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clin med b 2 > thoracic neoplasms > Flashcards

thoracic neoplasms Flashcards

1
Q

what is the mediastinum

A

anatomic space located between the lungs that contains all principal tissues and organs of the chest except the lungs

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2
Q

what are the borders of the anterior mediastinum

A

posterior sternum and anterior aspect of the great vessels and pericardium

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3
Q

what are the contents of the anterior mediastinum

A
  • thymus
  • internal mammary arteries
  • lymph nodes
  • connective tissue
  • fat
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4
Q

what are the MC etiologic masses in the anterior mediastinum

A
  • “terrible T’s” - thymoma, teratoma, thyroid/parathyroid tissue
  • Foramen of Morgagni hernia
  • Mesenchymal tumors (lipoma, fibroma)
  • Giant lymph node hyperplasia, lymphoma
  • Germ cell tumor - seminoma /teratoma
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5
Q

what are the borders of the middle mediastinum

A
  • ventral border: anterior aspect of the pericardium, great vessels and trachea
  • dorsal border: posterior pericardium, anterior esophagus
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6
Q

What are the MC etiologic masses of the middle mediastinum

A
  • Granulomatous or metastatic lymphadenopathy
  • Cysts (pleuropericardial, bronchogenic, enteric)
  • Masses of vascular origin (pulmonary artery enlargement (in PH), aortic aneurysm )
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7
Q

what are the borders of the posterior mediastinum

A
  • everything behind the posterior pericardium
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8
Q

what are the contents of the posterior mediastinum

A
  • descending thoracic aorta
  • esophagus
  • thoracic duct
  • azygos and hemiazygos veins
  • sympathetic chains
  • posterior group of mediastinal lymph nodes
  • spine
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9
Q

what are the MC etiologic masses of the posterior mediastinum

A
  • Neurogenic tumors, meningocele, meningomyelocele
  • Gastroenteric cysts, esophageal diverticula/tumor
  • Hiatal hernia, hernia through foramen of Bochdalek
  • Extramedullary hematopoiesis
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10
Q

when are most mediastinal masses found?

A

incidentally 50% of the time

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11
Q

what is required when a mediastinal mass is suspected

A

a comprehensive H&P with a full ROS

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12
Q

what physical exam systems are particularly important to be observed in mediastinal masses

A
  • head/neck
  • upper extremity
  • chest
  • abdomen
  • all lymph nodes
  • scrotal/testicular exam in males
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13
Q

what is the mediastinal mass effect

A

direct involvement or compression of normal cardiothoracic structures

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14
Q

what are symptoms associated with the mediastinal mass effect?

A
  • lungs - stridor, hoarseness, shortness of breath, dyspnea, cough, hemoptysis, retrosternal chest pain
  • esophagus - dysphagia
  • vascular compression - facial and/or extremity swelling
  • heart - cardiac compression, hypotension
  • sympathetic chain - horners syndrome
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15
Q

what is the mediastinal mass effect on the sympathetic chain

A

causes horners syndrome:

remember this is characterized by PAM Horner!!
P - Ptosis (drooping of the upper eyelid)
A - anhidrosis (absence of sweating of the face)
M - miosis (constriction of pupil)

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16
Q

what symptoms are more often related to malignant lesions such as lymphoma and paraneoplastic disorders

A

systemic (constitutional) effects
- fever
- night sweats
- weight loss

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17
Q

What is the imaging that is obtained with a mediastinal mass

A

initial - CXR - PA/lateral
CT chest w IV contrast - provides information on location, size, relationship to other structures, and tissue characters

(I feel like this is CXR to confrim that there is a nodule, then CT to learn more about the nodule)

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18
Q

what are some additional imaging options for mediastinal masses and when would you obtain these types of images

A
  • barium swallow - suspected esophageal disease
  • doppler US, CT/MRI - vascular etiology
  • thyroid scan and uptake - intrathoracic goiter
  • PET scan or PET-CT - suspected lymphoma or malignancy
  • testicular/ovarian US - to assess for primary site of germ cell tumor
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19
Q

what are laboratory evaluations that should be done in evaluation of mediastinal masses

A
  • tumor markers if thymoma or germ cell tumors are suspected
  • anti-acetylcholine receptor antibodies (+ in thymic tumors)
  • alpha fetoprotein and beta human chorionic gonadotropin (+ in germ cell tumors)
  • lactate dehydrogenase (high in seminomas and lymphoma)
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20
Q

what labs are positive in thymic tumors

A

anti-acetylcholine receptor antibodies

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21
Q

what labs are elevated with germ cell tumors

A

alpha fetoprotein and beta human chorionic gonadotropin

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22
Q

what labs are elevated with seminomas and lymphoma

A

lactate dehydrogenase

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23
Q

what other laboratory studies could be done in evaluation of mediastinal masses

A
  • lymphoma workup
  • thyroid workup
  • biopsy
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24
Q

what are the three types of biopsies for mediastinal masses

A
  • percutaneous
  • endobronchial
  • surgical mediastinoscopy with biopsy
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25
Q

what is a percutaneous biopsy

A

uses CT guidance for exact location of biopsy

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26
Q

when is a encobronchial biopsy obtained

A
  • appropriate if mediastinal mass is located immediately adjacent to an airway
  • using endobronchial US can improve yield of diagnostic procedure
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27
Q

when are surgical mediastinoscopy biopsies obtained

A
  • small tumors that can be resected at the time of biopsy
  • large masses that are unresectable to obtain biopsy
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28
Q

what is the treatment for mediastinal masses

A

Treatment and prognosis depend on the underlying cause of the mediastinal mass

so I assume we dont gotta know! yayyyy

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29
Q

what are solitary pulmonary nodules also referred to as

A

coin lesion

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30
Q

what are the characteristics of a solitary pulmonary nodule

A
  • less than/equal to 3 cm (30mm)
  • isolated and round opacity
  • surrounded by normal lung
  • not associated with infiltrate, atelectasis, adenopathy
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31
Q

what is the etiology of solitary pulmonary nodules

A

they can be benign or malignant but MOST are benign

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32
Q

what are the non-malignant (Benign) causes of solitary pulmonary nodules

A
  • infectious granulomas (80% of benign SPN)
  • benign tumors (hamartomas)
  • pulmonary AV malformation
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33
Q

what are the MC organisms causing infectious granulomas

A
  • endemic fungi (histoplasmosis, coccidioidomycosis)
  • mycobacteria (TB, non TB)
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34
Q

how do non-malignant (benign) SPN appear

A

well-demarcated and fully calcified or centrally calcified nodule

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35
Q

how do hamartomas typically present clinically and on imaging?

A
  • usually presents in middle age and grows slowly over years
  • radiologically and histologically heterogenous
  • CXR - popcorn calcifications
  • CT - areas of fat or alternating fat/calcifications
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36
Q

what are pulmonary AV malformations

A

a tangle of connecting arteries and veins

AVOID BIOPSY IN THESE

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37
Q

what are the three categories of malignant causes for SPN

A
  • primary lung cancer
  • lung metastasis
  • carcinoid tumors
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38
Q

what are the primary lung cancers

A
  • Small Cell Carcinoma - presents centrally
  • Adenocarcinoma - present peripherally
  • Squamous Cell Carcinoma - presents centrally
  • Large Cell Cancer - anywhere but often more peripheral
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39
Q

how do lung metastasis usually present ?

A

multiple nodules

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40
Q

what are the MC pulmonary metastises

A
  • melanoma
  • sarcoma
  • carcinomas
    of the:
  • bronchus
  • colon
  • breast
  • kidney
  • testicle
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41
Q

what type of carcinoid tumors are MC

A

endobronchial
20% are present peripherally

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42
Q

what are cancer risks that should be looked for in patient history

A
  • Smoking (increases with the pk yr hx)
  • Increasing age (risk increases beginning at age 35)
  • Family history
  • Female sex
  • Emphysema
  • Previous malignancy
  • Environmental - asbestos
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43
Q

what does comparison of a previous CXR determine when assessing a SPN

A
  • nodule stability
  • chance of malignancy
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44
Q

when is a repeat CXR prior to ordering CT indicated

A
  • suspected nodule that is likely a nipple shadow (repeat with nipple markers)
  • evidence of infection (repeat in 6-8 weeks)
  • nodule characteristics are pathognomonic for benign lesions
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45
Q

what does CT help to assess as far as malignancy risk factors

A
  • Size
  • Location
  • Attenuation
  • Calcification
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46
Q

what size nodules correlate to malignancy rates

A
  • Nodules <5 mm: <1%
  • Nodules 5 to 9 mm: 2-6 %
  • Nodules 8 to 20 mm: 18%
  • Nodules >20 mm: >50 %
  • larger nodules often have higher malignancy rates
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47
Q

what nodule location has increased probability of being malignant

A

nodules found in the upper lobe

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48
Q

what are the possible attenuations of SPN on CT imaging

A
  • solid - MC found and less likely to be cancer
  • subsolid - higher likelihood of cancer (can be ground glass nodules which have no solid component, or part-solid nodules which is combo of ground glass and solid)
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49
Q

How does shape differ between benign and malignant lesions

A
  • benign lesions are smooth, with well defined edge
  • malignant are ill-defined, lobular or spiculated in appearance; may have a peripheral halo on CT
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50
Q

how does growth differ from malignant to benign SPN

A
  • malignent - growth seen on serial imaging (3-12 mo)
  • benign - solid nodule stable for 2 years, subsolid nodule stable for 5
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51
Q

how does lesion calcification differ from benign and malignant lesions

A
  • benign lesions have dense calcifications
  • malignant lesions are associated with sparser calcification (stippled or eccentric patterns)
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52
Q

what is the management for SPN

A

based on probability of malignancy!

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53
Q

what is the solitary pulmonary nodule malignancy risk calculator

A

estimates the probability that a lung nodule will be diagnosed as cancerous within a 2-4 year f/u period

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54
Q

what is considered high malignancy

A
  • > 30mm nodule
  • <30mm and >60% solitary pulm nodule malignancy risk (based off of the calculator)
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55
Q

what is considered low and intermediate risk for malignancy

A
  • low - <30mm and <5% SPN malignancy risk
  • intermediate - <30 mm and 5-60% SPN malignancy risk
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56
Q

what treatment is reccommended for SPN that have high malignancy risk

A

resection

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57
Q

what is the treatment reccomendation for SPN that is low probability of malignancy

A

“watchful waiting” with serial CT scans
frequency of scanning depends on size of nodule and risk for cancer

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58
Q

what is the management for intermediate probability malignancy risk SPN

A

controversial recommendations (yay)
options include:
- sputum cytology
- PET scan
- refer for biopsy/tissue sample

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59
Q

when is sputum cytology recommended in intermediate risk SPNs

A

recommended only for central lesions and those patients who are poor candidates for invasive diagnostic procedures

highly specific but not sensitive

60
Q

why are PET scans suggested in intermediate risk SPNs

A

assesses glucose metabolism of lesions and detects metabolic activity of lesion

the higher the metabolism of the lesion, the higher the likelihood of malignancy

61
Q

what is used to biopsy SPN

A

CT transthoracic FNA or bronchoscopy

62
Q

when is VATS with frozen tissue sampling indicated

A

if (+) malignancy, lobectomy and lymph node sampling will follow

63
Q

how should you approach a patient with multiple nodules?

A

In patients who are found to have multiple nodules, each nodule should be assessed individually for the probability of malignancy and followed by CT surveillance or biopsy accordingly

64
Q

maybe look at this. im not sure

A
65
Q

youre actually gonna want to memorize this one im sorryyy

A
66
Q

what is cancer?

A

A disease in which abnormal cells rapidly divide resulting in an overcrowding of normal cells leading to tissue damage

67
Q

what are the 6 hallmark capabilities of cancer cells

A
  1. self-sufficiency in growth signals
  2. insensitivity to antigrowth signals
  3. evading apoptosis
  4. limitless replicative potential
  5. sustained angiogenesis
  6. tissue invasion and metastasis
68
Q

what is lung cancer?

A

aka bronchogenic carcinoma

“malignant tumors arising from the respiratory epithelium which includes the bronchi, bronchioles and alveoli

69
Q

How common is lung cancer

A

second MC cancer diagnosed in both men and women

70
Q

what is the leading cause of cancer death in both men and women

A

lung cancer

71
Q

why have lung cancer death rates declined from 1990 to 2002

A

reduction in smoking and advancements in medicine

1990 - death rate 43%
2002 - death rate 17%

72
Q

what percent of lung cancer deaths in the US are still caused by smoking

A

80%

73
Q

what are risk factors for lung cancer

A
  • tobacco smoking (10x increase in risk)
  • second hand smoke (1st degree relatives of smokers have 2-3x risk compared to people who dont have 1st degree relatives who smoke)
  • age (increased beginning at 30, peaks at 80)
  • occupational/environmental exposure
  • fam hx or personal hx
  • chronic lung disease (COPD, pulm fibrosis, sarcoidosis, TB)
74
Q

how much can smoking cessation affect lung cancer risk

A
  • Smoking cessation decreases a patient’s risk of lung cancer by > 50% compared to those who continue to smoke
  • Smoking cessation before middle age avoids more than 90% of the lung cancer risk attributable to tobacco
75
Q

what is the median age for lung cancer developement

A

70

76
Q

what is the screening criteria for obtaining an annual low-dose CT scan to look for lung cancer

A
  1. Must be 50 to 80 years and in fairly good health
  2. Must currently smoke or have quit within the past 15 years
  3. Must have at least a 20-pack-year smoking history (Should receive smoking cessation counseling if they are current smokers)
  4. Should be provided informed/shared decision making about the benefits, limitations, and harms¹ of screening with LDCT scans
  5. Should have access to a high-volume, high quality lung cancer screening and treatment center
77
Q

what are the intrathoracic symptoms that present in lung cancer?

A
  • often asymptomatic until advanced disease
  • dry or productive cough
  • sputum streaked with blood
  • chest pain (pleuritic/dull on affected side)
  • increased SOB
  • voice changes
  • recurrent infections: pneumonia or bronchitis
78
Q

what are the intrathoracic complications that present in lung cancer

A
  • malignant pleural effusions
  • superior vena cava syndrome
  • pan coast tumor
79
Q

what is malignant pleural effusion and how is it diagnosed/treated

A
  • malignancy spreading to the pleural space (this definition is googled! the slide didn’t have one)
  • not all pleural effusions associated with cancer are malignant effusions
  • must obtain a cytology of pleural fluid to identify presence of malignant cells in pleural fluid
  • considered incurable and managed palliatively
80
Q

what is superior vena cava syndrome in lung cancer? what is the MC lung cancer that presents with this?

A
  • compression of the SVC by the pulmonary mass
  • MC in small cell lung cancer d/t central pulm involvement
81
Q

what are the signs and symptoms of superior vena cava syndrome in lung cancer

A

symptoms
- fullness in head/neck
- facial edema

PE:
- dilated neck veins
- prominent veins on the chest
- facial plethora with arm extension (pembertons sign)

82
Q

what does CXR show in superior vena cava syndrome in lung cancer

A

mediastinal widening or right hilar mass

83
Q

what is pancoast tumor in lung cancer

A

tumor in the apex of the lung causing compression of surrounding structures

84
Q

what are the symptoms of pancoast tumor in lung cancer

A
  • shoulder pain (brachial plexus)
  • horners syndrome
  • bone destruction
  • atrophy of hand muscles
85
Q

what is the purpose of a CXR in evaluation of lung cancer?

A
  • initial imaging modality!
  • helps to determine the age and growth pattern of identified abnormalities
86
Q

what are indications for a CT chest in lung cancer

A
  • new or enlarging focal lesion
  • a pleural effusion
  • pleural nodularity
  • enlarged hilar or paratracheal nodes
  • endobronchial lesion
  • post-obstructive pneumonia
  • segmental or lobar atelectasis
87
Q

why would contrast be used in evaluation of lung cancer

A

Contrast is used to distinguish mediastinal invasion of the primary tumor or metastatic lymph nodes from vascular structures

( in notes, slide 70)

88
Q

what would a CT chest WITH contrast look like in lung cancer patients

A
  • Solid-appearing lesions that are stable in size for at least two years are highly unlikely to represent lung carcinoma
  • Malignant non-solid and part-solid nodules often grow more slowly, so a longer period of stability is needed to exclude malignancy
89
Q

when are PET scans used

A

PET scans are utilized for organs suspected of having malignancy based upon symptoms and CT imaging

90
Q

what could cause false negatives in PET scans

A

diabetic, in lesions <8 mm, and in slow-growing tumors

91
Q

what could cause false positives in PET

A

certain infections and granulomatous disease (e.g. TB)

92
Q

integrated PET/CT is more accurate for what type of staging

A

lymph node stagng

93
Q

when is lab evaluation indicated in lung cancer? what does it look for?

A
  • indicated if (+) radiographic evidence of malignancy
  • utilized to look for signs of metastasis/paraneoplastic syndrome
94
Q

what are the lab studies used to evaluate lung cancer

A
  • CBC - abnormal in hematologic paraneoplastic syndrome
  • Electrolytes - abnormal in various paraneoplastic syndromes
  • Calcium - elevated in bone mets or paraneoplastic syndrome
  • Alkaline phosphatase - elevated in bone or liver mets
  • AST/ALT, total bilirubin - elevated in liver mets
  • Creatine kinase (CK) - elevated in MSK paraneoplastic syndromes
  • Antinuclear antibodies (ANA) - elevated in * MSK paraneoplastic syndromes
95
Q

what is the MC sites for distant metastatic lung cancer

A
  • Liver
  • Adrenal glands
  • Bones
  • Brain
96
Q

what is the presentation of metastatic lung cancer that is affecting the liver? what is the diagnostics for this?

A
  • often asymptomatic
  • suspect if elevated LFTs
  • imaging of choice: non-contrasted CT or CT-PET
97
Q

what is the presentation of metastatic lung cancer that is affecting the bones? what is the diagnostics for this?

A
  • Pain in the back, chest, or extremity
  • Elevated levels of serum alkaline phosphatase
  • Elevated serum Ca in more severe mets
  • More often seen with SCLC
  • can do: PET scan preferred, MRI acceptable, Bone scan is alternative to PET scan
98
Q

what is the presentation of metastatic lung cancer that is affecting the adrenal glands? what is the diagnostics for this?

A
  • most often asymptomatic and found incidentally on staging CT scan
  • not all adrenal masses found are metastatic
  • PET scan can be used to differentiate a metastatic adrenal lesion from a non-metastatic lesion
99
Q

what is the presentation of metastatic lung cancer that is affecting the brian, spine, nerves? what is the diagnostics for this?

A
  • headache, vomiting, seizures
  • papilledema, visual field loss, hemiparesis, cranial/focal nerve deficit
  • MRI with contrast
100
Q

what is the only definitive way to make the diagnosis of malignancy in lung cancer

A

biopsy of suspected lesions

101
Q

what are the modality options for primary neoplasm biopsy in lung cancer

A
  • Endobronchial Ultrasound Bronchoscopy (used for CENTRALLY located tumors)
  • Transthoracic percutaneous fine-needle aspiration (FNA) with CT guidance (used for PERIPHERALLY located tumors)
  • Video assisted thoracic surgery (invasive)
  • mediastinoscopy (invasive)
102
Q

what are the two indications for invasive biopsies

A
  • resection is recommended prior to biopsy results
  • inadequate specimen or tumor remains undiagnosed after less invasive options
103
Q

what are the four WHO lung cancer classifications and how are they categorized?

A

categorized based on histologic evaluation of biopsy specimen

classifications:
- small cell lung cancer (SCLC)
- adenocarcinoma
- squamous cell carcinoma
- large cell carcinoma

104
Q

How common is small cell carcinoma and who is it MC in?

A
  • less common: accounts for appx 15% of lung cancers
  • Very rare in non-smokers….patient is almost always a smoker
105
Q

what is small cell carcinoma? what part of the lungs does it affect?

A
  • Very small cells that are very fast growing/doubling and result in an early development of widespread metastasis
  • generally starts in bronchi (centrally located)
  • Usually detected as a large hilar mass with bulky mediastinal adenopathy
106
Q

what is the MC lung cancer type

A

non small cell lung cancer

(adenocarcinoma, squamous cell carcinoma, large cell carcinoma)

107
Q

what is adenocarcinoma and who is it MC in

A
  • Slow growing and usually involves the periphery of the lung
  • More common in smokers than non-smokers
  • The MC form of lung cancer in nonsmokers
108
Q

where is squamous cell carcinoma usually found and who is it MC in?

A

Generally occurs in center of lung and develops in smokers

109
Q

what is large cell carcinoma, where is it typically found?

A

Rapidly growing mass occurring anywhere in the lung (more commonly found along the periphery)

110
Q

what is TNM staging parameters for “T”

A
111
Q

what is TNM staging for “N”

A
112
Q

what is TNM staging for “M”

A
113
Q

what is the treatment for non small cell lung cancer (NSCLC) stage 0

A
  • stage 0 = malignant cells on cytology but normal imaging
  • Requires meticulous examination of the bronchial tree with a fiberoptic bronchoscope
  • Cancer limited to the lining of the bronchus and no deeper invasion
  • Surgery alone is usually curative for these patients
114
Q

what is the treatment for non small cell lung cancer (NSCLC) stage 1

A
  • stage 1 = no nodal involvement or metastasis
  • surgery may be only treatment needed
  • radiation indicated if there are positive surgical margins or if patient isnt a candidiate/refuses surgery
115
Q

what is the treatment for non small cell lung cancer (NSCLC) stage 2 and 3

A
  • surgical resection (with lymph node removal if malignant involvement)
  • adjuvant chemo (strongly recommended in lymph node involvement)
  • post op radiation (if (+) surgical margins on tumor resection, nodal involvement or not a candidate/refuses surgery)
116
Q

what is the treatment for non small cell lung cancer (NSCLC) stage 4

A
  • stage 4 = widespread distant metastises
  • systemic therapy (chemo, molecularly targeted therapy, and/or immunotherapy
  • palliative radiation therapy and surgery may be needed
  • if isolated metastases - surgical excision of metastatic tumor may be beneficial
117
Q

what are molecularly targeted therapies

A

Targeted cancer therapies are drugs or other substances that block the proteins that are involved in the growth, progression, and spread of cancer.

(in notes slide 94)

118
Q

what is the prognosis for NSCLC

A
  • Overall 5 year survival rate is between 10-15%
  • Depends strongly on histology, tumor grade, comorbidity etc.
119
Q

what is limited stage SCLC

A

tumor iis limited to the unilateral hemithorax

120
Q

what is the treatment for limited stage SCLC

A
  • Patients with no distant metastasis and no evidence of disease in the mediastinum - Resection is indicated followed by chemotherapy
  • Patients with clinical or pathologic evidence of mediastinal disease or metastasis - Chemoradiotherapy is indicated as initial treatment
121
Q

what is extensive stage disease SCLC

A

when the tumor extends beyond thehemithorax

122
Q

what is treatment for extensive stage disease SCLC

A
  • Systemic chemotherapy
  • Prophylactic cranial and thoracic irradiation decreases risks of mets in patients who respond to systemic chemotherapy
123
Q

what is the prognosis for SCLC

A
  • Patient with SCLC rarely survive more than a few months without treatment
  • Median survival rate from time of original diagnosis is 8-13 months
  • < 5 % will survive beyond 2 years
124
Q

what is paraneoplastic syndrome

A

an altered immune system response to a neoplasm

a release of substances (hormones, hormone precursors, enzymes, or cytokines) produced by the tumor which affect other organ systems

125
Q

what are organ systems that can be affected by paraneoplastic syndromes

A
126
Q

what is the cause of hypercalcemia in paraneoplastic syndrome

A
  • tumor secretion of parathyroid hormone-related protein¹ (PTHrP) and vitamin D 1,25 inciting osteoclastic activity
  • calcium often rises quickly (weeks to months) compared to non-neoplastic etiologies
127
Q

what are the s/s of hypercalcemia in paraneoplastic syndrome

A
  • anorexia
  • nausea
  • vomiting
  • constipation
  • lethargy
  • polyuria
  • polydipsia
  • dehydration
128
Q

what stage is most assocaited with paraneoplastic syndrome and how does this impact survival rates

A

most often associated with advanced disease (stage III or IV) with a median survival time of a few months

129
Q

what is SIADH in paraneoplastic syndrome? what type of cancer is it MC in?

A
  • tumor releases ADH
  • MC assocaited w/ SCLC
130
Q

what are the symptoms of SIADH in paraneoplastic syndrome

A
  • related to severity of hyponatremia
  • anorexia, nausea, vomiting
  • cerebral edema occurs if hyponatremia is rapid onset
  • cerebral edema = irritability, restlessness, personality changes, confusion, soma, seizures, respiratory arrest
131
Q

when are neurologic presentations of paraneoplastic syndromes MC

A

most often assocated with SCLC

lung cancer is the most common cancer associated with paraneoplastic neurologic syndromes

132
Q

what is hte MC neurologic paraneoplastic syndrome

A
  • MC is Lambert-Eaton myasthenic syndrome (LEMS)
  • 3% of patients with SCLC will develop LEMS
133
Q

what is lambert-eaton myasthenic syndrome

A

autoantibody formation results in impaired release of acetylcholine

134
Q

Is LEMS or SCLC typically discovered first?

A
  • symptoms of LEMS often precede dx of SCLC
  • 50% of patients dx with LEMS have SCLC
  • CT chest and PET should be performed to look for SCLC
  • Confirmed with electrodiagnostic studies and antibody testing (neurology referral)
135
Q

what are hematologic syndromes that could present with paraneoplastic syndromes

A
  • Anemia, Leukocytosis,Thrombocytosis, Eosinophilia,
  • Hypercoagulable disorders
136
Q

what is hypertrophic osteoarthropathy in paraneoplastic syndromes

A
  • a symmetrical, painful arthropathy that usually involves the ankles, knees, wrists, and elbows
  • clubbing of digits
  • x-ray of long bones will show periosteal new bone formation
137
Q

what is Dermatomyositis/Polymyositis in paraneoplastic syndrome nad how does it present?

A
  • inflammatory myopathies manifested by muscle weakness
  • may present with symptoms prior to dx of lung CA
  • elevated CK and ANA
138
Q

what is cushing syndrome as paraneoplastic syndrome and how does it present

A
  • ectopic (tumor) production of ACTH
  • S/S: muscle weakness, central weight gain, hypertension, hirsutism, and osteoporosis
  • Hypokalemia and hyperglycemia are usually present
139
Q

what are bronchial carcinoid tumors

A

a rare type of lung cancer that develops in the central bronchi and rarely metastasizes

140
Q

when does bronchial carcinoid tumor typically present

A

before age 60

no links between smoking or other carcinogens

141
Q

what is the clinical presentation of bronchial carcinoid tumors?

A
  • hemoptysis, cough, focal wheezing and recurrent pneumonia
  • 25% of patients are asymptomatic
  • carcinoid syndrome¹ is rare - flushing, diarrhea, wheezing, hypotension
142
Q

what would a bronchoscopy show in bronchial carcinoid tumors

A

Bronchoscopy shows a pink/purple tumor (due to high vascularity) in the central air way

143
Q

what occurs when you biopsy a bronchial carcinoid tumor?

A

biopsy often results in significant bleeding

144
Q

what is management for bronchial carcinoid tumors

A
  • observation with serial CT scans to follow growth
  • follow up evaluation for symptomatic progress (MC complication is tumor bleeding and airway obsruction)
  • symptomatic lesions often require surgical excision
  • prognosis is “favorable”
145
Q

ugh so many cards…. but youre done! flip for doggo!

A

clin med b 2 (44 decks)

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