Pulmonology #7 (Lung Cancer, Paraneoplastic, Mesothelioma) Flashcards
What are some signs that a solitary pulmonary nodule has an increased risk of malignancy?
-Spiculated nodule
-Large > 2 cm
-Irregular borders
-Asymmetric calcification
-Upper lobe location
-> 40 years of age
-Smoker
-Enlarging
-Abnormal PET scan
What are some signs that the nodule has a decreased risk of malignancy?
-Well circumscribed smooth borders
-Small < 1 cm
-Dense diffuse calcification
-< 30 years of age
-Nonsmoker
-No change in size
-Normal CT scan
Initial diagnostic done for a pulmonary nodule
CXR
Then, what is the next diagnostic study done to determine malignancy or not
CT chest
______ may be used to determine metabolic functioning of the nodule
PET scan
If the nodule has an intermediate risk of being malignant, what should be done?
Bronchoscopy if central lesion
Transthoracic needle aspiration if peripheral
With a high risk of malignancy, what should be done?
Resection with biopsy
MC site of bronchial carcinoid tumors
GI tract
Lung is second most common site
What are the symptoms of carcinoma syndrome?
-Periodic episodes of diarrhea (serotonin release)
-flushing
-Tachycardia
-Bronchoconstriction (histamine release)
-Hemodynamic instability (hypotension)
Although biopsy is definitive to diagnose a carcinoid tumor, what is seen on bronchoscopy?
Pink to purple well-vascularized centrally-located tumor
What medication can be used to decrease symptoms of carcinoid tumors?
Octreotide
What is the definitive management of carcinoid tumors?
Surgical excision–they are often resistant to chemotherapy and radiation
Bronchogenic carcinoma is the ______ MC cancer diagnosed in the US, after _______
2nd MCC
After prostate in men and breast in women
True or False: Bronchogenic cancer is the MCC of cancer-related deaths in the US
True
Where are the greatest tendency for METS of bronchogenic carcinoma?
-brain, bone, liver, lymph nodes, adrenals
MCC of bronchogenic carcinoma
Smoking
Second MCC of bronchogenic carcinoma
Asbestosis
Other risk factors for lung cancer
Genetics
Radon exposure (miners)
COPD
TB
What are the two types of lung cancer?
Non-small cell cancer
Small cell cancer
Non-small cell cancer is usually treated with _______ and includes what types?
Surgical resection
Adenocarcinoma
Squamous Cell
Large cell
Small cell cancer is usually _______ and the initial treatment of choice is
usually metastatic at time of presentation
Chemotherapy (with or without radiation)
Who should have a low-dose CT scan of the lungs
55-80 who have no symptoms of lung cancer + 30 PPY smoking history who currently smoke or have quit within 15 years
MC primary lung cancer in smokers, women, men, and nonsmokers
Adenocarcinoma
Where is adenocarcinoma usually located in the lungs?
Typically peripheral
Treatment for adenocarcinoma of the lungs
Surgical resection in most cases
What are the characteristics of squamous cell lung carcinoma? CCCP
Centrally located
Cavitary lesions
Hypercalcemia
Pancoast syndrome
Although biopsy is definitive diagnostic for squamous cell carcinoma, what is another unique thing that can diagnose it?
May be detected in the sputum since it is commonly central
Describe small cell (oat cell) carcinoma of the lungs
Aggressive type of lung cancer that is associated with early metastasis
Strongest risk factor for small cell/oat cell carcinoma
Smoking
Symptoms of small cell carcinoma
Cough, chest pain, dyspnea, hemoptysis, wheezing, weight loss
-Paraneoplastic syndromes
Small cell carcinoma is usually located ________ and the treatment for most is usually ______
Centrally located
Chemotherapy
What is a paraneoplastic syndrome
Set of systemic symptoms and/or signs due to release of hormones and cytokines by an immune response against the tumor
What is the MC tumor to present with paraneoplastic syndromes?
Small cell lung carcinoma
Superior vena cava syndrome, due to obstruction of blood flow through the SVC, presents with symptoms such as
Face and/or neck swelling
Facial plethora
Headache
Dilated and prominent neck and chest veins
What does a CXR show in a person with SVC syndrome?
Right hilar mass or widening of mediastinum
Treatment for SVC syndrome
-Elevation of the head
-Endovascular management
What is the pathophysiology of Lambert-Eaton Myasthetic Syndrome?
-Antibodies against presynaptic voltage-gated Calcium channels prevent acetylcholine release, leading to muscular weakness
Symptoms of Lambert-Eaton Syndrome
-Proximal muscle weakness that improves with repeated muscle use (unlike myasthenia gravis)
-Dry mouth, erectile dysfunction, postural hypotension
-Hyporeflexia, no muscle atrophy
Diagnostics to evaluate for Lambert-Eaton Syndrome
-Voltage-gated Calcium channel antibody assay
-Electrophysiology
Treatment for Lambert-Eaton
Treat underlying malignancy
Initial medical treatment: Pyridostigmine
Second line: Plasmapheresis, IVIG, oral immunosuppressants
What is a pancoast tumor?
Tumor located near the superior sulcus (near the apex) with a distinct pattern of signs and symptoms
MC etiology of Pancoast tumors
Squamous cell lung carcinoma (non small cell lung carcinoma)
What is the pathophysiology of pancoast tumors
-Tumor compression of lower brachial plexus, ulnar nerve, and/or cervical sympathetic nerve chain
Symptoms of a pancoast tumor
-Shoulder and arm pain (MC initial symptom)
-Horner syndrome (ipsilateral ptosis, mitosis, and anhidrosis)
-Weakness and atrophy of muscles of hand
-Ulnar neuropathy
-Pulmonary symptoms uncommon until disease progresses
What are the three symptoms of Horner’s Syndrome?
-Ipsilateral ptosis
-Miosis (dilation)
-Anhidrosis (inability to sweat normally)
Although a CXR is initially ordered for a pancoast tumor, an MRI gives more information. However, what is the definitive diagnostic?
Needle biopsy
Mesothelioma is a tumor originating from the pleura. 80% are due to
Chronic asbestos exposure
Symptoms of mesothelioma
-Pleuritic chest pain
-Dyspnea
-Fever
-Night sweats
-Weight loss
-Hemoptysis
What is seen on CXR in mesothelioma
Unilateral pleural thickening, bloody pleural effusions
Treatment for mesothelioma
-Chemotherapy with resection or radiation therapy (it varies)
