OnlineMedEd: Pulmonology - "Lung Cancer"

Question 1

Why might you be suspicious of tuberculosis in a patient with lung cancer?

Answer 1

Similar symptom profile: fever, weight loss, and hemoptysis

Question 2

Describe the diagnostic workup of suspected lung cancer.

Answer 2

•First, for patients with fever, hemoptysis, and weight loss, order an x-ray.
•Second, interpret the x-ray:
- If there’s a nodule, then do a CT and biopsy.
- If the XR is negative and they don’t have a paraneoplastic syndrome, then stop; if they do have a paraneoplastic syndrome, then do a CT and biopsy.
- If the XR shows effusion, then do a tap of the effusion and look for malignant cells. If positive then CT.

Question 3

Describe the newer bronchoscopic technique.

Answer 3

Called EBUS (endobronchoscopic ultrasound), it involves doing a bronchoscopy with an ultrasound so that you can see any masses on the other side of the airway.

Question 4

Peripheral lesions can be sampled with _________. Central lesions can be sampled with ___________.

Answer 4

CT-assisted biopsy; video-assisted sampling (VATS)

Question 5

If a centrally located lesion looks highly suspicious for lung cancer, then you can _______________.

Answer 5

diagnose with resection

Question 6

How is lung cancer staging done?

Answer 6

PET-CT (then do PFTs to get a baseline)

Question 7

Who should receive low-dose CTs screening for lung cancer?

Answer 7

Those who are 55-80 yo, who have smoked for more than 30 pack years, and who quit smoking less than 15 years ago.

Question 8

What are the “good” characteristics in a lung nodule?

Answer 8

• Less than 8 mm in diameter (greater than 2 cm is bad)
• Smooth borders (spiculated is bad)
• No calcifications
• Person is younger than 45 and who didn’t smoke

Question 9

How frequently should LDCTs be done?

Answer 9

Yearly

Question 10

If a pulmonary nodule has not changed in _________, then it is considered to be stable and no follow-up is needed.

Answer 10

2 years

Question 11

If a pulmonary nodule is changing, what should you do?

Answer 11

• For low-risk nodules (unclear criteria but I think it has to do with the nodule’s characteristics, mentioned in another card), do serial CTs.
• For high-risk nodules (ditto), biopsy.

Question 12

Give a rundown on small cell carcinoma.

Answer 12

• Cannot do surgery, but usually sensitive to chemotherapy and radiation
• Paraneoplastic syndromes: SIADH, Cushing’s, anti-cerebellar antibodies, LEMS
• Smoking highly causative

Question 13

What is the pathophysiology of hypercalcemia in squamous cell carcinoma?

Answer 13

PTH-rp (related-peptide) is released by the tumor –not PTH.

(Remember the Sketchy with the PHd sneaking out of the SCC cell.)

Question 14

Adenocarcinoma –which is more common in non-smokers –is related to what exposure?

Answer 14

Asbestos