Clin Med: Pulmonary Neoplasia

Question 1

Lung cancer screening guidelines

Answer 1

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

Question 2

What imaging do we use for lung cancer screening

Answer 2

LDCT every year

Question 3

Solitary Pulmonary nodule are more prevalent in

Answer 3

high risk pts - smokers, COPD, older pts

Question 4

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

Answer 4

diffuse
central popcorn
concentric
size < 3cm

Question 5

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

Answer 5

Ground-glass
eccentric
size > 3cm

Question 6

Solitary Pulmonary nodules are primarily _______ lung nodules

Answer 6

benign

Question 7

What constitutes a Solitary Pulmonary nodule?

Answer 7

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

Question 8

Anything greater than 3 cm is called a

Answer 8

mass

Question 9

Anything smaller than 3 cm is called a

Answer 9

nodule

Question 10

Definitive dx of pulm nodules =

Answer 10

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

Question 11

80% of benign nodules are

Answer 11

infectious granulomas

Question 12

High risk for a solitary pulmonary nodule

Answer 12

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

Question 13

If found on CXR you need to follow up with a

Answer 13

Chest CT

Question 14

Bronchogenic Carcinomas is the traditional “______”

Answer 14

lung cancer
#1 cause of cancer deaths

Question 15

Bronchogenic Carcinomas are rare prior to the age of

Answer 15

40

Question 16

Bronchogenic Carcinomas risk factors

Answer 16

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

Question 17

Bronchogenic Carcinomas are divided into 2 types of cancer

Answer 17

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

Question 18

Non small cell includes

Answer 18

adenocarcinoma
squamous cell carcinoma
Large cell carcinoma (everything else)

Question 19

Bronchogenic Carcinomas:
Small cell =

Answer 19

neuroendocrine cells

Question 20

Small cell carcinoma has a strong association with

Answer 20

smoking

Question 21

Presentation of small cell carcinoma

Answer 21

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

Question 22

Adenocarcinoma is m/c in

Answer 22

non-smokers

Question 23

Presentation of Adenocarcinoma

Answer 23

Often found incidentally
paraneoplastic syndromes rare
peripheral masses

Question 24

Squamous cell carcinoma has a strong association with

Answer 24

smoking

Question 25

Presentation of squamous cell carcinoma

Answer 25

Often presents with hemoptysis central (bronchial) masses

Question 26

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

Answer 26

as peripheral or central masses

Question 27

Bronchogenic Carcinomas: Squamous cell =

Answer 27

bronchial epithelial cells

Question 28

Bronchogenic Carcinomas: Adenocarcinoma =

Answer 28

glandular (mucous) cells

Question 29

Bronchogenic Carcinomas: Large cell =

Answer 29

undifferentiated (cell types that don't fit others)

Question 30

Bronchogenic Carcinomas workup after diagnosis

Answer 30

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

Question 31

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

Answer 31

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

Question 32

Treatment of Bronchogenic Carcinomas

Answer 32

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

Question 33

Carcinoid tumors are a ______ and _________ tumor

Answer 33

rare malignant neuroendocrine

Question 34

Two different types of carcinoid tumors

Answer 34

typical and atypical

Question 35

Carcinoid tumor presens where in the body

Answer 35

central masses (bronchial masses)

Question 36

Carcinoid tumor Sx

Answer 36

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

Question 37

Carcinoid syndrome presents with

Answer 37

facial flushing SOB HTN wt gain hirsutism asthma

Question 38

Carcinoid tumor workup

Answer 38

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

Question 39

Carcinoid tumor on Chest CT usually looks like

Answer 39

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

Question 40

Carcinoid tumor treatment

Answer 40

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

Question 41

Pulmonary metastases is primarily through the

Answer 41

pulmonary artery

Question 42

Where does primary lung cancer metastasize to

Answer 42

bones liver brain lymph nodes adrenal glands

Question 43

Work up for pulmonary mets

Answer 43

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

Question 44

Pulmonary mets: on CT scan

Answer 44

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

Question 45

Treatment for pulmonary mets

Answer 45

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)

Question 46

Mesothelioma is nearly always secondary to

Answer 46

asbestos exposure

Question 47

Mesothelioma arises from

Answer 47

mesothelial tissue (pleura)

Question 48

Presentation of mesothelioma

Answer 48

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

Question 49

Work up for Mesothelioma

Answer 49

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

Question 50

Mesothelioma treatment

Answer 50

resection +/- chemotherapy +/- radiation no single treatment significantly improves mortality supportive treatments median survival 9-12 months