Lung CA Flashcards
(119 cards)
1
Q
“coin lesion”
A
solitary pulmonary nodule (SPN)
2
Q
Characteristics of SPN
A
< 3cm isolated, rounded opacity
completely surrounded by pulmonary parenchyma
not associated w/ infiltrate, atelectasis or adenopathy
most are benign
3
Q
Signs of benign
A
smooth, well-defined edges
dense central calcification
4
Q
Most common SPN
A
infectious granulomas
5
Q
Mass characteristics
A
> 3 cm in size
greater chance of malignancy
CA until proven otherwise
Goal:
- determine which needs resection
- limit invasive procedures for benign disease
6
Q
Causes of benign nodules
A
infectious (80%): TB, Cocci, abscess
Hamartoma
vascular
inflammatory
7
Q
Risk factors for malignancy
A
tobacco female FHx emphysema previous malignancy asbestos exposure
8
Q
PE findings
A
unexplained weight loss
supraclavicular LAD
fixed or localized wheeze
joint tenderness
9
Q
Approach to SPN
A
- Review old films: malignant nodules typicallyd ouble in 20-400 days; minimal growth = benign
- Calcification = benign
- Shape: smooth, well defined = benign
- Size: >5cm = 90% CA
10
Q
Imaging for SPN
A
CT w/o contrast w/ low radiation (thin 1 mm slices)
11
Q
Low probability <5% management nodule >8 mm
A
get CT @ 3 mo
- no growth = serial CT at 9-12 and 18-24
- growth = patho eval
12
Q
Intermediate probability (5-65%) nodule > 8 mm
A
FDG PET/CT and/or Bx
CT survellience at 3,9-12 and 18-34 mo (alt. to bx)
13
Q
High probabilty >65% nodule > 8 mm
A
biopsy or excision (staging with PET/CT may be helpful)
14
Q
Nodule <8 mm step
A
6-8 mm: follow w/ CT @ 6-12 mo then repeat as indicated
<6mm: doesn’t usually require f/u; CT @ 12 mo optional
15
Q
Lung malignancy types
A
SCLC: oat cell carcinoma NSCLC: -adenocarcinoma (42%) - squamous cell carcinoma (22%) - large cell carcinoma (2%)
16
Q
Oat cell lung cancer (SCLC) location
A
CENTRAL airways
17
Q
Presentation of SCLC
A
large hilar mass w/ bulky mediastinal adenopathy
cough, dyspnea, weight loss, debility
HIGHLY AGGRESSIVE
18
Q
Prognosis of SCLC
A
6-18 weeks w/o tx
19
Q
Categories for SCLC
A
limited (ipsilateral hemithorax and regional ndoes)
extensive (70%)
20
Q
Adenocarcinoma etiology
A
arises from mucous glands or any epithelial cell in or distal to the terminal bronchioles
21
Q
Location of adenocarcinoma
A
peripheral (distal or in terminal bronchioles)
22
Q
Squamous cell carcinoma location
A
centrally or in main bronchus
23
Q
Squamous cell carcinoma etiology
A
bronchial epithelium
24
Q
Characteristics of squamous cell carcinoma
A
intraluminal growth in bronchi may detect by sputum cytology more likely to cause hemoptysis likely to metastasize to regional lymph nodes can cavitate
25
More likely to cause hemoptysis
squamous cell
26
Found in bronchial tube
squamouss
27
found centrally
SCLC
28
Found distal to terminal bronchioles
Adenocarcinoma
29
Large cell carincoma location
central or peripheral masses
30
Characteristics of large cell
metastazes to distant organs
relatively undifferentiated
AGGRESSIVE - rapid doubling time
31
Metastasized to lymph nodes
squamous
32
metastasizes to distal organs
adeno and large cell
33
Sx result from
paraneoplastic syndromes
| metastasis: may have no lung complains
34
paraneoplastic syndrome
altered immune system response to neoplasm (ataxia, eye movements, etc)
35
Most common sx of lung canger
cough
36
Cough is most frequent with
squamous and small cell
37
poor prognosis for lung CA
weight loss
38
Hemoptysis
squamous cell
39
What is the most common cause of hemoptysis
bronchitis
40
Sx of intrathoracic pread
PE (direct pleural extention, mediastinal node involvement, lymph obstruction)
pericardial effusion
hoarseness (compression of laryngeal nerve; > w. left sided tumors)
41
Cause of SVC syndrome
```
patho process of:
right lung
lymph nodes
other mediastinal structure
thrombosis of devices
```
42
Most common to cause SVC
SCLC
43
Sx of SVC syndrome
dyspnea!
facial swelling/head fullness (worse w/ forward bend)
arm swelling, cough, chest pain, dysphagia
44
PE for SVC syndrome
facial edema
dilated neck veins
prominent venous pattern on chest
45
Dx for SVC syndrome
CXR
Duplex U/S (initial for indwelling devises or arm swelling)
CT w/ contrast (level and extent of block)
Superior vena cavogram (GOLD STANDARD) - identify and extent of thrombus formation
46
Gold standard for dx SVC syndrome
superior vena cavogram
47
Tx goals for SVC syndrome
alleviate sx and underlying disease
48
Tx options for SVC syndrome
Emergency RT
venous stent
chemo if indicated
removal of devices and anticoag
49
Indications for emergency RT (radiation)
stridor from central airway obstruction or laryngeal edema
| coma from cerebral edema
50
Pancoast syndrome
tumor involving superior sulcus (apical chest); compresses brachial plexus and cervical sympathetic nerves
51
Horner's Syndrome
injury of sympathetic nerves of the face
52
Pancoast syndrome sx
```
right shoulder > forearm, scapula and finger pain
ipsilateral to side of tumor
miosis
anhidrosis
ptosis
rib destruction
atrophy of hand mm.
pain C8, T1, T2 nerve roots
```
53
Most common to cause pancoast syndrome
Squamous cell
54
Sx of paraneoplastic syndrome
```
anorexia
weight loss
cachexia
fever
suppressed immunity
```
55
Hematologic dysfunction in paraneoplastic syn.
```
hypercalcemia (bone destruction)
anemia (fatigue, dyspnea)
leukocytosis (poor prognosis)
thrombocytosis (shortened survival)
hypercoagulability
```
56
Poor prognosis in paraneoplastic
leukocytosis and thrombocytosis
57
Endocrine dysfunction in paraneoplastic
PTH-like substance: hypercalcemia
| Excess HCG production: gynecomastia, milky nipple d/c
58
Most likely to cause hypercalcemia due to PTH
Squamous
59
Most likely to cause gynecomastia and nipple d/c
large cell
60
SIADH causing hyponatremia
small cell
61
Presentation of SIADH
```
irritable
restlesss
personality changes
confusion
coma
seizure
resp. arrest
```
62
Cushing syndrome due to ectopic ACTH
small cell
63
Small cell can cause what effects in paraneoplastic syndrome
SIADH and Cushings (ACTH) and Eaton-Lambert
64
Presentation of cushings
```
muscle weakness
weight loss
HTN
Hirsuitism
Osteoporosis
```
65
Neuro sign in paraneoplastic
Eaton-Lambert Syndrome
66
Eaton-Lambert Syndrome
immune mediated
| antibodies at NMJ: defective release of Ach, mm. weakness
67
Causes Eaton-Lambert
small cell
68
Most common sites of metastases
Liver (elevated LFT)
bone (elevated ALP)
adrenal (rarely symptomatic)
brain
69
What is most likely to metastasize to brain
SCLC
70
#1 cause of brain metastasis
lung CA
71
Sx of brain metastasis
```
HA
N/V
seizures
confusion
personality chagnes
```
72
Staging of SCLC
limited vs extensive
73
Staging of NSCLC
T - primary tumor
N - nodal involvement
M- distant metastases
74
Dx of Lung CA
bx
75
Obtaining tissue sample for tissue bx
sputum (central lesion- squamous)
Bronchoscopy w/ bx
thoracentesis (remove fluid from pleural space)
fine needle aspiration/CT-guided needle bx
transbronchial aspiration
VATS
Thoracotomy
76
Performance status
0- fully active
1- strenous activity restricted
2- capable of all self-care; can't carry out work activities; up >50% of walking hours
3= limited self care; confined to bed or chair
4 = completely disabled; no self-care
77
PFT
<60% = strongest indicator of post-op complications
78
used for staging
PET
79
used in PET
fluorodeoxyglucose (FDG)
80
Limitations of PET
does not detect all CA (bronchoalveolar CA)
| infections may be +
81
Normally light up in PET
kidneys
bladder
heart
82
Tx for NSCLC
```
surgical resection (I-IIIA)
IIIB-IV = palliative radiation or combo chemo
```
83
Tx for SCLC
```
chemo regardless of stage
(cisplatin + etoposide)
limited disease: chemo + radiation
radiation
prophylactic cranial radiation
relapse commo
surgery option <5%
```
84
Main tx for NSCLC
resection
85
Main tx for SCLC
chemo +/- radiation
86
Malignant effusion tx
thoracentesis
pleurodesis (chem agent)
pleurx catheter
87
SE of surgery
pain
88
SE of radiation
fatigue
89
SE of chemo
```
anemia, neutropenia
nephrotoxicity
cutaneous toxicity
n/v, anorexia, weightloss
fatigue, "chemo brain"
```
90
Stage 1 NSCLS tx
resection (lobectomy)
| alt: radiation
91
1B NSCLC tx
resection + chemo
92
Stage 2 NSCLC tx
surgical resection + chemo
93
Stage 3 NSCLC
unresected: chemo
resected: adjuvant chemo; RT if uncertain resection margin
94
Stage 4 NSCLC tx
palliative (sx baed)
chemo, clinical trials
resection of metastasis
"targeted therapy" - EGF-R inhibitors
95
Used for lung cancer screening
Low-dose helical CT (LDCT)
96
Who should get screened?
age 55-74 w/ 30 pack/yr history
or quit w/i 15 yrs
or 20 pack/yr hx with one more risk factor
97
Smoking cessation drugs
Zyban (wellbutrin)
Chantix (varenicline)
Nicotine replacement
98
chantix MOA
blocks alpha-4-beta-2 nicotinic acetylcholine receptors
99
Effects of chantix
stop smoking in 7 days
| Rx 12-24 weeks
100
Precaution of chantix
unstable CVD
101
drug interrxns with chantix
synergistic w/ nicotine
102
Adverse rxns of chantix
dizziness, HTN, palpitations, GI upset
103
zyban MOA
inhibits neuronal uptake of NE and dopamine
104
Effects of zyban
stop smoking 5-7 days
105
precaution of zyban
avoid EtOh
106
Black box warning
zyban;
| increased suicide in children, young adults, adolescents
107
Adverse rxns of zyban
seizures*, agitation, wt. loss
108
Nicotine replacement
```
nicotrol NS (nasal spray)
nicotrol inhaler
```
109
Precautions of nicotine replacemetn
unstable CVD
110
Adverse rxns of nicotine replacement
dizziness, HTN, palpitations, GI upset
111
OTC nicotine replacement
nicoderm CQ
nicorette
commit lozenge
112
thrombophlebitis
adenocarcinoma
113
most common NSCLC
adenocarcinoma
114
central bronchi
squamous cell
115
associated with PTH
squamous
116
slow growing, late metastasis
squamous
117
dx of exclusion
large cell
118
main cause of adenocarcinoma
smoking
119
associated with SCLC
cushing, eaton-lambert, SIADH
