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Clin Med2: Pulmonology > Neoplasms > Flashcards

Neoplasms Flashcards

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

A

bronchial epithelial cells

25
Q

what cells do adenocarcinomas affect

A

glandular (mucous) cells

26
Q

what cells do large cell cancer affect

A

undifferentiated (cell types that don’t fit others)

27
Q

what is the population affected by small cell carcinoma

A

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
Q

What is the presenation of small cell carcinoma

A

rapid onset of symptoms (8-12 weeks), paraneoplastic syndromes common, mets common at presentation, central (bronchial) masses

29
Q

what are the populations affected by adenocarcinoma

A

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
Q

what is the presentation of adenocarcinoma

A

often found incidentally (asymptomatic)
paraneoplastic syndromes rare
peripheral masses

31
Q

what does the treatment of adenocarcinomas target

A

Gene therapy targets:
EGFR mutation and ALK mutations

32
Q

what populations are affected by squamous cell carcinomas

A

second most common lung cancer
strong association with smoking
M>F
Most cases over age 50

33
Q

what is the presentation of squamous cell carcinoma

A

often present with hemoptysis, central (bronchial masses)

34
Q

what is Large cell carcinoma

A

diagnosis of exclusion
M>F most cases over age 50
may present as peripheral or central masses

35
Q

What is the general presentation of bronchiogenic carcinomas

A

some found incidentally
NEW or WORSENING cough or dyspnea is the most common
hemoptysis
chest pain
hoarseness
malaise
anorexia
weight loss

36
Q

What is horner’s syndrome

A

includes: mioisis (pupil bigger than other), ptosis (drooping eyelid), anhydrosis (lack of sweating) - pancoast tumor

37
Q

what is pancoast syndrome

A

shoulder/UE pain, weakness; hand atrophy
from invasion of brachial plexus by pancoast tumor

38
Q

what are paraneoplastic syndrome

A

syndrome of inappropriate anti-diuretic hormone (SIADH)
Bushings syndrome

39
Q

what are symptoms from mets

A

bone pain, AMS, lymphadenopathy

40
Q

what is the best way to evaluate a central lesion

A

bronchoscopy for biospy

41
Q

what does CT-guided FNA scan increase the risk for

A

Pneumothroax

42
Q

what is the after diagnosis workup for bronchiogenic carcinomas

A

PET scan, Ct abdomen and pelvis, +/- bone scan
MRI of chest if concern for adjacent structures
Head CT/MRI
lymph node biopsy

43
Q

what is the mainstay of treatment for small-cell carcinomas

A

chemo + radiation
can consider resection if localized disease (rare)

44
Q

what is the treatment for non-small cell lung cancer

A

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
Q

what is a very rare, malignant neuroendocrine tumor

A

carcinoid rumor

46
Q

what is the presentation of carcinoid tumors

A

most present as central masses - bronchial masses

47
Q

what are the symptoms of carcinoid tumors

A

primarily due to bronchial obstruction
- cough, wheezing, hemotysis, atelectasis, PNA

48
Q

what is carcinoid syndrome

A

facial flushing, SOB, HTN, weight gain, Hirsutism, asthma

49
Q

what is the workup for carcinoid tumors

A

CXR
chest CT = modality of choice
PET scan to differentiate between types
serum lab tests (plasma charomogranin A (CgA), CBC, CMP)

50
Q

how do we definitively diagnose carcinoid tumors

A

bronchoscopy and biopsy

51
Q

hat is the treatment for carcinoid tumors

A

resection (lobetcomy) perferred
+/- chemo and/or radiation
possible use of octreotide for hormonal control

52
Q

what are pulmonary metastasis

A

second most common form of lung cancer, and site of metastasis
all metastases to the lungs

53
Q

what is the presentation of pulmonary metastasis

A

often asymptomatic
cough, hemoptysis, dyspnea, hypoxia, pleural effusion
generalized SSX: N/V, back pain, fatigue, anorexia, weight loss
SSX of primary tumor

54
Q

what is the most common initial test for pulmonary mets

A

chest x-ray

55
Q

what is the treatment of pulmonary mets

A

solitary pulmonary nodules - resection
mets limited to the drug and few in number - consider resection
multiple nodules, multiple mets sites, unreachable - palliative care

56
Q

what is nearly always seocndary to asbestos exposure

A

mesothelioma

57
Q

where do mesotheliomas arise from

A

mesothelial tissue (pleura)

58
Q

what is the presentation of meothelioma

A

through screening
dyspnea, non-pleuritic CP most common
constitutional symptoms are rare
pleural effusion present in 95%

59
Q

how do we workup mesotheliomas

A

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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