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NM By Myself > Lung Cancer NM > Flashcards

Lung Cancer NM Flashcards

(69 cards)

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1
Q

Lung cancer T

A
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2
Q

Lung cancer N

A

N1 - peribronchial or hilar or intrapulmonary
N2 - mediastinal or subcarinal
N3 - contralateral

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3
Q

Lung cancer M

A

Liver
Adrenal
Bone
Brain
M1a - separate nodule in contralateral lobe
M1b - single extra thoracic MTS
M1 multiple extra thoracic MTS

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4
Q

Central tumor

A

Cough
Dyspnea
Atelectasis
Post obstructive pneumonia
Wheezing
Hemoptysis

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5
Q

Peripheral tumor

A

Cough
Dyspnea
Severe pain (parietal pleura)

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6
Q

Superior vena cava syndrome

A

Facial edema
Dusky skin color
Conjunctival edema
Upper extremity edema
Upper chest wall veins retrograde flow

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7
Q

Pancoast syndrome

A

Compression of brachial plexus root
Intense radiating pain in hand

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8
Q

Horner syndrome

A

Ipsilateral ptosis, miosis, enophtalmos, anhidrosis

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9
Q

NSCLC 85-90%

A

Adenocarcinoma - - peripheral solitary nodule or mass
SCC - smoking, large central tumor
Large cell carcinoma

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10
Q

SCLC 15%

A

Men >60y, 99% smokers
Central location - - main bronch - - obstruction
Larger tumor - - cavitation - - aggressive with early mediastinal LN - - 80% respond to chemo

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11
Q

Never smoke

A

15% men
>50% women

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12
Q

EGFR mutation 15% adenocarcinoma

A

Non smokers
62% Asian - - good prognosis

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13
Q

Lung cancer risk

A

Smoking 80%. Passive smoking 25%
Asbestos - - 5-fold increase risk
Radon 2-3% annually
HIV - 6.5-fold increase risk
Emphysema, chronic bronchitis - - impact on treatment
Idiopathic pulmonary fibrosis - 3-7-fold increase risk, 20% develop cancer

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14
Q

Paraneoplastic syndrome
SCLC

A

SIADH,
Parat hormone - - hyperparathyroidism
Cushing - - ACTH
Hyponatremia - - ADH
Hypocalcemia - - Calcitonin
gynecomastia - - gonadotropins
Carcinoid - - serotonin
Encephalomyelitis
Lambert - Eaton sy
Sensory neuropathy

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15
Q

Paraneoplastic syndrome
Adenocarcinoma

A

Clubbing
Hypertrophic pulmonary osteoarthropathy
Trousseau sy of hypercoagulopathy
Dermatomyositis / polimyositis

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16
Q

Surgery
Lung cancer

A

No mediastinal disease or invasion
Stage I and II only NSCLC
Lobectomy
Poor pulmonary reserve or peripheral nodule <2 cm, >50% GGO or doubling time >400 days - - wedge resection

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17
Q

NSCLC treatment

A

Stage I-II - - surgical resection
Resectable stage III - - surgery, chemo, radio or combi
Unresectable stage IIIA - - chemo radio
Stage IV - - chemo, palliative radio

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18
Q

SCLC treatment

A

Chemo radio
Neoadjuvant chemo and Surgery for 5% T1-2N0-1M0

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19
Q
A

Adenocarcinoma
Consolidation with air bronchogram
Peripheral nodule with pleural tail

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20
Q
A

SCC
15% cavitation
Central/perihilar

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21
Q

Large cell carcinoma

A

Large peripheral mass with necrosis

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22
Q

CT
Extent of primary tumor

A

Chest wall invasion - - >3 cm contact
Mediastinal invasion - - >3 cm contact
Pleural/pericardial effusion
Separate nodules
Important for staging - around tumor, same lobe, other lobes, contralateral

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23
Q

CT
Nodal disease

A

Mediastinal >10 mm
Subcarinal >13-15 mm
Lymphangitic carcinomatosis - - mimic interstitial lung disease

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24
Q

CT distant MTS

A

Lung - - contralateral, pleural nodules, effusion
Adrenal - - >3 cm, HU>10, Irregular rim enhancement
Bone - - vertebra, ribs, pelvis
Lytic>blastic
Elevated Ca, AlcPhos

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25
CT special scenario
2 separate lesions - - separate staging Part-solid nodule - - adenocarcinoma with lepidic component Patchy GGO, consolidation - - mucinous/lepidic adenocarcinoma
26
PET CT Lung cancer
Most accurate Limited for brain, can detect unexpected brain MTS >1.5 cm Patients selected for Operation - - 24% MTS Adrenal - - uptake >liver Lepidic adenocarcinoma - -Tis - - minimal uptake
27
RECIST response criteria Lung cancer
Unidimensional measurements At least 1 measurable lesion at baseline Min size 10 mm After radio - - 3 months
28
MRI Lung cancer
Most sensitive for brain MTS Chest - - cardiac invasion, brachial plexus, vertebra Subclavian vessels and carotid/vertebral artery - - precludes surgical resection
29
MRI Lung cancer Abs Contra surgery
Invasion of brachial plexus roots/trunks above T1 >50% vertebral body Esophagus / trachea
30
NSCLC Left hilar mass Elevated left hemidiaphragm - - phrenic nerve involvement - - stage T3
31
Pancoast tumor At least T3 T4 if invade brachial plexus, spine or great vessels
32
Paraneoplastic syndrome SCC
Hypercalcemia due to parathyroid like hormone Cushing
33
Immunotherapy
Tumor shrinkage later than after chemo or targeted therapy Temporal increase in tumor size - - pseudo progression
34
N2 treatment Lung cancer
Most undergo mediastinoscopy N2 negative after neoadjuvant - - critical for selection for thoracotomy EUS-FNA - - no adequate visualization of lower paratracheal LN Better - repeat FDG for restaging after neoadjuvant
35
Mesothelioma N
N1 - bronchopulmonary, hilar, mediastinal N2 - contralateral mediastinal or supraclavicular LN Nodal spread - - poor prognosis
36
Mesothelioma M
Lung Peritoneum Bone Subcutaneous tissue Liver
37
Mesothelioma presentation
Dyspnea Unexplained Pleural effusion Chest pain
38
Mesothelioma type
Epithelioid 55-65% - - best prognosis Sarcomatoid 10-15% - - poor prognosis Biphasic 20-35% Desmoplastic 10%
39
Mesothelioma risk
Arise from mesothelium (peritoneum, pericardium, tunica Vaginalis) Asbestos 80% - - latency >20 y Prior radio SV40 virus Intrapleural Thorotrast
40
Mesothelioma surgery
Non Sarcomatoid (biopsy proven) T1-3N0-1M0 Sufficient respiratory reserve Fit to chemo radio EPP = extrapleural pneumonectomy - - pleura, lung, pericardium, diaphragm Pleurectomy / decortication - - symptom control, not cure
41
Mesothelioma treatment
Stage I, II, III - - EPP + chemo + postop radio Stage III and IV unresectable - - palliative chemo and pleurodesis (sterile talc) Chemo - - cisplatin, premetrexed Immunotherapy - - pebrolizumab
42
Mesothelioma CT
Unilateral Pleural effusion 95% Tumoral encasement of lung Interlobular fissure thickening Calcified pleural plaque 20% Volume loss hemithorax Pleural thickness >1 cm
43
Mesothelioma CT treatment response
Measure tumor thickness perpendicular to chest wall or mediastinum in 2 locations
44
Mesothelioma PET CT
High avid SUV cutoff 3.0 Higher uptake - - shorter survival time SUV >2.0 - - biopsy >50% of circumference of vascular structure surrounded - - invasion Recurrent SUV 8.9
45
Mesothelioma MRI
Assess local disease Invasion of diaphragm, fascia, chest wall
46
Mesothelioma T1
47
Mesothelioma T1 Rind around lung
48
Mesothelioma T4
49
Mesothelioma T4N2
50
Thymus carcinoma M
Pleura Lung LN Mediastinum (thymoma) Bone (thymic cancer) Liver (thymic cancer)
51
Thymoma
>40 y Slow grow Risk of B lymphoma, GIT cancer, sarcoma after resection Paraneoplastic - - 30% myasthenia gravis (10% наоборот), 30-50% pure red cell aplasia, 3-6% Good sy (hypogammaglobulinemia), glomerulonephritis, autoimmune hepatitis
52
Thymic carcinoma
50 y More aggressive Worse prognosis
53
Thymic NET
2-5% Carcinoid MEN1 Paraneoplastic - - Cushing, Lambert Eaton, carcinoid
54
Thymus biopsy
Not recommended Seeding
55
Thymus CT
No dd thymoma vs thymic carcinoma No matter size Thymoma more homogenous Thymoma - - encapsulated Thymic carcinoma - - larger, with necrosis
56
Thymus PET CT
SUV >5.0 - - thymic carcinoma or lymphoma SUV 2.0-4.0 benign
57
Thymus resectable
Invasion of innominate vein Heart Great vessels Phrenic nerve
58
Thymus unresectable
Pleural or pericardial MTS Distant disease Chemo radio
59
Pulmonary nodule + high likelihood for malignancy by CT Next step
Trans thoracic needle aspiration or thoracoscopy with wedge resection
60
Pulmonary nodule + low likelihood for malignancy by CT or Indeterminate Next step
PET CT FDG
61
SUV mean cut off benign vs malignant pulmonary nodule
2.5
62
Negative PET
Excludes high grade lung carcinoma
63
% of nodules negative on PET that are malignant
5-10%
64
Normal size nodal MTS
15%
65
PET in mediastinal nodules
Negative - - no LN MTS Positive - - still need diagnostic mediastinoscopy
66
Uptake of FDG correlates with
Tumor grade
67
Adenocarcinoma
68
Multifocal lung adenocarcinoma
Slow growth Women, non smokers Longer median survival
69
Sarcoidosis

NM By Myself (25 decks)

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