Lung Cancer Flashcards
(90 cards)
1
Q
Interparenchymal lung lesion, commonly less than 3 cm in size and not assc. with atelectasis or adenopathy
A
Solitary Pulmonary Nodule (SPN)
2
Q
How many patients are “afflicted” with Solitary Pulmonary Nodule per year?
A
150,000
3
Q
Most findings of nodules in the lungs are _______.
A
Incidental
4
Q
When finding a single pulmonary nodule, what should be in your DDx?
A
- Malignant Neoplasm
- Benign Neoplasm
- Infection
- Inflammatory response
- Pulmonary Infarct
- Arteriovenous malformation
- Bronchogenic cyst
- Rounded atelectasis
- Intrapulmonary lymph nodes
- Pseudotumor (loculated fluid in fissure)
5
Q
True/False:
Most single pulmonary nodules are malignant.
A
False; very few are malignant
6
Q
What factors increase the risk of malignancy?
A
- Older age
- Hx of Smoking
- Hx of cancer
7
Q
First line of diagnosis in finding a singe pulmonary nodule:
A
- CXR
- CT Scan***
- PET
8
Q
Pros and Cons of using CXR for single pulmonary nodule:
A
Pros: Inexpensive; absence of growth over a two year time period in general indicated benign disease (compares to previous CXRs)
Cons: No characteristics consistently differentiate a benign from malignant lesion
9
Q
Pros of using CT
A
- Better imaging
- Used to identify synchronous lung lesions, metastatic lesions, and mediastinal adenopathy
- Used for follow up SPNs
10
Q
Likelihood of malignancy:
A
Size:
20+ mm > 8-20 mm > 4-7 mm > 1-3 mm
Borders:
Corona radiata > Spiculations > Scalloped/Lobulated > Smooth
11
Q
Calcification on imaging can suggest benign if
A
- Diffuse and homogenous
- Central
- Laminated (concentric)
- Popcorn
12
Q
Calcification on imaging can suggest malignancy if
A
- Reticular
- Punctate
- Amorphous
- Eccentric
13
Q
This type of imaging is least used when evaluating a single pulmonary nodule. Why?
A
PET
Very sensitive and specific for benign, less specificity for malignancy
BUT can give:
- False negatives for carcinoid tumors or bronchoalveolar carcinomas
- False positives for infectious or inflammatory etiologies
Useful in staging mediastinum and extrathoracic metastases
14
Q
How do you confirm diagnosis after seeing a single pulmonary nodule in the lungs?
A
- Transthoracic Needle Aspiration
- Bronchoscopy
- Surgery
15
Q
When should a SPN be indicative for Surgery?
A
- Patients with new SPN based on prior imaging
- Patients with PET positive SPN
- Patients with growing SPN
16
Q
In 2012, about how many people in the US died due to lung cancer?
In Florida?
A
160,000
12,000
17
Q
Lung cancer deaths are greater than
A
Breast, prostate and colon cancers combined
18
Q
Epidemiologic spread of lung cancer in the US is similar to the distribution of what?
A
Smoking distribution in the US
19
Q
Cigarette smoking is the leading cause of?
A
Lung cancer
20
Q
True/False
Quitting smoking does not modify the risk for lung cancer.
A
False
21
Q
For a given level of smoking, the relative risk for _________ developing lung cancer is higher.
A
Females
22
Q
True/False
Environmental Tobacco Smoke has a significant increase risk of lung cancer.
A
False!
Does increase risk, but in non-smokers it 1.2-1.7%; smokers: 2-3%
23
Q
Do COPD patients have a greater chance of developing lung cancer?
A
Yes
24
Q
What are assc occupational risk factors that can increase the likelihood of lung cancer?
A
- Asbestos
- Radon
- Polycyclic aromatic hydrocarbons
- Metals (Ar, Cr, Ni, Cd, Be)
25
This type of non-small cell carcinoma accounts for about 30% of lung cancers, and has a slightly higher predominance in males. About 2/3 of this will occur centrally and involve a mainstem or lobar bronchus.
Squamous Cell Carcinoma
26
This type of non-small cell carcinoma is the most common lung cancer, accounting for about 35%, and the most frequent type in women and non-smokers. Commonly arising in the periphery of the lung.
Adenocarcinoma
27
This type of non-small cell carcinoma accounts for about 10% and has poorly differentiated tumors.
Large Cell Carcinoma
28
This type of cancer accounts for about 20% of lung cancers and is the most aggressive form of lung cancer. Very common to have extrathoracic metastases.
Small Cell Carcinoma
29
How to lung cancer patients present in clinic?
1. Dyspnea
2. Cough
3. Chest Pain
4. Hemoptysis
5. Hoarseness
30
_______ occurs in 26-60% of patients and could suggest more extensive disease, most often due to underlying COPD, extensive tumor infiltration of the lung, major airway obstruction, or pleural effusion.
*Note it could also be due to post-obstructive pneumonia, lymphangitic tumor spread, PE, or tumor emboli
Dyspnea
31
This is the most common initial symptom of lung cancer noted in about 35-75% of patients.
Cough
32
If there is a notable change in chronic "smoker's cough," what should you do?
Investigate for lung cancer!
33
This symptom is noted in about 20-45% of patients usually arising via direct invasion of pain-sensitive structures.
Chest pain
34
When a peripheral tumor invades parietal pleura and/or chest wall, what symptom would commonly present
Chest pain
35
This complaint only occurs in 5-10% as a single complaint, but most commonly is presented with other symptoms in about 50% of patients
Hemoptysis
36
This complain is common in 5-18% of patients and usually indicates mediastinal extension or adenopathy involving the left recurrent larygneal nerve
Hoarseness
37
Some patients with this will be asymptomatic and others can be dyspneic and hypoxemic. Usually this is present together with fevers, chills, productive cough, and may suggest post-obstructive pneumonia.
Atelectasis
38
This is the most common cause of dyspnea in lung cancer patients, but only occurs in 7-25% of patients.
Common assc symptoms: cough and chest pain
Pleural Effusion
39
If there is a pleural effusion and a sample is taken and found that there are malignant cells in the fluid, what would this suggest?
Poor prognosis!!
40
This syndrome is most commonly associated with small cell lung cancer.
Superior vena cava syndrome
41
Superior Vena Cava Syndrome complaints:
1. Headache
2. Swelling of head and neck
3. Dizziness
4. Visual Changes
42
Physical Exam Findings for Superior Vena Cava Syndrome:
1. Facial or upper extremity edema
2. Distended neck veins
3. Venous engorgement over chest
43
When dealing with a superior sulcus or Pancoast tumor, symptoms and physical exam findings can be ________.
Extrathoracic -- direct extension to adjacent structures such as the branchial plexus.
44
If there is cervical sympathetic chain involvement of a cancer, the group of symptoms are grouped together as a ______ Syndrome
Homer's
45
What do you see in Homer's Syndrome?
1. Ptosis (drooping of upper eyelid)
2. Miosis (constricted pupil)
3. Anhidrosis (loss of sweat) over forehead and face
4. All occur on the same side of the lung mass
46
Extrathoracic symptoms occur in about
1/3 of patients with metastases
47
Most common extrathoracic pain
1. Bone pain! (Back pain most commonly)
2. Nausea, Vomiting, Headaches
3. Incoordination, Mental status changes, and Szs
48
When a tumor secretes a hormone or hormone-like substance that has effects on the body due to excess hormone reaction.
Paraneoplastic Syndrome
49
Common effects of Paraneoplastic Syndrome
1. Syndrome of Inappropriate ADH (typically by SCC)
2. Hypercalcemia (typically squamous cell)
3. Eaton-Lambert Syndrome (typically SCC)
50
What symptoms are seen in Eaton-Lambert Syndrome?
Similar to myasthenia gravis
| Strength improves with exercise
51
Sometimes, if metastases on adrenal gland, what can occur?
```
Nausea
Vomiting
Weakness
Hyponatremia
Hyperkalemia
Weight loss
```
52
About ________% of small cancers may be missed on a CXR
10-20%
53
Do old CXRs help with dx of lung cancer?
YES!
54
Lab tests are ________ in determine the diagnosis of lung cancer.
Not very useful. However, you do the tests anyways.
55
PFTs are necessary when the patient is about to go in for ________ due to the lung cancer
Surgical Resection
56
This is the most useful diagnosing technique for central tumors. Sensitivity is 75-100% (greater for larger peripheral lesions than smaller)
Flexible Bronchoscopy
57
This is a useful diagnosing technique for peripheral tumors with a sensivity of 90%. False negative rate of about 10-25%.
Transthoracic Needle Biopsy
58
One side effect of transthoracic needle biopsy is __________.
Pneumothorax
Increases by 10% for every 1 cm transverse
59
This is useful for diagnosis and staging if there is a pleural effusion present
Thoracentesis
60
This method provides staging and diagnostic information.
Supraclavicular Node Biopsy
61
This method is only used on patients with symptomatic non-small cell carcinomas.
Head CT/MRI
62
This method is recommented for symptomatic non-small cell caricinoma patients with hypercalcemia. Sometimes it is also recommended for staging the disease.
Bone Scan
63
For Stage I or II Non-small cell carcinoma, what is the first line of treatment?
Surgery!!!
70% 5-year survival for Stage I
55% 5-year survival for Stage II
64
If a patient with Stage I or II does not want surgeries, what should you do?
```
Chemotherapy (Adjunctive)
Radiation Therapy (Can't tolerate or refuse sx)
Stereostatic Radiation Therapy (Can't tolerate or refuse sx)
```
65
Radiation therapy 5 year survival rate for Stage I or II non-small cell carcinoma?
20%
66
Stereostatic Radiation Therapy 5 year survival rate for Stage I or II non-small cell carcinoma?
50-70%
67
How would you treat Stage IIIa non-small cell carcinoma?
Chemotherapy and/or radiation therapy
68
5-year survival rate for Stage IIIa non-small cell carcinoma in the lungs?
10-15%
69
Some studies have shown that using ______ after Chemo/Radiation in Stage IIIa non-small cell carcinoma .
Surgery
70
How would you treat Stage IIIb non-small cell carcinoma?
Chemotherapy and/or radiation therapy
71
5-year survival rate for Stage IIIb non-small cell carcinoma in the lungs?
10%
72
How would you treat Stage IV non-small cell carcinoma?
Chemotherapy, but debatable utility of treatment
73
Median survival rate for Stage IV non-small cell carcinoma
3-6 months
74
Chemotherapy in Stage IV non-small cell carcinoma has been shown to extend survival by _______.
3-4 months
75
What does limited stage small cell carcinoma mean?
Disease is confined to a hemithorax
76
How would you treat limited stage small cell carcinoma?
Chemotherapy and/or Radiation Therapy
77
Survival Rates of this Disease
2-year: 20-25%
| 5-year: 10%
78
What does extensive stage small cell carcinoma mean?
Disease beyond a hemithorax
79
How would you treat extensive stage small cell carcinoma?
Chemotherapy
80
Median survival rate of extensive stage small cell carcinoma
6-10 months
81
Palliative Measures for pleural effusions
Pleurodesis
82
Palliative Measures for bony metastases
Radiation Therapy
83
Palliative Measures for Endobronchial obstruction
Broncoscopic modalities
84
Palliative Measures for dyspnea, pain, and cough
Opiates
85
Palliative Measures for general QOL
Hospice
86
DDx for Anterior Mediastinal Mass
4 T's:
1. Thymic Tumors
2. Teratoma
3. Thyroid
4. Terrible Lymphoma
87
DDx for Middle Mediastinal Mass
4 A's:
1. Adenopathy
2. Awful Primary Neoplasm
3. Aneurysm/Vascular
4. Abnormalities of Development
88
DDx of Posterior Mediastinal Mass
1. Neurogenic Tumors
2. Esophageal Tumors and Duplication Cysts
3. Neuroenteric Cysts
4. Hiatal Hernias
89
Signs and Symptoms of most mediastinal tumors:
1. Most Asymptomatic or with vague complaints
2. Advanced Invasive Disease: Pain
3. Airway compression can lead to dyspnea and recurrent infection
4. Esophageal compression may cause dysphagia
5. Spinal canal can result in paralysis
6. Phrenic nerve damage may cause elevated hemidiaphragm
7. Laryngeal nerve involvement may result in hoarseness
8. SVC syndrome
9. Horner’s syndrome due to sympathetic ganglion involvement
90
How to diagnose mediastinal tumors?
1. Need to decide whether lesion can be observed, aspirated, excised, or biopsied
2. If excision is indicated as is case with teratoma, thymoma, and most isolated lesions likely to be benign, definitive operation should be performed
3. Biopsy is procedure of choice if mass is likely to be a lymphoma, germ cell tumor, or unresectable invasive malignancy
- --- Surgical biopsy versus CT guided biopsy (core, fine needle)
