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Pulmonology > Clin Med: Pulmonary Neoplasia > Flashcards

Clin Med: Pulmonary Neoplasia Flashcards

1
Q

Lung cancer screening guidelines

A

Adults aged 50-80 years who have a 20 pack-year smoking history and currently or have quit within the past 15 years

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2
Q

What imaging do we use for lung cancer screening

A

LDCT every year

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3
Q

Solitary Pulmonary nodule are more prevalent in

A

high risk pts - smokers, COPD, older pts

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4
Q

Benign vs Malignant types of nodules:
More likely to be benign

A

diffuse
central popcorn
concentric
size < 3cm

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5
Q

Benign vs Malignant types of nodules:
More likely to be malignant

A

Ground-glass
eccentric
size > 3cm

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6
Q

Solitary Pulmonary nodules are primarily _______ lung nodules

A

benign

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7
Q

What constitutes a Solitary Pulmonary nodule?

A

Discrete, round, size < 3 cm
“coin lesions”
not fixed to the pleura or chest wall
NO lymphadenopathy, infiltrate, atelectasis

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8
Q

Anything greater than 3 cm is called a

A

mass

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9
Q

Anything smaller than 3 cm is called a

A

nodule

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10
Q

Definitive dx of pulm nodules =

A

bx - CT guided fine needed, bronchoscopy with bx, excisional, etc.

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11
Q

80% of benign nodules are

A

infectious granulomas

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12
Q

High risk for a solitary pulmonary nodule

A

hx of smoking
+ Fhx of lung cancer
carcinogen exposure
upper lobe nodule
emphysema
pulmonary fibrosis

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13
Q

If found on CXR you need to follow up with a

A

Chest CT

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14
Q

Bronchogenic Carcinomas is the traditional “______”

A

lung cancer
#1 cause of cancer deaths

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15
Q

Bronchogenic Carcinomas are rare prior to the age of

A

40

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16
Q

Bronchogenic Carcinomas risk factors

A

85-90% secondary to smoking
+FHx
Pre-existing pulmonary disease
Exposure-related risks

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17
Q

Bronchogenic Carcinomas are divided into 2 types of cancer

A

small-cell (aka oat cell)
non-cell cancer types

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18
Q

Non small cell includes

A

adenocarcinoma
squamous cell carcinoma
Large cell carcinoma (everything else)

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19
Q

Bronchogenic Carcinomas:
Small cell =

A

neuroendocrine cells

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20
Q

Small cell carcinoma has a strong association with

A

smoking

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21
Q

Presentation of small cell carcinoma

A

rapid onset of sx (8-12 wks)
paraneoplastic syndromes common
mets common at presentation
central (bronchial) masses

22
Q

Adenocarcinoma is m/c in

A

non-smokers

23
Q

Presentation of Adenocarcinoma

A

Often found incidentally
paraneoplastic syndromes rare
peripheral masses

24
Q

Squamous cell carcinoma has a strong association with

A

smoking

25
Q

Presentation of squamous cell carcinoma

A

Often presents with hemoptysis
central (bronchial) masses

26
Q

Large cell carcinoma is a dx of exclusion and may present _______? (where are the masses located)

A

as peripheral or central masses

27
Q

Bronchogenic Carcinomas:
Squamous cell =

A

bronchial epithelial cells

28
Q

Bronchogenic Carcinomas:
Adenocarcinoma =

A

glandular (mucous) cells

29
Q

Bronchogenic Carcinomas:
Large cell =

A

undifferentiated (cell types that don’t fit others)

30
Q

Bronchogenic Carcinomas workup after diagnosis

A

PET scan
CT abdomen and pelvis +/- bone scan
MRI of chest if concern for adjacent structures
Head CT/MRI
Lymph node bx

31
Q

Staging:
small cell lung cancer=
non-small cell lung cancer=

A

limited disease or extensive disease
follows the TMN staging (tumor size, lymph node, mets)

32
Q

Treatment of Bronchogenic Carcinomas

A

chemo + radiation for small cell carcinoma
non-small cell depends on stage:
- resection alone
- +chemo
- unresectable: chemo +/- radiation
- +/- adjunctive immunotherapy

33
Q

Carcinoid tumors are a ______ and _________ tumor

A

rare
malignant neuroendocrine

34
Q

Two different types of carcinoid tumors

A

typical and atypical

35
Q

Carcinoid tumor presens where in the body

A

central masses (bronchial masses)

36
Q

Carcinoid tumor Sx

A

usually due to bronchial obstruction:
cough
wheezing
hemoptysis
atelectasis, PNA
carcinoid syndrome

37
Q

Carcinoid syndrome presents with

A

facial flushing
SOB
HTN
wt gain
hirsutism
asthma

38
Q

Carcinoid tumor workup

A

Chest CT is modality of choice
CBC, CMP
test for endocrine dysfunction

39
Q

Carcinoid tumor on Chest CT usually looks like

A

well defined, round, maybe lobulated nodule
+/- calcifications

40
Q

Carcinoid tumor treatment

A

resection (lobectomy) preferred
+/- chemo and/or radiation
possible use of octreotide for hormonal control

41
Q

Pulmonary metastases is primarily through the

A

pulmonary artery

42
Q

Where does primary lung cancer metastasize to

A

bones
liver
brain
lymph nodes
adrenal glands

43
Q

Work up for pulmonary mets

A

CXR most common initial test
helical chest CT if the BEST test
+/- PET for concern
+/- bronchoscopy if a central metastasis

44
Q

Pulmonary mets: on CT scan

A

spherical, fairly well defined, varying in size (m/c will find multiple)

45
Q

Treatment for pulmonary mets

A

solitary pulmonary nodule - resection
mets limited to the lung and few in # - consider resection
multiple nodules, multiple met sites, unreachable - palliative care (rad and/ or chemo)

46
Q

Mesothelioma is nearly always secondary to

A

asbestos exposure

47
Q

Mesothelioma arises from

A

mesothelial tissue (pleura)

48
Q

Presentation of mesothelioma

A

through screening
ssx: dyspnea, non-pleuritic CP most common
pleural effusion is present 95% of the time

49
Q

Work up for Mesothelioma

A

CXR commonly done
CT for further differentiation
Thoracentesis for pleural effusion
Pleural bx
CT, MRI, PET, bronchoscopy for staging

50
Q

Mesothelioma treatment

A

resection +/- chemotherapy +/- radiation
no single treatment significantly improves mortality
supportive treatments

median survival 9-12 months

Pulmonology (18 decks)

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