Flashcards in Pulmonary 2 (Step up son) Deck (21):
A CXR/CT shows a solitary lung nodule
Cancer...primary or metastasis (40% of time)
A solitary pulmonary nodule is seen on CXR. What is the next step?
Look at a previous CXR to compare
A solitary pulmonary nodule was seen on CXR and compared to a previous CXR and was found to have changed (or there was no previous CXR). What is the next step?
Get a CT to determine location, progression, and size
What are characteristics of a benign solitary pulmonary nodule? What should be done for follow up?
What are characteristics of a malignant solitary pulmonary nodule? What is done?
Patient is a smoker >45yo
New or progressive nodule
No calcifications or irregular calcifications
FDG-PET, biopsy, or immediate resection
What percentage of lung cancers are metastases from another primary source? What are the common sources?
Metastases make up 10% of lung cancers
Breast, colon, prostate, endometrial, cervical cancers
90% of primary lung cancers are related to smoking. What is the most common primary lung cancer in NONsmokers? Where is the cancer located in the lung?
Located in the periphery
A nonsmoker is found to have a single pulmonary nodule on CXR. What is a possible low grade subtype?
An old ship worker is found to have wide metastases and a pleural effusion. What is the diagnosis? What would be found in the effusion?
Adenocarcinoma secondary to asbestos exposure (more common than mesothelioma)
Increased hyaluronidase levels
A patient is diagnosed with adenocarcinoma. What are syndromes caused by adenocarcinoma?
Adenocarcinoma can cause hemolytic problems (DIC, thrombophlebitis, and MAHA) and dermatomyositis
A cavitary pulmonary lesion is seen that is attached to a hilar lymph node. What is it?
Squamous cell carcinoma
What is a peptide produced by squamous cell lung cancers that can cause problems?
PTH-related peptide...hypercalcemia (if severe: polydipsia/polyuria, N/V/C, muscle weakness, bone pain, confusion, lethargy, and/or fatigue)
A solid, central pulmonary nodule is seen on CXR and a PET scan shows many distant metastases. What is the likely diagnosis? What else can be seen?
Small cell carcinoma
Ectopic GH and ACTH (--> Cushing syndrome)
Peripheral neuropathy and subacute sensory neuropathy
Antibodies to voltage-gated calcium channels --> Lambert-Eaton syndrome (similar to myasthenia gravis)
Subacute cerebellar degeneration
A guy comes in smelling of tobacco and with gynecomastia. A CXR shows a cavitary, peripheral lung lesion. What is the likely diagnosis? Besides gynecomastia, what other complication(s) can happen with this cancer?
Large cell carcinoma
What are some syndromes that can occur with any lung cancer?
Horner syndrome: miosis, ptosis, and anhidrosis
Pancoast syndrome: Horner + brachial plexus involvement
Superior vena cava syndrome: SVC obstruction --> head swelling and CNS symptoms
Lung cancers are broken up into small cell and non-small cell for staging and treatment. A NSCLC is found to have mediastinal invasion. What is the stage? What is the treatment?
Mediastinal invasion automatically makes it stage III...so does distant nodes and/or metastases
Treatment is palliative
Lung cancers are broken up into small cell and non-small cell for staging and treatment. A NSCLC is found to have NO lymph node involvement beyond ipsilateral hilar nodes, NO mediastinal invasion, and NO metastases. What is the stage? What is the treatment?
Stage I NSCLC
Treat with surgical resection*, +/- adjuvant chemotherapy, +/- radiation; radiation therapy if unable to do surgery
Lung cancers are broken up into small cell and non-small cell for staging and treatment. A NSCLC is found to have extension to ipsilateral mediastinal nodes, but NO mediastinal invasion or metastases. What is the stage? What is the treatment?
Stage II NSCLC
Treat with radiation*, consider chemo induction and surgery
Lung cancers are broken up into small cell and non-small cell for staging and treatment. A SCLC is found to have NO nodal spread or metastases. What is the stage? What is the treatment?
Treat with Chemo* +/- adjuvant radiation, consider surgery if very small
Lung cancers are broken up into small cell and non-small cell for staging and treatment. A SCLC is found to have nodal spread or metastases. What is the stage? What is the treatment?
Treat with Chemo* +/- adjuvant radiation, NO surgery