cell carcinoma?

1. Combination chemotherapy | A. 2 year survival rate is 20-40% in limited diseases and < 5% in extensive disease

What are the complications for bronchogenic carcinoma?

1. SVC Syndrome A. Compression SVC: plethora (↑ body fluid), H/A, mental status changes 2. Pancoast Tumor A. Tumor of lung apex: causes Horner’s Syndrome & shoulder pain 3. Horner's syndrome A. Unilateral facial anhidrosis, ptosis, miosis 4. Endocrine A. Carcinoid tumor: flushing, diarrhea, telangiectasias 5. Recurrent Laryngeal Nerve A. Hoarseness 6. Effusions A. Exudative

What is the neumontic for bronchogenic carcinomas?

SPHERE

What is the most common primary tumor of the small bowel and appendix?

Carcinoid tumor

What are the characteristics of carcinoid tumors?

Considered low grade malignant neoplasms Grow slowly and rarely metastasize

What hormones are activated in carcinoid tumors?

``` Neuroendocrine tumors producing a variety of biologically active peptides and hormones Serotonin Adrenocorticotropin hormone (ACTH) Antidiuretic hormone (ADH) Melanocyte-stimulating hormone (MSH) ```

What are the serum results for carcinoid tumors?

``` Serotonin (5-HT) ACTH ADH Chromogranin A (CgA) Glycoprotein ```

What are the urine results in carcinoid cancer?

5-HIAA | Serotonin metabolite

What are the tumor markers in carcinoid cancer?

Serum and urine

What are the sxs of carcinoid cancer?

``` Often asymptomatic Tachycardia Flushing Bronchoconstriction Hemodynamic instability Diarrhea Acidosis ```

What is the prevalence of bronchial carcinoid tumors?

Bronchopulmonary carcinoid ≈ 10% of all carcinoid tumors

What percentage of all lung cancers are carcinoid tumors?

1-6% of lung tumors are carcinoid tumors

What are the complications of bronchial carcinoid tumors?

``` Bronchial obstruction Atelectasis Recurrent pneumonia Pulmonary abscess Bronchiectasis Bleeding SIADH < common than in SCLC Cushing Syndrome Hypoglycemia ```

What is the treatment of bronchial carcinoid tumors?

Surgical resection

What are the characteristics of solitary pulmonary nodules?

1. Coin lesions A. < 5 cm in diameter, round or oval, & sharply circumscribed 2. Most are infectious granulomas A. Old or active TB B. Fungal infection

What percentage of solitary pulmonary nodules are malignant?

40%

Who is at a risk of malignant nodules?

Smokers

What are the sxs of solitary pulmonary nodules?

1. Most are asymptomatic | 2. Nodules are found incidentally on CXR

What are the cxr results in solitary pulmonary nodules?

Round or oval, well circumscribed lesion | Solid vs Subsolid

What study is indicated after cxr in solitary pulmonary nodules?

CT scan

How are high suspicion for solitary pulmonary nodule pts managed?

thoracic sugeon

How are indeterminate suspicion for solitary pulmonary nodule pts managed?

PET scan

How are low suspicion for solitary pulmonary nodule pts managed?

Low suspicion → CT q 6 mo x 2-3 yrs

When is a solitary pulmonary nodule most likely benign?

Solid nodule that has been stable for two yr | Subsolid nodule that is stable for three yr