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Surgery EOR > Thoracic Neoplasms > Flashcards

Thoracic Neoplasms Flashcards

1
Q

Mediastinum

A

Anatomic space located between the lungs

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2
Q

Anterior mediastinum borders

A

Sternum to anterior aspect of the heart

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3
Q

Anterior mediastinum contents

A

Thymus
Internal mammary arteries
Lymph nodes

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4
Q

MC etiologies of anterior mediastinal masses

A

Thymoma
Teratoma
Thyroid/parathyroid

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5
Q

Middle mediastinal borders

A

Anterior aspect of the heart to the posterior aspect of the heart

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6
Q

Contents of middle mediastinum

A

Heart
Great vessels
Trachea

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7
Q

MC etiologies of middle mediastinal masses

A

Granulomatous or metastatic lymphadenopathy

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8
Q

Posterior mediastinum borders

A

Everything posterior to the heart

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9
Q

Contents of posterior mediastinum

A

Esophagus
Thoracic duct
Sympathetic chain
Spine
Descending thoracic aorta

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10
Q

MC etiologies of posterior mediastinal masses

A

Neurogenic tumors
Meningocele
Esophageal diverticula
Hiatal hernia

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11
Q

50% of mediastinal masses are found ___

A

Incidentally

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12
Q

Clinical presentation of mediastinal mass

A

Symptoms related to the structures that are compressed by the mass
Constitutional symptoms if malignant

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13
Q

Effects of compression of the lungs, esophagus, vascular, heart and sympathetic chain

A

Lungs: hoarseness
Esophagus: dysphagia
Vascular: facial or extremity swelling
Heart: hypotension
Sympathetic chain: Horner’s syndrome

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14
Q

Initial imaging of a mediastinal mass

A

CXR

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15
Q

If the CXR is inconclusive, what is the follow-up imaging for mediastinal mass?

A

Chest CT with IV contrast

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16
Q

If the patient complains of difficulty swallowing due to mediastinal mass, what test could be run?

A

Barium swallow

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17
Q

If there is a suspected malignancy of mediastinal mass, what test should be run first?

A

PET scan

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18
Q

PET scan

A

Shows metabolic activity

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19
Q

Anti-acetylcholine receptor antibodies are elevated in ___ tumors

A

Thymic

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20
Q

Alpha fetoprotein and beta HCG are elevated in ___ tumors

A

Germ cell

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21
Q

LDH is elevated in ___ tumors

A

Seminomas and lymphoma

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22
Q

Referral for mediastinal masses

A

Cardiothoracic or general surgery

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23
Q

Indications for percutaneous biopsy of mediastinal mass

A

If it is near the periphery of the chest

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24
Q

Percutaneous biopsy

A

Uses CT guidance for exact location of biopsy

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25
Q

Indications for endobronchial biopsy

A

If mediastinal mass is located immediately adjacent to an airway

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26
Q

Indications for mediastinoscopy biopsy

A

If they are also planning to resect the tumor at that time

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27
Q

Characteristics of a solitary pulmonary nodule (SPN)

A

Less than 3cm
Isolated and round opacity
Surrounded by normal lung
Not associated with infiltrate, atelectasis, or adenopathy

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28
Q

T/F most SPN are malignant

A

F - most are benign

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29
Q

Benign causes of SPN

A

Infectious granulomas
Hamartomas
Pulmonary AV malformation

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30
Q

MC organisms that cause infectious granuloma SPN

A

Endemic fungi
Mycobacteria

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31
Q

Appearance of infectious granuloma SPN

A

Well-demarcated, fully calcified, or centrally calcified

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32
Q

Presentation of hamartoma

A

Heterogenous
CXR: popcorn
CT: areas of fat

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33
Q

Pulmonary AV malformation

A

Tangle of connecting arteries and veins causing a hard time for blood to move through

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34
Q

Should you biopsy pulmonary AV malformations?

A

No - there is a bleeding risk

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35
Q

Malignant causes of an SPN

A

Primary lung cancer
Lung metastasis
Carcinoid tumors

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36
Q

Most pulmonary metastases present as ___

A

Multiple nodes

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37
Q

Risk factors for malignancy in SPN

A

Smoking
Age
Family History
Female sex
Emphysema
Previous malignancy
Asbestos exposure

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38
Q

You should repeat CXR prior to ordering CT if ___

A

Suspected nodule is likely a nipple shadow
Evidence of infection
Nodule characteristics are pathognomonic for benign lesion

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39
Q

Imaging modality of choice for SPN

A

CT chest w/o contrast

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40
Q

CT imaging helps to assess malignancy risk factors such as ___

A

Size
Location
Attenuation
Calcification

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41
Q

___ nodules have a higher malignancy rate

A

Larger

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42
Q

Nodules found in the ___ have an increased risk of being malignant

A

Upper lobe

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43
Q

(Solid/subsolid) nodules are more likely to be malignant

A

Subsolid

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44
Q

Types of subsolid nodules

A

Ground glass nodules
Part-solid nodules

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45
Q

Shape of nodules that are more likely to be malignant

A

Ill-defined, lobular, speculated, and peripheral halo
Benign lesions have smooth, well-defined borders

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46
Q

Growth of SPN

A

More likely to see growth on malignant tumors
Benign tumors are likely stable

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47
Q

Calcification patterns of SPN

A

Benign: diffuse, central, popcorn, laminated
Malignant: stippled and eccentric

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48
Q

If the nodule is over 3cm, then it is already classified as ___ risk

A

High

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49
Q

If the nodule is under 3cm, how do you determine risk?

A

Risk calculator

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50
Q

Risk calculator for determining malignancy probability

A

Low: less than 5%
Intermediate: 5-60%
High: over 60%

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51
Q

Management of low probability SPN

A

Watchful waiting with serial CT scans

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52
Q

Management of high probability SPN

A

Surgical resection and staging

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53
Q

Management for intermediate probability SPN

A

If a central lesion: sputum cytology
If you suspect malignancy: PET scan
Biopsy for further malignancy testing

54
Q

Management of patients with multiple nodules

A

Each nodule should be assessed individually for the probability of malignancy

55
Q

Bronchogenic carcinoma

A

Malignant tumors arising from the respiratory epithelium, which excludes the bronchi, bronchioles and alveoli (lung cancer)

56
Q

T/F second hand smoke exposure is still a significant risk factor for the development of lung cancer

A

True

57
Q

Median age of lung cancer diagnosis

A

70

58
Q

Risk factors for lung cancer

A

Smoking
Age
Occupational exposure
Family history
COPD

59
Q

Screening criteria for lung cancer

A

Must be between 50-80
In good health
Currently smokers or has quit within the last 15 years
Has a 20 pack year history

60
Q

Modality of lung cancer screening

A

Annual low-dose CT

61
Q

Clinical presentation of lung cancer

A

Intrathoracic symptoms: cough, sputum streaked with blood, chest pain, SOB, recurrent infections

62
Q

Intrathoracic complications

A

Malignant pleural effusions
Superior vena cava syndrome
Pan coast tumor

63
Q

How is malignant pleural effusion managed?

A

Palliatively

64
Q

How to identify the presence of malignancy cells in the pleural fluid?

A

Cytology

65
Q

Superior vena cava syndrome

A

Compression of the SVC by pulmonary mass leading to facial and neck edema

66
Q

CXR of superior vena cava syndrome

A

Mediastinal widening or high hilar mass

67
Q

Pancoast tumor

A

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

68
Q

Symptoms of pancoast tumor

A

Shoulder pain
Horners syndrome
Bone destruction around the tumor

69
Q

Initial imaging modality for lung cancer

A

CXR

70
Q

Indications for chest CT for lung cancer

A

New or enlarging lesion
Pleural effusion

71
Q

What type of CT is used for lung cancer?

A

With contrast

72
Q

T/F: the whole body PET scans are recommended for lung cancer

A

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

73
Q

PET false negatives

A

Diabetics
Small lesions
Slow-growing tumors

74
Q

PET false positives

A

Certain infections and granulomatous disease

75
Q

When are labs indicated for suspected lung cancer?

A

If radiologic evidence shows likely malignancy

76
Q

MC sites for distant metastatic lung cancer

A

Liver
Adrenal glands
Bones
Brain

77
Q

Liver mets in lung cancer

A

Often asymptomatic
Elevated LFTs

78
Q

Imaging of choice for liver mets in lung cancer

A

CT w/o contrast

79
Q

Bone mets in lung cancer

A

Pain in the back, chest, or extremities
Elevated serum alk phos and serum Ca

80
Q

Imaging of choice for bone mets in lung cancer

A

PET scan

81
Q

Adrenal mets in lung cancer

A

Often asymptomatic and found incidentally on staging CT

82
Q

Imaging of choice in adrenal mets in lung cancer

A

PET scan

83
Q

Brain mets in lung cancer

A

N/V, vision changes, papilledema, cranial nerve deficit

84
Q

Imaging modality for brain mets of lung cancer

A

MRI with contrast

85
Q

Only definitive way to make the diagnosis of malignancy in lung cancer

A

Biopsy

86
Q

Modality options for primary neoplasm of lung biopsy

A

Endobronchial ultrasound bronchoscopy: preferred for centrally located tumors
Transthoracic percutaneous fine-needle aspiration with CT guidance: preferred for peripherally located tumors

87
Q

Biopsy modalities for lung cancer

A

Video-assisted thoracic surgery
Mediastinoscopy for tumors that are going to be resected anyways

88
Q

Classification of WHO lung cancer

A

Small cell lung cancer
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

89
Q

Small cell carcinoma patient population

A

Almost always a smoker

90
Q

Where does small cell carcinoma generally start?

A

Bronchi (centrally located)

91
Q

How is small cell carcinoma usually detected?

A

Large hilar mass with bulky mediastinal adenopathy

92
Q

Most common type of lung cancer

A

Non-small cell lung cancer

93
Q

Most common form of lung cancer in nonsmokers

A

Adenocarcinoma

94
Q

Adenocarcinoma

A

Slow-growing and usually involves the periphery of the lung

95
Q

Squamous cell carcinoma generally occurs in the ___ and develops in ___

A

Large cell carcinomas

96
Q

Large cell carcinomas

A

Rapidly-growing mass occurring anywhere in the lung

97
Q

Location of large cell carcinoma

A

Peripheral

98
Q

TNM staging

A

Tumor: size of tumor
Node: lymph node involvement
Metastasis: mets to other organs

99
Q

Stage 1 NSCLC

A

No nodal involvement or mets

100
Q

Treatment of stage 0 NSCLC (in situ)

A

Surgery alone is usually curative for these patients

101
Q

Treatment of stage 1 NSCLC

A

Surgery
Radiation if the surgical margins are positive and patient isn’t a candidate for surgery

102
Q

Treatment of stage 2 and 3 NSCLC

A

Surgical resection
Followed by chemo
Post-op radiation if positive surgical margins and is not a candidate for surgery

103
Q

Stage 4 NSCLC

A

Wide-spread with distant mets

104
Q

Treatment of stage 4 NSCLC

A

Chemotherapy
Palliative radiation and surgery

105
Q

Prognosis of NSCLC

A

5 year survival is 10-15%

106
Q

Limited stage SCLC

A

Patients with no distant mets and no evidence of disease in the mediastinum
Patients with clinical or pathologic evidence of mediastinal disease or mets

107
Q

Treatment for limited stage SCLC in patients with no distant mets and evidence of disease in the mediastinum

A

Resection followed by chemo

108
Q

Treatment for limited stage SCLC in patients with evidence of mediastinal disease or mets

A

Chemoradiotherapy as initial therapy

109
Q

Extensive stage SCLC

A

Tumor extends beyond the hemithorax

110
Q

Treatment of extensive stage SCLC

A

Systemic chemo

111
Q

Prognosis of SCLC

A

Rarely survive more than a few months without treatment

112
Q

Paraneoplastic syndrome

A

Release of hormones by a tumor that affects other organ systems

113
Q

Hypercalcemia in paraneoplastic syndrome

A

Tumor secretion of parathyroid hormone related protein and calcitriol inciting osteoclastic activity

114
Q

S/S of hypercalcemia in paraneoplastic syndrome

A

Anorexia
N/V/C
Polyuria
Polydipsia
Dehydration

115
Q

Hypercalcemia is most often associated with ___ paraneoplastic syndrome

A

Advanced stage

116
Q

SIADH paraneoplastic syndrome

A

Tumor releases ADH

117
Q

SIADH paraneoplastic syndrome is most commonly associated with ___

A

SCLC

118
Q

S/S of SIADH paraneoplastic syndrome

A

Hyponatremia (neuro changes)
N/V
Anorexia

119
Q

Lung cancer is the most common cancer associated with paraneoplastic ___ syndromes

A

Neurologic

120
Q

Neurologic presentations are most often associated with ___

A

SCLC

121
Q

MC neurologic paraneoplastic syndrome

A

Lambert-Eaton myasthenic syndromes

122
Q

Lambert-Eaton myasthenic syndrome

A

Autoantibody formation results in impaired release of ACH which leads to poor muscle contraction

123
Q

Hypertrophic osteoarthropathy paraneoplastic syndrome

A

Symmetrical painful arthropathy that usually involves the ankles, knees, wrists, and elbows
Digital clubbing
Periosteal new bone formation

124
Q

Dermatomyositis/polymyositis paraneoplastic syndrome

A

Inflammatory myopathies manifested by muscle weakness

125
Q

Cushing syndrome paraneoplastic syndrome

A

Ectopic production of ACTH

126
Q

Bronchial carcinoid tumor

A

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

127
Q

Bronchial carcinoid tumor commonly presents before ___

A

60

128
Q

T/F - there are links to bronchial carcinoid tumor and smoking

A

False

129
Q

Clinical presentation of bronchial carcinoid tumor

A

Hemoptysis
Cough
Wheezing
Recurrent pneumonia

130
Q

Bronchoscopy of bronchial carcinoid tumor

A

Pink/purple tumor in the central airway

131
Q

Why is the bronchial carcinoid tumor purple?

A

High vascularity

132
Q

Management of bronchial carcinoid tumor

A

Observation with serial CT
Surgically remove if symptomatic

Surgery EOR (6 decks)

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