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pulmonary > pulmonary neoplastic disease > Flashcards

pulmonary neoplastic disease Flashcards

1
Q

lung cancer screening for high risk individual with negative chest x-ray

A

low dose chest CT detects lung cancer at earlier stage

-dx earlier allow more opportunity of effective treatment

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2
Q

most common type of cancer

A

bronchogenic cancer is most common
small cell lung cancer
nonsmall cell lung cancer

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3
Q

risk factors

A
  • cigarette smoking
  • occupation exposure (Asbestos, arsenic,hexavalent chromium)
  • appears higher in adults who are low in fruit and veggies
  • ionized radiation (miners and survivors or atom bombs)
  • lung disease (COPD ect)
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4
Q

lung cancer presentation

A

cough, weight loss, dyspnea, chest pain, hemoptysis, bone pain, clubbing, fever, night sweats, weakness, anorexia

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5
Q

central endobronchial growth of primary tumor symptoms

A

cough, hemoptysis

dyspnea, wheeezing

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6
Q

peripheral growth of primary tumor symptoms

A

pain from pleura or chest wall involvement
dyspnea
lung abscess from tumor cavitation

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7
Q

regional spread of tumor in thorax symptoms

A

tracheal obstruction, esophageal compression, laryngeal paralysis (hoarseness)
horner’s syndrome: ptosis, endopthalmos, miosis & anhydrosis

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8
Q

malignant pleural effusion symptoms (advanced disease)

A

pain, dyspnea or cough

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9
Q

primary tumor

A

tumors arising from the respiratory epithelium bronchi, bronchioles and alveoli

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10
Q

NSCLC primary tumor most common

A

adenocarcinoma 42%

mucous glands or epithelial cells within/distal/terminal bronchials

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11
Q

NSCLC primary tumor second most common

A

squamous cell carcinoma 22%

bronchial epithelium- most common presentation hemoptysis

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12
Q

small cell lung cancer percentage and origin

A

13% bronchial origin begins centrally

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13
Q

locations of lung cancer metastisis

A

regional lymph nodes
liver
bone and bone marrow
central nervous system

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14
Q

5 mechanisms for metastasis

A
  • pulmonary or bronchial artery
  • lymphatic system
  • pleural space
  • airway
  • direct neoplastic invasion
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15
Q

most common route for metastasis is

A

hematogenous

reaching arterioles and capillary beds

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16
Q

horners syndrome

A

miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face)

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17
Q

imaging for lung cancer dx

A

CXR: initial diagnosis
CHEST CT: aids in confirmation of suspected lesion
PET scanning: defines the nature of primary lesion and extent of disease

18
Q

other methods of dx for lung cancer

A

Sputum cytology: 25-75% sensitive

Percutaneous transthoracic fine needle biopsy: 30% risk of pneumothroax

Video-assisted thoracoscopic surgery: for pts not tolerating pneumothorax

19
Q

TNM lung cancer staging

A

Tumor: Size of the tumor

Node: Regional node involvement

Metastasis: The presence or absence of distant metastasis

20
Q

non-small cell lung cancer treatment

A

surgery: 35-45% have resectable disease

radiation used preoperatively with chemo

21
Q

small cell lung cancer treatment

A

more sensitive to chemo and thoracic radiation

surgery usually not possible in 85% with extensive disease

surgery is only an option in early stages

22
Q

types of NSCLC

A

adenocarcinoma
squamous cell carcinoma
large cell carcinoma

23
Q

patters of adenocarcinoma and prognosis

A

Lepidic predominant - has favorable prognosis

Acinar & Papillary - have intermediate prognosis

Solid predominant -has a poor prognosis

24
Q

squamous cell carcinoma

A

centrally located 2nd most common lung cancer

morphology similar to extrapulmonary squamous cell. tumors show karatinization and or intercellular bridges that arise from bronchial epithelium

tumors consist of sheets

25
Q

squamous cell is associated with

A

tobacco use and is usually centrally located and producing bronchial obstruction

26
Q

large cell carcinoma

A

frequently located in periphery

tumors lack cytologic and architectual features of small cell carcinoma and grandular and sqamous

27
Q

large cell carcinoma tends to

A

metastasize hematogenously in early stages of disease which leads to bone, liver and brain disease

28
Q

small cell lung cancer can produce ectopic hormone production leading to

A

cushings

inappropropriate secretion of ADH

29
Q

small cell lung cancer is strongly associated with

A

heavy tobacco use and accounts for 15% lung cancer

30
Q

rapid and aggressive cancer

A

small cell lung cancer

50-75% patients present with metastatic presentation

31
Q

carcinoid tumors arist

A

from the small bowel (53%), colon (12%), esophagus through duodenum (6%), or lung (bronchial carcinoid [5%]).

32
Q

carcinoid symptoms

A

symptom complex characterized by paroxysmal vasomotor disturbances, diarrhea, and bronchospasm

33
Q

bronchial carcinoid tumors dx

A

fiberoptic bronchoscopy

These lesions have a well-vascularized stroma, and biopsy may be complicated by significant bleeding.

34
Q

bronchial carcinoid tumor symptoms

A

Common symptoms include hemoptysis, cough, focal wheezing, and recurrent pneumonia.

Carcinoid syndrome (flushing, diarrhea, wheezing, hypotension) is rare.

35
Q

benign pulmonary nodules

A
  • lack of growth for 2 yrs
  • calcification within the nodule
  • 99% of noncalcified lesions less than 4 mm
  • 94% of noncalcified lesion 4-8 mm
36
Q

malignant pulmonary nodules

A
  • growth of 1-18 months
  • 50% of lesions greater than 8mm are malignant
  • CT finding of small ground glass opacities
37
Q

malignant mesothelioma

A

A neoplasm that originates from the mesothelial surfaces of the pleural cavities - 80%
Or peritoneal cavities – 20%
Both related to asbestos exposure from 20-40 years after asbestos

38
Q

malignant mesothelioma presentation

A

Dyspnea *, Cough , Nonpleuritic chest pain
Fever, Weight Loss, Sweats, Fatigue, Anorexia
Horner syndrome in advances stages

Auscultation may reveal unilateral loss of breath sounds
Dullness to percussion

39
Q

malignant mesothelioma produces a

A

pleural fluid accumulations (effusion)
Fluid may be bloody & often contain malignant cells
Right sided involvement is more common

40
Q

diagnosis of malignant mesothelioma

A

CXR: pleural plaques or calcification in the diaphragm
CT: chest and abd use to assess extent of disease
BONE SCAN: used to assess extend of disease

41
Q

superior sulcus tumors

A

pancoast tumors

arist from the apex of the lung and may invade the second or third rib, the brachial plexus, the subclavian vvessels, the stellate ganglion and adjacent vertebral bodies

42
Q

superior sulcus tumors

A

pancoast syndrome: characterized by pain that arise in the shoulders or chest wall and radiates to the neck
radiates to the ulnar surface of the hand

pulmonary (6 decks)

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