Lung Cancer

Question 1

Define Lung Cancer

Answer 1

Lung cancer, or bronchogenic carcinoma, is a proliferative malignant neoplasm arising from the primary respiratory epithelium.

Question 2

What is the most common malignant neoplasm among men

Answer 2

Lung Cancer

Question 3

What is the most common Cancers in women

Answer 3

Breast is MC

Then cervical then Lung (3rd)

Question 4

Small Cell Lung Cancer is most common to what demographic

Answer 4

Smokers

Question 5

What is the most common Non Small Cell Lung Cancer

Answer 5

Adenocarcinoma

Question 6

What are the three types of Non Small Cell Lung CA

Answer 6

Adenocarcinoma (MC)

Squamous Cell

Large Cell Carcinoma Subtypes

Question 7

What is the biggest risk factor for development of Lung Cancer

Answer 7

Smoking is #1

Then radiation, 2nd hand smoke/ exposure to toxins, then genetics

Question 8

If a solitary pulm nodule has not changed from an old CXR or Ct in the past two years.. what further work up is required

Answer 8

No change in 2 years mean benign and no further workup is needed

Question 9

You find a solitary pulm nodule on CXR, the pt is low risk for malignancy

What is the F/u approach

Answer 9

Serial CRT scan at 3, 6, 9, 12, 18 and 24 months

Question 10

You find a single pulm nodule on CXR, and the pt is high risk of malignancy, what is the F/u approach

Answer 10

Pet scan, Bronchoscopy, or FNA biopsy

To determine if benign or malignant.

If benign then serial Ct Scans at 3-6-9-12-18-24 months

If Malignant refer for SRGRY

Question 11

What is the criteria to determine high risk of malignancy F/u for a single pulm nodule

Answer 11

Smoking History

Or nodule size greater than 8mm

Question 12

A pt presents with chest pain, hemoptysis, clubbing of the fingers, anemia , and fever, wt loss, and fatigue

With clubbing on the fingers think

Answer 12

CANCER!

Question 13

What is the percent of brain metastases with small cell and adenocarcinoma

Answer 13

20-30% for small cell

10% for adenocarcinoma

Question 14

A pt with lung cancer that has a recent change in voice should raise high index of suspicion of what ..

Answer 14

Involvement with the recurrent larygeal nerve

Question 15

All Suspected Lung Cancer pts should get what work up labs

Answer 15

CBC and CMP

Question 16

What is the definitive Diagnosis for lung cancer

Answer 16

FNA of palpable lymph nodes , direct Bronchoscopy, or transthoractic needle aspiration

Question 17

What would be the route to Dx a mediastinal mass

Answer 17

Transbronchial needle aspiration (TBNA)

Endobronchial ultrasound with Fine Needle Aspiration (EBUS-FNA)	

Esophageal endoscopic ultrasound with fine needle aspiration (EUS-FNA)

Anterior mediastinotomy

Question 18

What are the indications for Low dose Helical CT scan screening

Answer 18

Adults 50-80 years old
+20 pack year history
+currently smokes or quit within the past 15 years
Or life expectancy that would support ability of willining to have a curative lung cancer screening

Question 19

A Soliatery pulm nodule less than 3 cm is considered a

Answer 19

Nodule

Question 20

A solitary pulm nodule greater than 3 cm is considered a..

Answer 20

Mass

Question 21

What are the features of a pulm nodule that are most likely to be malignant

Answer 21

Age over 30, smokers, with any PmHx of Ca,
Greater than 8 cm at discovers
Or eccentric calcification, thick walled cavitations, or ill defined borders that are speculated

Also Corona radiata margins

Question 22

What are the two CT calcifications that are likely to be malignant in a single pulm nodule

Answer 22

Stippled or Eccentric

Question 23

What should we Always evaluate old films in the work up for malignancy

Answer 23

allows est. of doubling time (important marker for malignancy)

Rapid progression (<30d) suggests infection

Long term stability (>365d) suggests benign lesion

Question 24

What the the imaging tool of choice to evaluate a single pulm nodule

Answer 24

Chest CT

Question 25

What is the most common pathway for metz lung cancer

Answer 25

Pulmonary Artery MC

Question 26

What are the most common primary tumors that metx to the lungs

Answer 26

Kidney, breast, colorectal, cervix, and malignant melanoma

Question 27

What are the findings of Metz lung cancer on Chest XRay

Answer 27

The findings of metastatic lung cancer on CXR are: Multiple, spherical densities with sharp margins Most are < 5cm Bilateral More common in the lower lung fields Cavitations—suggests squamous cell

Question 28

Small cell carcinoma is commonly associated with what endocrine d/o

Answer 28

SIADH

Question 29

What is the most common primary lung cancer

Answer 29

Adenocarcinoma

Question 30

Adenocarcinoma arises from what glands

Answer 30

Mucus glands

Question 31

You find intraluminal sessile or polyploid mass that presents with hemoptysis Think

Answer 31

Squamous cell | Common in women and non smokers that spreads LOCALLY

Question 32

Where do large cell carcinomas most commonly present

Answer 32

Peripheral masses

Question 33

What is the major diff between Small Cell and non small cell CA

Answer 33

``` Small Cell Lung Ca (SCLC) -Early hematogenous spread -Rarely amenable to surgical resection -Very aggressive course (6-18 wk survival, untreated) ``` Non-Small Cell Lung Ca (NSCLC) (the other 4 types) -Slower spread -Resection of early disease leads to high cure rates -Chemo tailored to specific histological findings but poor response

Question 34

What is the common tumor type in a pan coast tumor

Answer 34

NSCLC

Question 35

A pt presents with Shoulder and arm pain with horners syndrome with weakness and atrophy of the hand With face/neck Edelman, dyspnea and chest pain Shoulder pain radiates downt eh c8 and T1 nerve roots Think what D/o/ Tumor

Answer 35

Pancoast syndrome

Question 36

A pt is presenting with SAID, what type of cancer is this associated with

Answer 36

Small cell CA

Question 37

A pt presents with hypercalcemia What type of cancer is this associated with

Answer 37

Squamous cell CA

Question 38

What are some common tumor complications

Answer 38

Recurrent larygeal nerve- voice hoarseness Phrenic nerve injury_ Diaphram elevation SVC syndrome _facial/ neckl edema, mimics HF MG SIAD Hypercalcemia

Question 39

What is the difference between limited and extensive small cell carcinoma

Answer 39

Limited (about 30%) one side of lung and regional nodes Extensive (about 70%) both lungs and/or distant spread

Question 40

What is the prognosis of Lung Cancer

Answer 40

Overall 5-year survival rate is 10-15% Cell type, age, and general health are major factors Squamous cell survival with resection does better than adenocarcinoma or large cell Small cell rarely live past 5 years after diagnosis

Question 41

What are the s/s fro carcinoid syndrome

Answer 41

Flushing, diarrhea, wheezing, HOTN Tx: surgical excision

Question 42

What is the specific assay for Carcinoid syndrome

Answer 42

24 hr urine excretion of 5 Hydroxyindoleactice acid

Question 43

Describe mesothelioma

Answer 43

Primary tumor of surface lining of pleura (80%) or peritoneum (20%) Men : Women- 3:1 Proven association w/ asbestos exposure ``` 10% lifetime risk for asbestos workers Typically 20-40 yrs after exposure -Mining, milling, manufacturing -Shipyard work, insulation -Construction, demolition, roofing ```

Question 44

What is the treatment and prognosis for mesothelioma

Answer 44

Chemo Median survival less than 12 months

Question 45

What are the most common tumors associated with anterior mediastinal mass

Answer 45

Thymoma, teratoma, thyroid lesions, “terrible” lymphoma, mesenchymal tumors (lipoma, fibroma) The Terrible Ts

Question 46

What are the common masses found in the middle mediastinal area

Answer 46

Lymphadenopathy, pulm artery enlargement, Aortic Aneurism, Developmental cyst

Question 47

What are the common masses found in posterior mediastinal area

Answer 47

Hiatal hernia, neurogenic tumor, meningocele, esophageal tumor, thoracic spine lesions