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clin med pulmonology > Pulmonary neoplasm > Flashcards

Pulmonary neoplasm Flashcards

1
Q

What is the age range that the USPSTF recommends having lung cancer screening

A

50-80 for those who have 20 pack year smoking history that is current or within that last 15 years

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2
Q

What are some benign characteristics for lung tumors

A

Size <3cm
Solid round nodules
Age<30
non-smoker
Dense central calcification
well defined borders, no halo

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3
Q

What are some characteristics of malignant lung nodules

A

Size>3cm
Sub-solid (ground glass)
Smokers
Age>30
Stripped/eccentric calcification
irregular margins
lobular
cavitary with thick walls

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4
Q

Which population is most effected by solitary pulmonary nodules

A

men
smoker, COPD, older
**if non-smoker = women higher risk

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5
Q

What constitutes a solitary pulmonary nodule

A

‘coin lesion’
Discrete, round, <3cm

*not fixed to pleura/ chest wall
*No lymphadenopathy, infiltrate, atelectasis

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6
Q

What is the most common benign solitary pulmonary nodule

A

Infectious granuloma

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7
Q

What is the most common malignant solitary pulmonary nodule

A

Adenocarcinoma

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8
Q

What is a definitive dx for solitary pulmonary nodules

A

Biopsy

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9
Q

Which patient population is at increased risk for developing a solitary pulmonary nodule

A

Any hx of smoking
+FH lung cancer
Carcinogen exposure
Upper lobe nodule
emphysema
pulmonary fibrosis

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10
Q

What is the Fleischner criteria used for

A

managing incidentally detected solid pulmonary nodules in adults

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11
Q

What is considered a traditional lung cancer

A

Bronchogenic carcinoma

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12
Q

What is the #1 cause of cancer deaths

A

bronchogenic carcinoma

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13
Q

What is the median age to be diagnosed with bronchogenic carcinoma

A

70

*rare prior to 40y/o

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14
Q

What is the survival range with bronchogenic carcinomas

A

5 years max

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15
Q

What is the highest risk factor for bronchogenic carcinomas

A

smoking

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16
Q

What are the types of bronchogenic carcinoma

A

small cell (oat cell)
non-small cell

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17
Q

What types of cancer are considered non-small cell carcinoma

A

Adenocarcinoma
squamous cell carcinoma
Large cell carcinoma (everything else)

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18
Q

Which type of bronchogenic carcinoma is less common

A

small cell

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19
Q

What type of cell make up small cell carcinoma

A

neuroendocrine cells

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20
Q

What type of cells make up squamous cell carcinoma

A

bronchial epithelial cells

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21
Q

What type of cells make up adenocarcinoma

A

Glandular (mucous) cells

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22
Q

What are large cell carcinomas made up of

A

Undifferentiated

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23
Q

Which population is at highest risk of developing small cell carcinoma

A

Males over 50 (avg age = 70)
Smoking history
caucasian

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24
Q

What is the presentation of small cell carcinoma

A

rapid onset of symptoms (8-12 wks)
Mets common
central (bronchial) masses
paraneoplastic syndromes (SIADH, cushings)

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25
Q

What are paraneoplastic syndromes

A

Things associated with malignant diseases

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26
Q

What is the most common type of lung cancer in NON-smokers

A

adenocarcinoma

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27
Q

Which population is at greater risk of developing adenocarcinoma

A

Males over 50 (avg age = 70)

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28
Q

What gene mutation is associated with adenocarcinoma

A

P53

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29
Q

What is the presentation of adenocarcinoma

A

Peripheral masses but mostly asymptomatic

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30
Q

What are gene therapy targets for adenocarcinoma

A

EGFR mutations
ALK mutations

31
Q

What is the presentation os squamous cell carcinoma

A

Hemoptysis
central (bronchial) masses

32
Q

What is the second most common lung cancer

A

Squamous cell carcinoma (strong association with smoking)

33
Q

How do you diagnose large cell carcinoma

A

dx of exclusion

*may present with peripheral or central masses

34
Q

What is the most common presentation of bronchogenic carcinomas

A

New or worsening cough or dyspnea

*Hemoptysis (2) and chest pain (3)

35
Q

What are some associated symptoms with bronchogenic carcinomas

A

Dysphagia
SVC syndrome
Horners syndrome
Pancoast syndrome
Paraneoplastic syndrome
Digital clubbing
Sx from mets

36
Q

What is Horners syndrome

A

miosis, ptosis, anhydrous

37
Q

What is pan coast syndrome

A

Shoulder/UE pain, weakness and hand atrophy from invasion of brachial plexus

38
Q

What is the workup for bronchogenic carcinomas

A

Imaging (CXR -> then CT)

Bronchoscopy is central lesion
CT FNA is peripheral

39
Q

What is the staging for small cell carcinomas

A

limited disease = confined to hemithorax

Extensive disease = extends to other lung / outside lung

40
Q

How are non-small cell lung cancers staged

A

via the TMN staging system

41
Q

What is the mainstay treatment for small cell carcinoma

A

Chemo and radiation
*resection if localized

42
Q

How do you treat stage 1&2 non-small cell carcinoma w/o nodes

A

Resection

43
Q

How do you treat late stage 2 or stage 3 non-small cell carcinoma

A

Resection with chemotherapy

44
Q

How do you treat stage 3 unresectable small cell carcinomas

A

Chemo +/- radiation

+/-adjunctive immunotherapy (-mads)

45
Q

What type of tumor is carcinoid tumors

A

rare, malignant, neuroendocrine tumors (atypical or typical)

46
Q

What are the risk factors for carcinoid tumors

A

Smoking (atypical ONLY)
+FH
Multiple endocrine neoplasia type 1 (MEN1 gene)

47
Q

What is the #1 pulmonary tumor in kids

A

carcinoid tumors

48
Q

How much later do atypical carcinoid tumors present after typical

A

roughly 10 years

49
Q

Where are carcinoid tumors found in the lungs

A

central bronchial masses (typical)

Peripherally (atypical)

50
Q

What is carcinoid syndrome

A

Facial flushing
SOB
HTN
Hirsutism
asthma
weight gain

51
Q

What is the workup for a carcinoid tumor

A

Chest CT (test of choice)
*should be well defined, lobulated nodules +/- calcifications

52
Q

What test allows to differentiate types of carcinoid tumors

A

PET

53
Q

What is a tumor marker for neuroendocrine tumors

A

plasma chromogranin (CgA)

54
Q

How do you test for endocrine dysfunction

A

5-HIAA (seretonin byproduct)
Serum /urine cortisol
ACTH levels
GHRH & IGF

55
Q

What test gives a definitive diagnosis for carcinoid tumors

A

Bronchoscopy and biopsy

56
Q

What is the treatment for carcinoid tumors

A

Resection preferred
+/- chemo and/or radiation
Possible hormonal control

57
Q

What can be used for hormonal control with carcinoid tumors

A

octreotide

58
Q

What is the second most common form of lung cancer

A

Pulmonary metastasis

59
Q

What is the second most frequent site of cancer metastasis

A

Pulmonary system (primarily via pulmonary artery)

60
Q

Which cancers typically metastasize to the lungs

A

Colorectal
head/neck
urologic (Kidney, prostate, testicular)
GI cancers
Breast cancer
melanoma
gynecologic tumor

61
Q

Where does primary lung cancer metastasize to

A

Liver
Bones
Brain
Lymph nodes
Adrenal glands

62
Q

What is the most common initial test for pulmonary metastasis

A

CXR

63
Q

What is the best test for pulmonary metastasis

A

Helical chest CT

64
Q

What is the most common finding on imaging with pulmonary metastasis

A

multiple, bilateral nodules. Spherical, fairly well defined, varying sizes

65
Q

How can you ID the primary tumor if not already known

A

Look for tumor markers
Biopsy results

66
Q

What is the treatment for multiple pulmonary nodules, multiple met sites, and unreachable nodules

A

Palliative care (radiation +/- chemo)

67
Q

What is the criteria to be able to resect a pulmonary nodule

A

Have primary tumor under control
Sufficient cardiopulmonary status
Ability to remove all mets
All non-operative options exhausted

68
Q

What is the prognosis for pulmonary metastasis

A

5 year survival = 36%
10 year survival = 26%

69
Q

What causes mesothelioma

A

Asbestos exposure

70
Q

What is the presentation of mesothelioma

A

Dyspnea
non-pleuritic chest pain
unilateral pleural effusion

71
Q

What is the workup for mesothelioma

A

CXR
CT for further differentiation
Thoracentesis
Pleural bx
CT,MRI,PET for staging

72
Q

What is the treatment for mesothelioma

A

Resection, +/- chemo, +/- radiation

73
Q

What is the average survival of mesothelioma

A

9-12 months

clin med pulmonology (12 decks)

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