Lung Cancer

Question 1

General Lung Cancer (Bronchogenic Carcinoma) Etiology:

Answer 1

Malignancy that originates in the airways or pulmonary parenchyma

Question 2

General Lung Cancer (Bronchogenic Carcinoma) Diagnosis:

Answer 2

1. Order a CXR
2. Further define w/ CT
3. If suspicious, refer for biopsy
4. Most diagnoses made via biopsy (transbronchial needle aspiration, thoracotomy, etc.)

Question 3

General Lung Cancer (Bronchogenic Carcinoma) Common Clinical presentation:

Answer 3

Cough, hemoptysis, dyspnea, chest pain (pleuritic)

Question 4

Paraneoplastic syndrome Etiology:

Answer 4

Cross reactivity between malignant cells and normal tissue (WBCs attacking normal cells), caused by a substance secreted by tumor/metastases. SCLC or mediastinal masses (thymoma). poor prognosis

Question 5

Paraneoplastic syndrome Symptoms:

Answer 5

Endocrine - SIADH, Hypercalcemia
Neuro - Eaton-Lambert Syndrome
Myasthinia Gravis

Question 6

Paraneoplastic syndrome treatment:

Answer 6

Treat the cancer

Suppress the substance causing it

Question 7

Squamous cell lung cancer Etiology:

Answer 7

Generally comes from cells in proximal airways.

Question 8

Squamous cell lung cancer symptoms:

Answer 8

May cause airway obstruction leading to atelectasis or pneumonia. May cavitate. Highly vascular. Usually spreads intrathoracic rather than distant metastasese

Question 9

Squamous cell lung cancer treatment:

Answer 9

Stage I-II: Surgery - good prognosis
Stage IIIb-IV: no surgery, try XRT/Chemo - poor prognosis
Stage IIIa: may try surgery, try XRT/Chemo - poor prognosis.

Question 10

Adenocarcinoma Etiology:

Answer 10

Often arises as a solitary peripheral pulmonary nodule, generally localized. may arise in an old parenchymal scar. NSCLC

Question 11

Adenocarcinoma clinical presentation:

Answer 11

Spreads to hilar and mediastinal nodes, and to distant sites

Question 12

Adenocarcinoma treatment:

Answer 12

Stage I-II: Surgery - good prognosis
Stage IIIb-IV: no surgery, try XRT/Chemo - poor prognosis
Stage IIIa: may try surgery, try XRT/Chemo - poor prognosis.

Question 13

Large Cell lung cancer etiology:

Answer 13

similar to adenocarcinoma

Often arises as a solitary peripheral pulmonary nodule, generally localized. may arise in an old parenchymal scar. NSCLC

Question 14

Large Cell Lung cancer clinical presentation:

Answer 14

Spreads to hilar and mediastinal nodes, and to distant sites

Question 15

Large Cell lung cancer treatment:

Answer 15

Stage I-II: Surgery - good prognosis
Stage IIIb-IV: no surgery, try XRT/Chemo - poor prognosis
Stage IIIa: may try surgery, try XRT/Chemo - poor prognosis.

Question 16

Small Cell Lung Cancer etiology

Answer 16

Arise in proximal airways

Question 17

SCLC clinical presentation:

Answer 17

Commonly produce polypeptide hormones that mimic normal hormones.
Hilar and mediastinal involvement.
Early distant metastasis.

Question 18

SCLC treatment:

Answer 18

No surgery
Limited (unilateral) and Extensive (bilateral) may benefit from XRT/chemo.
Poor prognosis

Question 19

Pancoast (superior sulcus) tumor etiology

Answer 19

NSCLC, usually squamous cell or adenocarcinoma.

Question 20

Pancoast tumor diagnosis:

Answer 20

First try needle biopsy, sputum, bronchoscopy.

If no diagnosis, then VATS or thoracotomy.

Question 21

Pancoast tumor clinical presentation:

Answer 21

Involves cervical and thoracic nerves (brachial plexus), causes shoulder pain with ulnar distribution. Can lead to muscle weakness/wasting, ulnar paralysis, Horner’s syndrome.

Question 22

Pancoast tumor treatment:

Answer 22

Try presurgical radiation and chemo to try to shrink the tumor back from the brachial plexus.
THEN do surgery 2-4 weeks after.
Then more chemo or radiation, based on the success of the surgery.

Question 23

Mesothelioma etiology:

Answer 23

malignancy of pleural space.

Caused by sustained asbestos exposure. Cancer may develop 30-50 years later!

Question 24

Mesothelioma diagnosis:

Answer 24

Thoracotomy with biopsy

Question 25

Mesothelioma clinical presentation:

Answer 25

Pleuritic pain and Dry cough most common! | SOA, weight loss...

Question 26

Mesothelioma treatment:

Answer 26

Radiation, surgery, or both

Question 27

Carcinoid tumors etiology:

Answer 27

Can be found in lung, GI tract, and rarely in the ovaries/testes. Develop primarily in neuroendocrine cells

Question 28

Carcinoid tumors diagnosis:

Answer 28

Sometimes difficult to distinguish from SCLC on small tissue samples.

Question 29

Carcinoid tumors clinical presentation:

Answer 29

Cough, hemoptysis, and asthma-like symptoms. Very slow growing. Is typically seen in 40-60 year olds, BUT is the most common pulmonary neoplasm in children and adolecents

Question 30

Carcinoid tumors treatment:

Answer 30

Surgery with 10 year survival rate of 90-95%!

Question 31

Anterior Mediastinal Mass etiology

Answer 31

Could be thyroid tumor, thymus tumor, teratoma, or lymphoma

Question 32

Middle Mediastinal Mass etiology:

Answer 32

Could be vascular aneurysm, lymph node metastasis, cyst...

Question 33

Posterior Mediastinal Mass etiology:

Answer 33

Could be a neurogenic tumor, aneurysm, paraspinal mass (tumor or infection)

Question 34

Mediastinal masses diagnosis:

Answer 34

Order CXR Further define with a CT If suspicious, refer for biopsy most diagnoses made with biopsy

Question 35

Mediastinal masses clinical presentation:

Answer 35

Weight loss, anemia, asymptomatic, cough, fever...

Question 36

Mediastinal masses treatment:

Answer 36

Treat underlying cause. | Surgery if needed and possible

Question 37

Pulmonary nodules etiology:

Answer 37

Includes infection (TB, histoplasmosis), lung irritants, abnormal blood vessels, inflammatory conditions, and lung cancer

Question 38

Pulmonary nodules diagnosis:

Answer 38

Determine growth and size, rule out benign lesions first (serial CXRs) Then consider fungal test, percutaneous biopsy, bronchoscopic evaluation with biopsy, thoracotomy, sputum cytology (not great). Size and border is KEY (>8 cm and speculated is worst)

Question 39

Pulmonary nodules treatment:

Answer 39

Treat underlying condition | Surgery if needed

Question 40

Horner's syndrome triad

Answer 40

Miosis, partial ptosis, anhidrosis

Question 41

Eaton-Lambert Syndrome

Answer 41

muscle weakness, depressed tedon reflexes

Question 42

Myasthenia Gravis symptoms

Answer 42

Muscle weakness affecting occulofacial muscles, proximal limbs, and in severe cases respiratory muscles.

Question 43

Histoplasmosis etiology

Answer 43

Widely distributed infectious disease caused by histoplasma, commonly found in soil. Associated with bird droppings.

Question 44

Compression/obstruction of the superior vena cava resulting in facial swelling.

Answer 44

Superior Vena Cava Syndrome