Pulmonary Neoplasms Flashcards
(66 cards)
List the common risk factors for lung cancer
1) Smoking history: 20 PYH or less than 15 years since quitting
2) Age
3) Chronic lung disease
4) BMI < 25 Kg/m2
5) Family history of lung cancer?
6) Environmental: air/environmental pollution, radon, asbestos
Who should get screened for lung cancer?
Anyone aged 50 to 80 with a 20 pack year smoking history and currently smoke or have quit within the past 15 years
Differentiate between pulmonary nodules and lesions. Which is often noted on lung cancer screening or incidental finding on CXR?
1) 30 mmor less = anodule (coin lesion)
2) > 30 mm cmthe lesion = amass
-PN often noted on lung cancer screening or incidental finding on CXR
What patient characteristics favor malignancy?
1) Increasing age and smoking history increases risk of lung cancer:
-Age > 50
-Smoking > 20 PYH and currently smoking or quit less than 15 years
2) + family history lung cancer
3) Exposure to air/environmental pollution, asbestos, uranium, radium (solid), or radon (gas)
What 2 pulmonary nodule characteristics indicate increased risk of for lung cancer?
1) Solid nodules that are large, have irregular boarders, asymmetric calcification, volume doubling time of 1-12 months, or are in the upper lobes
2) Subsolid (ground glass) nodules more likely to be cancer than solid nodules
-Combination: subsolid with solid component
Which are more likely to be cancer, ground glass/ subsolid nodules or solid nodules?
Ground glass/ subsolid
Are lung cancers single nodules or multiple?
May not be a single PN or multimodule; address evaluation with largest most concerning nodule
Describe what each of the following would look like to suggest malignant etiology of a pulmonary neoplasm:
1) Appearance
2) Boarder
3) Density
4) Location
5) Multiple nodules
6) Size
7) Doubling time
1) Eccentric calcifications, noncalcified or ground glass (subsolid)
2) Spiculated or irregular
3) Subsolid (ground glass)
4) Upper lobes
5) No dominant nodule present
6) 6 or more mm
7) Between 30-400 days
What are usually benign lesions?
Healed granulomas
1) What are 3 characteristics of malignant pulmonary nodules?
2) What are 2 common pt characteristics?
1) ->/= 10 mm
-Irregular boarder
-Malignant calcifications: stippled or eccentric/asymmetric
2) Older age + h/o smoking
Benign pulmonary nodules:
1) What are the common characteristics?
2) What are 2 common pt characteristics?
1) < 10 mm
Regular boarder
Benign calcifications – central, laminated, diffuse, or popcorn
2) Younger age
No history of smoking
Describe what each of the following would look like to suggest benign etiology:
1) Appearance
2) Boarder
3) Density
4) Location
5) Multiple nodules
6) Size
7) Doubling time
1) Concentric, central, diffuse, or popcorn like calcifications
2) Smooth
3) Solid
4) Perifissural, subpleural
5) Dominant nodule present
6) <6mm
7) Less than 30 days (infection) or more than 400 days (granuloma)
What are 4 patterns of appearance that suggest benign pulmonary nodules noted on hrct?
1) Diffuse
2) Central
3) Popcorn
4) Concentric (NOT eccentric)
1) What are the symptoms and signs of pulmonary nodules?
2) What abt specifically benign pulmonary nodules?
3) What does evidence of malignancy include?
1) Asymptomatic
2) Asymptomatic
3) Weight loss, fever, diminished BS, ddventitious BS
“Incidental” Pulmonary Nodules:
1) Are found how?
2) What is the goal of initial imaging?
1) Often incidental finding on CXR/CT or found on lung cancer screening
2) Estimate the malignant potential of the nodule
PN found on CXR or lung cancer screening
1) What CXR do you order to look for pulmonary nodules (PNs)?
2) What do you do for benign or probably benign nodules? What does screening interval depend on?
1) CXR PN - Chest CT w/o contrast
2) Repeat low dose chest CT
-Morphology and size
Define morphology and size of a benign pulmonary nodule
1) Morphology = solid or subsolid, calcification pattern, boarders
2) Size:
Small < 6 mm
Medium 6-8 mm
Large > 8 mm
1) What additional imaging is needed for concerning nodules?
2) What are the 2 groups of nodules that are considered concerning?
1) HRCT or PET/CT or referral for biopsy
2) For very suspicious large solid PN: 15 mm + or 8mm + that are new or growing
Subsolid PN with large solid component: 8 mm + or 4 mm + if new or growing
American academy of chest physicians
1) Patient risk based on what?
2) What are the 3 groups of risk?
1) Clinical judgement of validated clinical risk calculator
2) High (>65%), intermediate (5-65%), or low (<5%)
Describe what to do for a solitary incidental PN <6mm based on risk
1) Low risk (nodule and patient – based on validated clinical tool) = no f/u
2) Moderate to high risk = repeat CT @ 12 months
Describe what to do for a solitary incidental PN 6-8mm based on risk
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 @ 18–24 months
Describe what to do for a solitary incidental PN >8mm based on risk
1) Low risk: CT @ 3 months, then @ 9 & 24 months
2) Moderate to high risk: PET/CT, refer for biopsy or resection
Describe what to do for multiple incidental PNs based on the size and risk of the largest nodule
1) < 6 mm and low risk: no routine f/u
-Higher risk: Optional CT @ 12 months
2) 6 mm or bigger & low risk: CT @ 3-6 months, then consider CT @ 18-14
-Higher risk: CT @ 3-6 months, repeat CT @ 18-24 months
List what to do for low risk (< 5%) cancer nodules based on size and number
1) <6mm = No routine f/u
2) 6-8mm = CT @ 6-12 months, then consider CT @ 18-24 months
3) >8mm = CT @ 3, 9 & 24 months
4) Multiple, largest < 6 mm = No routine f/u
5) Multiple, largest >/= 6mm = CT @ 3-6 months, then consider CT @ 18-24 months
