Neoplastic Pulmonary Disease

Question 1

What is the leading cause of cancer death in men and women?

Answer 1

lung cancer

Question 2

What is the typical peak age range for lung cancer?

Answer 2

55-65 year olds

Question 3

What are the 4 major types of lung cancer?

Answer 3

Squamous or epidermoid carcinoma
Small cell (also called oat cell) carcinoma
Adenocarcinoma
Large cell carcinoma

Question 4

What is the number one risk factor for lung disease?

Answer 4

Smoking is the #1 risk factor

Question 5

What percentage of all patients with lung cancer of all histological varieties are current smokers or have a history of smoking?

Answer 5

85%

Question 6

The most common form of lung cancer is what type?

Answer 6

Adenocarcinoma

Question 7

Lung cancer is often referred as?

Answer 7

Bronchogenic Carcinoma

Question 8

Bronchogenic carcinoma classified in what 2 main categories?

Answer 8

Non-small cell lung cancer ~80%
Small cell lung cancer ~20%

Question 9

Which types of lung cancer are the peripheral tumors?

Answer 9

Adenocarcinoma
Large cell carcinoma

Question 10

Which types of lung cancer are the central tumors?

Answer 10

Squamous cell carcinoma
Small cell carcinoma

Question 11

Which type of lung cancer is described below?

Central masses

Tends to originate in proximal bronchial epithelium/central bronchi as intraluminal growth

Tends to be a slower growing tumor

Answer 11

Squamous Cell Carcinoma

Question 12

Which type of lung cancer is described below?

Most common form

Arise from mucus glands, can arise from any epithelial cell within or
distal to terminal bronchioles

Usually present as more peripheral in location, often as peripheral nodules or masses

Most common in patients with underlying lung disease

Answer 12

Adenocarcinoma

Question 13

Which type of lung cancer is described below?

AKA “oat cell carcinoma”

Part of family of neuroendocrine tumors arising throughout body

Also occurs centrally and tends to narrow or obstruct bronchus

Widespread metastases is common (spreads quickly)

Poor prognosis

Answer 13

Small Cell Carcinoma

Question 14

Which type of lung cancer is described below?

Heterogenous group of poorly differentiated tumors that don’t have
features of other tumor types

Present as peripheral or central masses

Rapid doubling time and aggressive clinical course – very aggressive

Answer 14

Large Cell Carcinoma

Question 15

What is the Large Cell Carcinoma’s claim to fame?

Answer 15

Rapid doubling time

Question 16

Lung CA (adenocarcinomas and small cells) accounts for 70% of
symptomatic what?

Answer 16

brain metastases

Question 17

Examples of Paraneoplastic syndromes from lung cancer include:

Answer 17

Cushing’s syndrome
SIADH
Hypercalcemia
gynecomastia

Question 18

What location is most common for lung cancer metastasis?

Answer 18

brain

Question 19

A tumor of the superior sulcus at the extreme apex of the lung

Either a large cell or adenocarcinoma

Answer 19

Pancoast Tumors

Question 20

What method is the definitive diagnosis of lung cancer?

Answer 20

Cytology

Question 21

What is the modality as well as the guidelines for screening for lung cancer?

Answer 21

Use low-dose chest CT

Recommended for patients 55-74 years who have smoked ≥30 pack years and either continue to smoke or have quit within past 15 years

Question 22

Which type of lung cancer has the best outcome/prognosis?

Answer 22

Squamous cell

Question 23

Which type of lung cancer has the worst outcome/prognosis?

Answer 23

Small cell

Question 24

A single round or oval shaped circumscribed isolated pulmonary lesion, up to <3cm, surrounded by normal lung tissue

Historically called “coin lesions”

Not associated with infiltrate, atelectasis, or adenopathy

Answer 24

Solitary Pulmonary Nodule

Question 25

Based on ACCP guidelines, assessment of a solitary pulmonary nodule should be based primarily on two factors:

Answer 25

Patient’s risk of cancer (age, smoking history, etc) Nodule size

Question 26

What size of solitary pulmonary nodule should you start to get concerned/look into further?

Answer 26

Anything >8mm : 8mm is where the malignancy risk starts to increase

Question 27

Most solitary pulmonary nodules are what?

Answer 27

infectious granulomas (80%) - TB, endemic fungi (ex. Histoplasmosis)

Question 28

If multiple pulmonary nodules present, consider what?

Answer 28

metastatic disease

Question 29

What are some risk factors to ask about/consider when evaluating a solitary pulmonary nodule?

Answer 29

Age Smoking history Environmental/work exposures (ex. Asbestos) Prior history of CA Coexisting lung disease Travel or residence in endemic fungal areas (ex. Histoplasmosis)

Question 30

A pulmonary nodule with the morphology of spiculated margins or a peripheral halo should raise your suspicion of what?

Answer 30

That the nodule is malignant (not benign)

Question 31

What are the two most common benign lung neoplasms?

Answer 31

bronchial adenomas and hamartomas (90% of the total)

Question 32

The majority of bronchial adenomas are what type?

Answer 32

80-90% of them are carcinoids

Question 33

A neuroendocrine tumor is called what?

Answer 33

Carcinoid

Question 34

Rare group of pulmonary tumors characterized by neuroendocrine differentiation and relatively indolent clinical behavior (rarely metastasize)

Answer 34

Carcinoid tumors

Question 35

Carcinoid syndrome triad

Answer 35

Flushing Diarrhea Hypotension

Question 36

What is the mainstay treatment of Carcinoid tumor and why?

Answer 36

Surgical removal only real treatment - mainstay Resistant to radiation and chemotherapy

Question 37

Generally considered a benign tumor in middle age patients that grows slowly over years Think of it as a hunk of lung tissue that grows abnormally Believed to arise as outgrowth from normal mesenchymal and epithelial lung elements Contain mixture of cartilage, fat, smooth muscle, bone, and respiratory epithelium

Answer 37

Hamartoma

Question 38

Appear as lobulated lesions with “popcorn” calcification

Answer 38

Hamartoma

Question 39

What caution should you exercise with Hamartomas and why?

Answer 39

Hypervascular and they bleed profusely so caution used in surgery