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Pulmonary Medicine > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Interparenchymal lung lesion, commonly less than 3 cm in size and not assc. with atelectasis or adenopathy

A

Solitary Pulmonary Nodule (SPN)

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2
Q

How many patients are “afflicted” with Solitary Pulmonary Nodule per year?

A

150,000

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3
Q

Most findings of nodules in the lungs are _______.

A

Incidental

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4
Q

When finding a single pulmonary nodule, what should be in your DDx?

A
  1. Malignant Neoplasm
  2. Benign Neoplasm
  3. Infection
  4. Inflammatory response
  5. Pulmonary Infarct
  6. Arteriovenous malformation
  7. Bronchogenic cyst
  8. Rounded atelectasis
  9. Intrapulmonary lymph nodes
  10. Pseudotumor (loculated fluid in fissure)
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5
Q

True/False:

Most single pulmonary nodules are malignant.

A

False; very few are malignant

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6
Q

What factors increase the risk of malignancy?

A
  1. Older age
  2. Hx of Smoking
  3. Hx of cancer
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7
Q

First line of diagnosis in finding a singe pulmonary nodule:

A
  1. CXR
  2. CT Scan***
  3. PET
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8
Q

Pros and Cons of using CXR for single pulmonary nodule:

A

Pros: Inexpensive; absence of growth over a two year time period in general indicated benign disease (compares to previous CXRs)

Cons: No characteristics consistently differentiate a benign from malignant lesion

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9
Q

Pros of using CT

A
  1. Better imaging
  2. Used to identify synchronous lung lesions, metastatic lesions, and mediastinal adenopathy
  3. Used for follow up SPNs
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10
Q

Likelihood of malignancy:

A

Size:
20+ mm > 8-20 mm > 4-7 mm > 1-3 mm

Borders:
Corona radiata > Spiculations > Scalloped/Lobulated > Smooth

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11
Q

Calcification on imaging can suggest benign if

A
  1. Diffuse and homogenous
  2. Central
  3. Laminated (concentric)
  4. Popcorn
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12
Q

Calcification on imaging can suggest malignancy if

A
  1. Reticular
  2. Punctate
  3. Amorphous
  4. Eccentric
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13
Q

This type of imaging is least used when evaluating a single pulmonary nodule. Why?

A

PET

Very sensitive and specific for benign, less specificity for malignancy

BUT can give:

  • False negatives for carcinoid tumors or bronchoalveolar carcinomas
  • False positives for infectious or inflammatory etiologies

Useful in staging mediastinum and extrathoracic metastases

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14
Q

How do you confirm diagnosis after seeing a single pulmonary nodule in the lungs?

A
  1. Transthoracic Needle Aspiration
  2. Bronchoscopy
  3. Surgery
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15
Q

When should a SPN be indicative for Surgery?

A
  1. Patients with new SPN based on prior imaging
  2. Patients with PET positive SPN
  3. Patients with growing SPN
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16
Q

In 2012, about how many people in the US died due to lung cancer?

In Florida?

A

160,000

12,000

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17
Q

Lung cancer deaths are greater than

A

Breast, prostate and colon cancers combined

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18
Q

Epidemiologic spread of lung cancer in the US is similar to the distribution of what?

A

Smoking distribution in the US

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19
Q

Cigarette smoking is the leading cause of?

A

Lung cancer

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20
Q

True/False

Quitting smoking does not modify the risk for lung cancer.

A

False

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21
Q

For a given level of smoking, the relative risk for _________ developing lung cancer is higher.

A

Females

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22
Q

True/False

Environmental Tobacco Smoke has a significant increase risk of lung cancer.

A

False!

Does increase risk, but in non-smokers it 1.2-1.7%; smokers: 2-3%

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23
Q

Do COPD patients have a greater chance of developing lung cancer?

A

Yes

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24
Q

What are assc occupational risk factors that can increase the likelihood of lung cancer?

A
  1. Asbestos
  2. Radon
  3. Polycyclic aromatic hydrocarbons
  4. Metals (Ar, Cr, Ni, Cd, Be)
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25
Q

This type of non-small cell carcinoma accounts for about 30% of lung cancers, and has a slightly higher predominance in males. About 2/3 of this will occur centrally and involve a mainstem or lobar bronchus.

A

Squamous Cell Carcinoma

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26
Q

This type of non-small cell carcinoma is the most common lung cancer, accounting for about 35%, and the most frequent type in women and non-smokers. Commonly arising in the periphery of the lung.

A

Adenocarcinoma

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27
Q

This type of non-small cell carcinoma accounts for about 10% and has poorly differentiated tumors.

A

Large Cell Carcinoma

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28
Q

This type of cancer accounts for about 20% of lung cancers and is the most aggressive form of lung cancer. Very common to have extrathoracic metastases.

A

Small Cell Carcinoma

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29
Q

How to lung cancer patients present in clinic?

A
  1. Dyspnea
  2. Cough
  3. Chest Pain
  4. Hemoptysis
  5. Hoarseness
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30
Q

_______ occurs in 26-60% of patients and could suggest more extensive disease, most often due to underlying COPD, extensive tumor infiltration of the lung, major airway obstruction, or pleural effusion.

*Note it could also be due to post-obstructive pneumonia, lymphangitic tumor spread, PE, or tumor emboli

A

Dyspnea

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31
Q

This is the most common initial symptom of lung cancer noted in about 35-75% of patients.

A

Cough

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32
Q

If there is a notable change in chronic “smoker’s cough,” what should you do?

A

Investigate for lung cancer!

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33
Q

This symptom is noted in about 20-45% of patients usually arising via direct invasion of pain-sensitive structures.

A

Chest pain

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34
Q

When a peripheral tumor invades parietal pleura and/or chest wall, what symptom would commonly present

A

Chest pain

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35
Q

This complaint only occurs in 5-10% as a single complaint, but most commonly is presented with other symptoms in about 50% of patients

A

Hemoptysis

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36
Q

This complain is common in 5-18% of patients and usually indicates mediastinal extension or adenopathy involving the left recurrent larygneal nerve

A

Hoarseness

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37
Q

Some patients with this will be asymptomatic and others can be dyspneic and hypoxemic. Usually this is present together with fevers, chills, productive cough, and may suggest post-obstructive pneumonia.

A

Atelectasis

38
Q

This is the most common cause of dyspnea in lung cancer patients, but only occurs in 7-25% of patients.
Common assc symptoms: cough and chest pain

A

Pleural Effusion

39
Q

If there is a pleural effusion and a sample is taken and found that there are malignant cells in the fluid, what would this suggest?

A

Poor prognosis!!

40
Q

This syndrome is most commonly associated with small cell lung cancer.

A

Superior vena cava syndrome

41
Q

Superior Vena Cava Syndrome complaints:

A
  1. Headache
  2. Swelling of head and neck
  3. Dizziness
  4. Visual Changes
42
Q

Physical Exam Findings for Superior Vena Cava Syndrome:

A
  1. Facial or upper extremity edema
  2. Distended neck veins
  3. Venous engorgement over chest
43
Q

When dealing with a superior sulcus or Pancoast tumor, symptoms and physical exam findings can be ________.

A

Extrathoracic – direct extension to adjacent structures such as the branchial plexus.

44
Q

If there is cervical sympathetic chain involvement of a cancer, the group of symptoms are grouped together as a ______ Syndrome

A

Homer’s

45
Q

What do you see in Homer’s Syndrome?

A
  1. Ptosis (drooping of upper eyelid)
  2. Miosis (constricted pupil)
  3. Anhidrosis (loss of sweat) over forehead and face
  4. All occur on the same side of the lung mass
46
Q

Extrathoracic symptoms occur in about

A

1/3 of patients with metastases

47
Q

Most common extrathoracic pain

A
  1. Bone pain! (Back pain most commonly)
  2. Nausea, Vomiting, Headaches
  3. Incoordination, Mental status changes, and Szs
48
Q

When a tumor secretes a hormone or hormone-like substance that has effects on the body due to excess hormone reaction.

A

Paraneoplastic Syndrome

49
Q

Common effects of Paraneoplastic Syndrome

A
  1. Syndrome of Inappropriate ADH (typically by SCC)
  2. Hypercalcemia (typically squamous cell)
  3. Eaton-Lambert Syndrome (typically SCC)
50
Q

What symptoms are seen in Eaton-Lambert Syndrome?

A

Similar to myasthenia gravis

Strength improves with exercise

51
Q

Sometimes, if metastases on adrenal gland, what can occur?

A 
Nausea
Vomiting
Weakness
Hyponatremia
Hyperkalemia
Weight loss
52
Q

About ________% of small cancers may be missed on a CXR

A

10-20%

53
Q

Do old CXRs help with dx of lung cancer?

A

YES!

54
Q

Lab tests are ________ in determine the diagnosis of lung cancer.

A

Not very useful. However, you do the tests anyways.

55
Q

PFTs are necessary when the patient is about to go in for ________ due to the lung cancer

A

Surgical Resection

56
Q

This is the most useful diagnosing technique for central tumors. Sensitivity is 75-100% (greater for larger peripheral lesions than smaller)

A

Flexible Bronchoscopy

57
Q

This is a useful diagnosing technique for peripheral tumors with a sensivity of 90%. False negative rate of about 10-25%.

A

Transthoracic Needle Biopsy

58
Q

One side effect of transthoracic needle biopsy is __________.

A

Pneumothorax

Increases by 10% for every 1 cm transverse

59
Q

This is useful for diagnosis and staging if there is a pleural effusion present

A

Thoracentesis

60
Q

This method provides staging and diagnostic information.

A

Supraclavicular Node Biopsy

61
Q

This method is only used on patients with symptomatic non-small cell carcinomas.

A

Head CT/MRI

62
Q

This method is recommented for symptomatic non-small cell caricinoma patients with hypercalcemia. Sometimes it is also recommended for staging the disease.

A

Bone Scan

63
Q

For Stage I or II Non-small cell carcinoma, what is the first line of treatment?

A

Surgery!!!

70% 5-year survival for Stage I
55% 5-year survival for Stage II

64
Q

If a patient with Stage I or II does not want surgeries, what should you do?

A 
Chemotherapy (Adjunctive)
Radiation Therapy (Can't tolerate or refuse sx)
Stereostatic Radiation Therapy (Can't tolerate or refuse sx)
65
Q

Radiation therapy 5 year survival rate for Stage I or II non-small cell carcinoma?

A

20%

66
Q

Stereostatic Radiation Therapy 5 year survival rate for Stage I or II non-small cell carcinoma?

A

50-70%

67
Q

How would you treat Stage IIIa non-small cell carcinoma?

A

Chemotherapy and/or radiation therapy

68
Q

5-year survival rate for Stage IIIa non-small cell carcinoma in the lungs?

A

10-15%

69
Q

Some studies have shown that using ______ after Chemo/Radiation in Stage IIIa non-small cell carcinoma .

A

Surgery

70
Q

How would you treat Stage IIIb non-small cell carcinoma?

A

Chemotherapy and/or radiation therapy

71
Q

5-year survival rate for Stage IIIb non-small cell carcinoma in the lungs?

A

10%

72
Q

How would you treat Stage IV non-small cell carcinoma?

A

Chemotherapy, but debatable utility of treatment

73
Q

Median survival rate for Stage IV non-small cell carcinoma

A

3-6 months

74
Q

Chemotherapy in Stage IV non-small cell carcinoma has been shown to extend survival by _______.

A

3-4 months

75
Q

What does limited stage small cell carcinoma mean?

A

Disease is confined to a hemithorax

76
Q

How would you treat limited stage small cell carcinoma?

A

Chemotherapy and/or Radiation Therapy

77
Q

Survival Rates of this Disease

A

2-year: 20-25%

5-year: 10%

78
Q

What does extensive stage small cell carcinoma mean?

A

Disease beyond a hemithorax

79
Q

How would you treat extensive stage small cell carcinoma?

A

Chemotherapy

80
Q

Median survival rate of extensive stage small cell carcinoma

A

6-10 months

81
Q

Palliative Measures for pleural effusions

A

Pleurodesis

82
Q

Palliative Measures for bony metastases

A

Radiation Therapy

83
Q

Palliative Measures for Endobronchial obstruction

A

Broncoscopic modalities

84
Q

Palliative Measures for dyspnea, pain, and cough

A

Opiates

85
Q

Palliative Measures for general QOL

A

Hospice

86
Q

DDx for Anterior Mediastinal Mass

A

4 T’s:

  1. Thymic Tumors
  2. Teratoma
  3. Thyroid
  4. Terrible Lymphoma
87
Q

DDx for Middle Mediastinal Mass

A

4 A’s:

  1. Adenopathy
  2. Awful Primary Neoplasm
  3. Aneurysm/Vascular
  4. Abnormalities of Development
88
Q

DDx of Posterior Mediastinal Mass

A
  1. Neurogenic Tumors
  2. Esophageal Tumors and Duplication Cysts
  3. Neuroenteric Cysts
  4. Hiatal Hernias
89
Q

Signs and Symptoms of most mediastinal tumors:

A
  1. Most Asymptomatic or with vague complaints
  2. Advanced Invasive Disease: Pain
  3. Airway compression can lead to dyspnea and recurrent infection
  4. Esophageal compression may cause dysphagia
  5. Spinal canal can result in paralysis
  6. Phrenic nerve damage may cause elevated hemidiaphragm
  7. Laryngeal nerve involvement may result in hoarseness
  8. SVC syndrome
  9. Horner’s syndrome due to sympathetic ganglion involvement
90
Q

How to diagnose mediastinal tumors?

A
  1. Need to decide whether lesion can be observed, aspirated, excised, or biopsied
  2. If excision is indicated as is case with teratoma, thymoma, and most isolated lesions likely to be benign, definitive operation should be performed
  3. Biopsy is procedure of choice if mass is likely to be a lymphoma, germ cell tumor, or unresectable invasive malignancy
    - — Surgical biopsy versus CT guided biopsy (core, fine needle)

Pulmonary Medicine (14 decks)

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