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Clin Med2: Pulmonology > Neoplasms > Flashcards

Neoplasms Flashcards

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1
Q

what is the USPSTF recommendations for lung cancer screenings

A

Grade: B
Adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

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2
Q

what are ways that nodules can be defined

A

perifissural nodules
solid nodules
part solid nodules
non-solid nodules
endobronchial nodules
complete, central, popcorn, concentric, rings and fat containing nodules

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3
Q

What are the characteristics of Benign nodules

A

< 3cm (30mm)
solid nodules
Age < 30
non-smokers
dense central calcifications
well defined borders and no halo
round
doubling time >400 days
negative FH or personal hx of cancer
history of underlying lung disorder

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4
Q

what are characteristics of malignant nodules

A

> 3 cm (30mm)
sub-solid (ground glass or part solid)
age > 30
smokers
stippled or eccentric calcifications
irregular margins (spiculated or halo)
Cavitary with thick walls
lobular
doubling time < 400 days
located in upper lobes
postive FH or personal hx
+/- pervious underlying lung disorder

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5
Q

What are ways to determine benign vs malignant nodules

A

Brock Calculator
Mayo Clinic Risk calculator

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6
Q

What are solitary pulmonary nodules

A

primarily benign lung nodules
discrete, round and size < 3cm “aka coin lesion”
not fixed to pleura or chest wall
NO lymphadenopathy, infiltrate or atelectasis

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7
Q

what is any nodule > 3cm considered

A

a mass

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8
Q

Who do we often see solitary pulmonary nodules in

A

M>W but if looking at only non-smokers, W>M
more prevalent in high risk patients - smokers, COPD, older
incidental CXR + CT scans

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9
Q

what are benign solitary pulmonary nodules

A

infectious granuloma*
-atypical mycobacteria, coccidioidomycosis, histoplasmosis, TB
hamartoma

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10
Q

What are malignant solitary pulmonary nodules

A

adenocarcinoma
squamous cell carcinoma
solitary metastasis (breast, colon, kidney)
small cell carcinoma

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11
Q

What is the workup for solitary pulmonary nodules

A

if found on CT - no further images
if found on CXR - chest CT
+/- PET scan if concern for malignancy
chest CT preferred for follow-up imaging
Definitive diagnosis with biopsy

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12
Q

what is the most common etiology of solitary pulmonary nodule

A

Infectious granulomas

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13
Q

what makes a person at high risk for solitary pulmonary nodules

A

any history of smoking
+ FH lung CA
carcinogen exposure
upper lobe nodule
emphysema
pulmonary fibrosis

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14
Q

What is the Fleischner Guidelines used for

A

management of incidentally detected solid pulmonary nodules in adults + sub-solid nodules

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15
Q

What are traditional ‘lung’ cancers

A

bronchiogenic carcinomas
#1 cause of cancer deaths

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16
Q

what is the median age for bronchogenic carcinomas

A

median age: 70
rare prior to 40 years old
5 year survival rate about 19%

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17
Q

What are risk factors for bronchogenic carcinomas

A

secondary to smoking (85-90%)
+FH
pre-existing pulmonary disease (pulmonary fibrosis, COPD, sarcoidosis)
exposure-related risks (second hand, radon, asbestos, diesel exhaust, etc.)

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18
Q

what is the leading cause of preventable death in the US

A

cigarette smoking
causes more than 480,000 deaths each year

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19
Q

where else can smoking cause cancer in within the body

A

bladder
blood
cervix
colon and rectum
esophagus
kidney and ureter
larynx
liver
oropharynx
pancreas
stomach
trachea, bronchus and lung

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20
Q

what are the types of bronchogenic carcinomas

A

small-cell and non-small cell cancer types

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21
Q

what is another name for small-cell cancer

A

AKA ‘oat cell’

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22
Q

what are adenocarcinomas, squamous cell carcinomas, large-cell carcinomas part of

A

non-small cell cancer

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23
Q

what cells do small cell cancer affect

A

neuroendocrine cells

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24
Q

what cells do squamous cell cancers affect

Study These Flashcards
A

bronchial epithelial cells

25
what cells do adenocarcinomas affect
glandular (mucous) cells
26
what cells do large cell cancer affect
undifferentiated (cell types that don't fit others)
27
what is the population affected by small cell carcinoma
strong association with smoking decreasing in incidence - decrease in smoking rates M>F Most cases over age of 50, avg age: 70 White>black patients
28
What is the presenation of small cell carcinoma
rapid onset of symptoms (8-12 weeks), paraneoplastic syndromes common, mets common at presentation, central (bronchial) masses
29
what are the populations affected by adenocarcinoma
most common type of lung cancer even in non-smokers M>F, most over age of 50. mean age:71 most with p53 gene mutation
30
what is the presentation of adenocarcinoma
often found incidentally (asymptomatic) paraneoplastic syndromes rare peripheral masses
31
what does the treatment of adenocarcinomas target
Gene therapy targets: EGFR mutation and ALK mutations
32
what populations are affected by squamous cell carcinomas
second most common lung cancer strong association with smoking M>F Most cases over age 50
33
what is the presentation of squamous cell carcinoma
often present with hemoptysis, central (bronchial masses)
34
what is Large cell carcinoma
diagnosis of exclusion M>F most cases over age 50 may present as peripheral or central masses
35
What is the general presentation of bronchiogenic carcinomas
some found incidentally NEW or WORSENING cough or dyspnea is the most common hemoptysis chest pain hoarseness malaise anorexia weight loss
36
What is horner's syndrome
includes: mioisis (pupil bigger than other), ptosis (drooping eyelid), anhydrosis (lack of sweating) - pancoast tumor
37
what is pancoast syndrome
shoulder/UE pain, weakness; hand atrophy from invasion of brachial plexus by pancoast tumor
38
what are paraneoplastic syndrome
syndrome of inappropriate anti-diuretic hormone (SIADH) Bushings syndrome
39
what are symptoms from mets
bone pain, AMS, lymphadenopathy
40
what is the best way to evaluate a central lesion
bronchoscopy for biospy
41
what does CT-guided FNA scan increase the risk for
Pneumothroax
42
what is the after diagnosis workup for bronchiogenic carcinomas
PET scan, Ct abdomen and pelvis, +/- bone scan MRI of chest if concern for adjacent structures Head CT/MRI lymph node biopsy
43
what is the mainstay of treatment for small-cell carcinomas
chemo + radiation can consider resection if localized disease (rare)
44
what is the treatment for non-small cell lung cancer
stage 1-2: resection alone advanced stage 2-3: add chemotherapy stage 3 unresectable or stage 4: chemo _ radiation +/- adjunctive immunotherapy (-mabs) If EGFR +: add an EGFR tyrosine kinase inhibitors (-nibs) if ALK+: add ALk tyrosine inase inbiits (-nibs)
45
what is a very rare, malignant neuroendocrine tumor
carcinoid rumor
46
what is the presentation of carcinoid tumors
most present as central masses - bronchial masses
47
what are the symptoms of carcinoid tumors
primarily due to bronchial obstruction - cough, wheezing, hemotysis, atelectasis, PNA
48
what is carcinoid syndrome
facial flushing, SOB, HTN, weight gain, Hirsutism, asthma
49
what is the workup for carcinoid tumors
CXR chest CT = modality of choice PET scan to differentiate between types serum lab tests (plasma charomogranin A (CgA), CBC, CMP)
50
how do we definitively diagnose carcinoid tumors
bronchoscopy and biopsy
51
hat is the treatment for carcinoid tumors
resection (lobetcomy) perferred +/- chemo and/or radiation possible use of octreotide for hormonal control
52
what are pulmonary metastasis
second most common form of lung cancer, and site of metastasis all metastases to the lungs
53
what is the presentation of pulmonary metastasis
often asymptomatic cough, hemoptysis, dyspnea, hypoxia, pleural effusion generalized SSX: N/V, back pain, fatigue, anorexia, weight loss SSX of primary tumor
54
what is the most common initial test for pulmonary mets
chest x-ray
55
what is the treatment of pulmonary mets
solitary pulmonary nodules - resection mets limited to the drug and few in number - consider resection multiple nodules, multiple mets sites, unreachable - palliative care
56
what is nearly always seocndary to asbestos exposure
mesothelioma
57
where do mesotheliomas arise from
mesothelial tissue (pleura)
58
what is the presentation of meothelioma
through screening dyspnea, non-pleuritic CP most common constitutional symptoms are rare pleural effusion present in 95%
59
how do we workup mesotheliomas
CXR common CT for further exam thoracentisis for Pleural effusion pleural biopsy open biopsy if needed CT, MRI, PET, bronchoscopy for staging

Clin Med2: Pulmonology (13 decks)

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