Pulm neoplasms highlights

Question 1

1) Define coin lesion/ nodule
2) Define mass
3) What is often noted on lung cancer screening or as an incidental finding on CXR?

Answer 1

1) 30 mmor less = anodule (coin lesion)
2) > 30 mm cm = amass
3) PN (pulmonary nodule)

Question 2

What is the most common malignant pulmonary neoplasm?

Answer 2

Adenocarcinoma

Question 3

What is the most common kind of benign pulmonary nodule?

Answer 3

Healed infectious granuloma

Question 4

What is the goal of initial imaging of a neoplasm?

Answer 4

Estimate the malignant potential of the nodule

Question 5

You should repeat low dose chest CT for benign or probably benign nodules; screening interval depends on the ___________ and ___________ of the initial nodule

Answer 5

morphology and size

Question 6

Additional imaging besides CXR, like HRCT or PET/CT or referral for biopsy for concerning nodules, should be done when?

Answer 6

Very suspicious large solid PN - 15 mm + or 8mm + that are new or growing

Question 7

Describe what to do for a solitary incidental PN 6-8mm based on risk

Answer 7

1) Low risk: repeat CT @ 6-12 months, then consider @ 18–24 months
2) Moderate to high risk: repeat CT @ 6 -12 months, then repeat CT @ 1 –24 months

Question 8

When is a PET-CT and biopsy always warranted?

Answer 8

If any PN is concerning for malignancy

Question 9

True or false: pulmonary neoplasm does not mean cancer. Explain your answer.

Answer 9

True (but your patient will think cancer when you use it!!!!)

Question 10

Lung cancer is the # 1 cause of ___________ deaths in WOMEN and MEN

Answer 10

cancer

Question 11

Majority of lung cancers divided into what 2 histologic types? What % does each make up?

Answer 11

1) Non-small cell lung cancer (NSCLC; 85%)
2) Small cell lung cancer (SCLC; 15%)

Question 12

What do Small cell lung cancer (SCLC) and NSCLC have in common?

Answer 12

Both assoc. w smoking

Question 13

List the risk factors for lung cancer

Answer 13

1) Cigarette smoking
2) Prior radiation
3) COPD
4) Environmental exposure (radon, asbestos)

Question 14

Lung cancer symptoms include what 3 things?

Answer 14

Hemoptysis, cough, dyspnea

Question 15

1) If you have a pt with a puln nodule and their test comes back and says they have hyponatremia, what is the most likely cancer?
2) What if it was hypercalcemia instead?

Answer 15

1) Small cell carcinoma [causing SIADH]
2) SCC [hyper PTH]

Question 16

True or false: adenocarcinoma is not associated with smoking and is more peripheral

Answer 16

True

Question 17

True or false: even if a CXR is normal, that does not rule out cancer because the sensitivity is low

Answer 17

True

Question 18

Is Non-small cell Squamous cell lung cancer more centrally or peripherally located?

Answer 18

Centrally

Question 19

What is the primary concern of lung cancer Dx confirmation?

Answer 19

Tissue

Question 20

Non-small cellcan be treated with what?

Answer 20

Surgery, then radiotherapy, CTX

Question 21

Cigarette smokeis associated with what lung cancers?

Answer 21

1) Small cell (oat cell)
2) Some non-small cell cancers: SCC + large cell carcinoma

Question 22

1) What is the most common lung cancer in non-smokers? What are 2 common causes?
2) Pancoast tumors are masses in the______ region of the lung, compress the nerves andblood vessels, & are most likely SCCor___________________

Answer 22

1) Adenocarcinoma; air pollution & radon common cause
2) upper; adenocarcinoma

Question 23

What 3 things are Pancoast tumors assoc. with?

Answer 23

1) Shoulder pain
2) Horner’s syndrome
3) Bony destruction

Question 24

Carcinoid syndrome (rare):
Specific to carcinoid tumors, causes the release of serotonin/vasoactiveresulting in what 3 things?

Answer 24

Flushing, diarrhea, and bronchoconstriction (asthma type lung Sx)

Question 25

What is a treatment of non-small cell lung carcinoma after initial surgery?

Answer 25

Erlotinib

Question 26

1) Lung cancer often found as incidental nodule on ________ or chest CT. 2) Large cell and carcinoid tumors (non-small cell types) can be found throughout the __________. 3) Small cell and Squamous cell found “S”entrally; both are associated with what?

Answer 26

1) CXR 2) lungs 3) Smoking

Question 27

What is the mnemonic to remember what doesn't cause adnocarcinoma?

Answer 27

Found peripherally, not associated with smoking (Ain’t Smoking)

Question 28

What are the 2 types of Pancoast tumors?

Answer 28

Adenocarcinoma or squamous cell carcinoma

Question 29

What is needed for definitive lung CA dx?

Answer 29

Biopsy/FNA

Question 30

Carcinoid syndrome (rare, ~ 1-2%): What are the classic S/Sx?

Answer 30

Cutaneous flushing, diarrhea, itching, bronchoconstriction (wheezing), and hypotension -S/S manifested when vasoactive substance(serotonin, histamine, & bradykinin) secreted into systemic circulation from liver or lung mets

Question 31

1) What arise from neuroendocrine cells in GI (appendix most common), lungs, ovaries, and thymus? 2) What is the most common site of metastatic spread?

Answer 31

1) Carcinoid tumors 2) Liver

Question 32

Increased Serotonin synthesis leads to what Sx? Why?

Answer 32

Pellagra due to decreased tryptophan + niacin/B3

Question 33

What is the purpose of getting a urinalysis for a carcinoid tumor? *know this*

Answer 33

**Elevated 5-HIAA** (5-hydroxyindoleacetic acid): main metabolite of serotonin and is used to determine serotonin levels in body

Question 34

Who should be screened for lung cancer?

Answer 34

50-80 y/o, > 20 PYH smoking, either currently smoking or quit < 15 years

Question 35

What are the 5 As of smoking cessation?

Answer 35

Ask all patients every visit about smoking Advise patients to quit Assess patient’s willingness to quit Assist patient to quit with pharmacology – Chantix has best EB Arrange follow up