Thoracic Surgery - Diseases of the Lungs Flashcards
What is the number of annual deaths from lung cancer?
160,000 (most common cancer death in the US in men and women)
1 risk factor for lung cancer?
Smoking
True or false - asbestos exposure increases the risk of lung cancer in patients who smoke.
True
What type of lung cancer arises in non-smokers?
Adenocarcinoma
Cancer arises more often in which lung?
R>L
Upper>lower
Signs and symptoms of lung cancer?
Change in a chronic cough
Hemoptysis, chest pain, dypsnea
Pleural effusion (suggests chest wall involvement)
Hoarseness (recurrent laryngeal nerve involvement)
SVC syndrome
Diaphragmatic paralysis (phrenic nerve involvement)
Symptoms of mets/paraneoplastic syndrome
Finger clubbing
What is a pancoast (superior sulcus) tumor?
Tumor at the apex of the lung or superior sulcus that may involve the brachial plexus, sympathetic ganglia, and vertebral bodies, leading to pain, upper extremity weakness, and Horner’s syndrome
What is Horner’s syndrome?
Injury to the cervical sympathetic chain; think “MAP”
- Miosis (small pupil)
- Anhidrosis of ipsilateral face
- Ptosis
What are the 5 most common sites of extrathoracic metastases?
- Brain
- Bone
- Adrenals
- Liver
- Kidney
What are paraneoplastic syndromes?
Syndromes that are associated with tumors but may affect distant parts of the body; they may be caused by hormones released from endocrinologically active tumors or may be of uncertain etiology
Name 5 general types of paraneoplastic syndromes.
- Metabolic - Cushing’s, SIADH, hypercalcemia
- Neuromuscular: Eaton-Lambert, cerebellar ataxia
- Skeletal: hypertrophic osteoarthropathy
- Dermatologic: acanthosis nigricans
- Vascular: thrombophlebitis
What are the associated radiographic tests for lung cancer?
CXR, CT, PET
How is a tumor diagnosed?
- Needle biopsy (CT or fluoro guidance)
- Bronch with brushings, biopsies, or both
- +/- mediastinoscopy, mediastinotomy, scalene node biopsy, or thoracoscopic/open lung biopsy for definitive diagnosis
How is small cell carcinoma treated?
Chemo +/- XRT and prophylactic whole brain irradiation (very small isolated lesions can be surgically resected)
Contraindications to surgery for lung cancer
SSSSTOP IT
SVC syndrome Supraclavicular node mets Scalene node mets Tracheal carina involvement Oat cell carcinoma (rx with chemo +/- radiation) PFTs FEV1 <0.8 L Infarction (myocardial) Tumor elsewhere (mets)
What post-op FEV1 must you have?
FEV1 >/= 800 CC; preoperative FEV1 >/= 2L usually needed for pneumoectomy
If FEV1 is <2L, V/Q scan should be performed
What is hypertrophic pulmonary osteoarthropathy?
Periosteal proliferation and new bone formation at the end of long bones and in the bones of the hand (seen in 10% of patients with lung cancer)
What is a solitary pulmonary nodule (SPN)?
Intraparenchymal pulmonary lesion <3 cm (considered at mass at 3cm); causes can be benign (60%) or malignant (40%)
Risk of malignancy based on size of SPN?
<3 mm: 0.2%
4-7 mm: 0.9%
8-20 mm: 18%
>20 mm: 50%
Dx solitary pulmonar nodule?
CXR, chest CT
Characteristic appearance of hamartoma on CXR?
Popcorn calficiation
Common benign etiologies of SPN?
Infectious granuloma (80% of benign SPN) Hamartoma (10% of benign SPN)
What percentage of SPNs are malignant?
Overall 5-10%, but >50% in smokers >50 y/o
Is there a gender risk?
Yes; the incidence of coin lesions is 3-9x higher and malignancy is nearly 2x as common in men as in women
Risk factors for malignancy?
Size: lesions >1 cm hae a significant chance of malignancy and those >4 cm are very likely to be malignant Indistinct margins (corona radiata) Documented growth on follow-up XR (if no change in 2 years, most likely benign) Increasing age
Dx modalities available for tissue diagnosis?
CT-guided perc biopsy (excellent accuracy if 1+ cm) Navigational bronch (employs CT and electromagnetic guidance to target the bronchus associated with the pulmonary nodule for biopsy; also can place markers to aid in thorascopic ID for wedge resection
Thorascopic (better tolerated) or open thoracotomy with wedge resection
What is the risk of cancer in a patient with SPN and pulmonary hypertrophic osteoarthropathy?
> 75% of carcinoma
Incidence of pulmonary hyeprtrophic osteoarthropathy?
~7% of patients with lung cancer (2-12%)
Signs of pulmonary hpyertrophy osteoarthropathy?
Associated with finger clubbing
Dx by x-ray of long bones revealing perisosteal bone hypertrophy
