respiratory neoplasms

Question 1

What is the ddx for a solitary pulmonary nodule?

Answer 1

granuloma, hamartoma, cancer (primary or met), carcinoid tumor, PNA

Question 2

What is one approach to work up a solitary pulmonary nodule?

Answer 2

1. compare to prior CXR
2. If changed or no prior CXR, get CT to determine location, size, progression
3. If characteristic of a benign lesion, follow with CXR every 3-6 months: 45, new/progessing, irregular calcifications or no calcifications, >2 cm, irregular margins

Question 3

What are 3 complications due to local extension of lung CA?

Answer 3

• Horner syndrome- invasion of the cervical ganglia
• Pancoast tumor: Horner syndrome + brachial plexus involvement
• SVC syndrome- head swelling and CNS symptoms

Question 4

What are the most common sites for lung mets?

Answer 4

bone, liver, adrenals, brain

Question 5

What cancers commonly send mets to the lungs?

Answer 5

breast, colon, prostate, endometrial, and cervical

Question 6

What are the characteristics of squamous cell carcinoma of the lungs?

Answer 6

central lesions that are typically cavitary and extend to the hilar lymph nodes

Question 7

What are characteristics of adenocarcinoma?

Answer 7

typically peripheral primary lesions with wide metastesies. can be caused by asbestos
pleural effusions show increased hyaluronidase levels

Question 8

What is bronchioalveolar cancer?

Answer 8

subtype of adenocarcinoma that sis low grade and occurs in single nodules

Question 9

What is SCLC?

Answer 9

very agressive with early distant mets and several paraneoplastic syndromes
often central

Question 10

large cell carcinoma

Answer 10

peripheral cancer with early cavitation and late distant mets

Question 11

What are the common paranemoplastic syndromes seen with squamous cell lung cancer?

Answer 11

hypercalcemia and dermatomyositis

Question 12

What are the paraneoplastics of adenocarcinoma?

Answer 12

DIC, thrombophlebitis, microangiopathic hemolytic anemia, dermatomyositis

Question 13

What are the paraneoplastics of SCLC?

Answer 13

cushing syndrome, SIADH, ectopic GH and ACTH secretion, peripheral neuropathy, subacute cerebellar degeneration, LEMS, limbic encephalitis, dermatomyositis

Question 14

What are the paraneoplastic disease seen with large cell carcinoma?

Answer 14

gynecomastia and dermatomyositis

Question 15

How is Non-small cell lung cancer managed?

Answer 15

• if No lymph nodes beyond ipsilateral hilar nodes and no mets, do surgical resection with adjuvant chemo and radiation
• if no mets but extension to ipsilateral mediastinal nodes, do radiation and consider surgery or chemo (chemo may shrink
• If mediastinal invasion or above, all tx is palliative

Question 16

How is laryngeal cancer diagnosed?

Answer 16

suspect if hoarseness worsens with time in pt with hx of alcohol or tobacco use
need biopsy for diagnosis; MRI or contrast CT or PET may be helpful

Question 17

How is laryngeal cancer treated?

Answer 17

larngectomy to remove lesions confined to larynx; radiation with surgery or as sole tx if extensive lesions.
may need surgery, radiation, and chemo