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Gen Med Unit 6 > Pulmonary Neoplastic Deck > Flashcards

Pulmonary Neoplastic Deck Flashcards

1
Q

What conditions are included in pulmonary neoplastic disease?

A

Bronchogenic Carcinoma
Solitary pulmonary nodule
Carcinoid tumors

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2
Q

What is the epidemiolgy of Bronchogenic Carcinoma?

A

Second most common cause of cancer in men and women

Overall 5 year survival rate is 15%

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3
Q

What types of cancer are included in Bronchogenic carcinoma?

A
  1. Divided into 2 categories based on staging and treatment options:
    A. Small Cell Lung Cancer (SCLC)
    B. Non-SCLC (NSCLC)
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4
Q

What are the characteristics of small cell lung cancer?

A

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

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5
Q

What are the characteristics of non small cell lung cancer?

A
  1. Grows slower with ‘better’ prognosis

A. Depends on cytology & timing of diagnosis

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6
Q

What is the pathophys of bronchogenic cancer?

A

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

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7
Q

Where in the lungs do most cancers originate?

A
  1. 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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8
Q

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

A

Squamous Cell Carcinoma (SCC)
Adenocarcinoma
Large cell carcinoma

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9
Q

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

A

Represents 25-35% of lung cancer cases

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10
Q

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

A
  1. Originates in central bronchi and metastasizes to regional lymph nodes
  2. Prone to early mets with aggressive course
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11
Q

What are the sxs of squamous cell carcinoma?

A
  1. Cough
  2. Hemoptysis
    Later sxs:
  3. Chest Pain
  4. Weight loss
  5. Dyspnea
  6. Usually Hx of smoking
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12
Q

What are the CXR results in Squamous cell carcinoma?

A
  1. Hilar masses
  2. Peripheral masses
  3. Atelectasis: precursor to pneumonia
  4. Infiltrates
  5. Pleural Effusion
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13
Q

What are the histologic diagnoses in Squamous cell carcinoma?

A
  1. Sputum cytology
  2. Bronchoscopy
  3. Pleural fluid analysis
  4. Tissue biopsy
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14
Q

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

A

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

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15
Q

What are the other treatment options in squamous cell carcinoma?

A

Radiation Therapy

Chemotherapy

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16
Q

What is the most common type of bronchogenic carcinoma?

A

Adenocarcinoma

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17
Q

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

A

35-40%

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18
Q

True/false: adenocarcinoma typically does not metastasize.

A

Typically metastasize to distant organs

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19
Q

What is the pathophys of adenocarcinoma?

A

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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20
Q

What are the sxs of adenocarcinoma?

A
  1. Cough
  2. Lymphadenopathy
  3. Hepatomegaly
  4. Weight loss
  5. Hx smoking
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21
Q

What are the CXR results in adenocarcinoma?

A

CXR (PA & Lat)

Reveal small peripheral masses

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22
Q

What are the Carcinoembryonic antigen results in adenocarcinoma?

A

Positive, but not diagnostic

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23
Q

How is adenocarcinoma treated?

A
  1. Disease often metastatic when diagnosed
  2. Symptomatic lung cancer is usually advanced
    A. Usually not amenable to surgery
  3. If amenable to surgery, bronchoalveolar tumor has most favorable prognosis
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24
Q

How is adenocarcinoma diagnosed?

A

Cytology from a biopsy

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25
Q

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

A

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

26
Q

Define large cell carcinoma?

A
  1. Heterogenous group of undifferentiated types that do not fit elsewhere
27
Q

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

A

3-5% of lung cancers

28
Q

What are the characteristics of large cell carcinoma?

A
  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
29
Q

What percentage of all lung cancers is small cell carcinoma?

A

10-15% of lung cancers

30
Q

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

A
  1. Most aggressive type
  2. Small cells that metastasize early
    Lymphatic and hematogenous spread
31
Q

What is the pathophys of small cell carcinoma?

A
  1. Tumor of bronchial origin that usually begins centrally, causing narrowing or obstruction of bronchus
  2. Hilar & mediastinal abnormalities are common
32
Q

What are the sxs of small cell carcinoma?

A
  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
33
Q

What are the most important sxs of small cell carcinoma?

A
  1. Significant polyuria
  2. Syndrome of Inappropriate ADH (SIADH)
    A. 10-15% of pts with SCLC can develop this syndrome
    B. Paraneoplastic syndrome
34
Q

What are the paraneoplastic syndromes in small cell carcinoma?

A

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

35
Q

What systems are included in paraneoplastic syndromes?

A 
Endocrine
Neuromuscular
Cardiovascular
Hematologic
Cutaneous
36
Q

What are the CXR results in small cell carcinoma?

A

Hilar adenopathy and mediastinal widening

37
Q

What is the treatment of small cell carcinoma?

A
  1. Combination chemotherapy

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

38
Q

What are the complications for bronchogenic carcinoma?

A
  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
39
Q

What is the neumontic for bronchogenic carcinomas?

40
Q

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

A

Carcinoid tumor

41
Q

What are the characteristics of carcinoid tumors?

A

Considered low grade malignant neoplasms

Grow slowly and rarely metastasize

42
Q

What hormones are activated in carcinoid tumors?

A 
Neuroendocrine tumors producing a variety of biologically active peptides and hormones
Serotonin 
Adrenocorticotropin hormone (ACTH)
Antidiuretic hormone (ADH) 
Melanocyte-stimulating hormone (MSH)
43
Q

What are the serum results for carcinoid tumors?

A 
Serotonin (5-HT)
ACTH
ADH
Chromogranin A (CgA)
Glycoprotein
44
Q

What are the urine results in carcinoid cancer?

A

5-HIAA

Serotonin metabolite

45
Q

What are the tumor markers in carcinoid cancer?

A

Serum and urine

46
Q

What are the sxs of carcinoid cancer?

A 
Often asymptomatic
Tachycardia 
Flushing 
Bronchoconstriction
Hemodynamic instability
Diarrhea 
Acidosis
47
Q

What is the prevalence of bronchial carcinoid tumors?

A

Bronchopulmonary carcinoid ≈ 10% of all carcinoid tumors

48
Q

What percentage of all lung cancers are carcinoid tumors?

A

1-6% of lung tumors are carcinoid tumors

49
Q

What are the complications of bronchial carcinoid tumors?

A 
Bronchial obstruction 
Atelectasis 
Recurrent pneumonia 
Pulmonary abscess
Bronchiectasis
Bleeding
SIADH < common than in SCLC
Cushing Syndrome
Hypoglycemia
50
Q

What is the treatment of bronchial carcinoid tumors?

A

Surgical resection

51
Q

What are the characteristics of solitary pulmonary nodules?

A
  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
52
Q

What percentage of solitary pulmonary nodules are malignant?

53
Q

Who is at a risk of malignant nodules?

54
Q

What are the sxs of solitary pulmonary nodules?

A
  1. Most are asymptomatic

2. Nodules are found incidentally on CXR

55
Q

What are the cxr results in solitary pulmonary nodules?

A

Round or oval, well circumscribed lesion

Solid vs Subsolid

56
Q

What study is indicated after cxr in solitary pulmonary nodules?

57
Q

How are high suspicion for solitary pulmonary nodule pts managed?

A

thoracic sugeon

58
Q

How are indeterminate suspicion for solitary pulmonary nodule pts managed?

59
Q

How are low suspicion for solitary pulmonary nodule pts managed?

A

Low suspicion → CT q 6 mo x 2-3 yrs

60
Q

When is a solitary pulmonary nodule most likely benign?

A

Solid nodule that has been stable for two yr

Subsolid nodule that is stable for three yr

Gen Med Unit 6 (14 decks)

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