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foundations pulm exam > pulmonary neoplasms > Flashcards

pulmonary neoplasms Flashcards

1
Q

define solitary pulmonary nodule (SPN) “coin lesion”

A 
well-circumscribed
isolated
round opacity
completely surrounded by normal lung
not associated with infiltrate, atelectasis or adenopathy
3 cm or less
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2
Q

what are the most common etiologies of SPN?

A

bronchogenic carcinoma
metastatic lesion
infectious granuloma
calcification

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3
Q

what is the clinical presentation of SPN?

A

asymptomatic

found incidentally on CXR

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4
Q

what are important history components to obtain for SPN?

A 
age of pt
smoking
recent travel
recreational activities
occupation
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5
Q

what are CXR features of SPN

A

size 1% malignancy in 2-5 mm
well circumscribed
cavitary with thick walls > 16 mm (higher malignancy)
calcification (less = more malignant; dense calcification = less malignant)

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6
Q

what CT features for SPN = malignancy?

A

spiculated margins
peripheral halo
density on CT scan

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7
Q

who is a low risk for SPN malignancy (<5%)?

A

age <30
stable lesion x 2 or more years
characteristic benign calcification pattern

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8
Q

how to manage low vs intermediate vs high risk SPN pts?

A

low: watchful waiting/serial imaging (CXR or CT)
intermediate: diagnostic biopsy (transthoracic needle aspiration or bronchoscopy) and PET
high risk: resection

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9
Q

what are the steps to take when evaluating a SPN?

A

obtain chest CT
if benign - no F/U
if not benign - consider biopsy or resection if nodule is growing

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10
Q

define lung cancer

A

malignant neoplasm of the lung arising from respiratory epithelium (bronchi, bronchioles/alveoli)

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11
Q

what are the two most common lung cancers?

A

adenocarcinoma

squamous cell carcinoma

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12
Q

what are the two groupings of lung cancer?

A

non-small cell lung cancer (NSCLC) - most common

small cell lung cancer (SCLC)

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13
Q

what is the average age of a lung cancer pt?

A

65+ y/o

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14
Q

what is the most common risk factor of lung cancer?

A 
tobacco smoke
radon exposure (second most common)
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15
Q

what are the NSCLCs?

A

adenocarcinoma
adenosquamous carcinoma
squamous cell carcinoma
large cell carcioma

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16
Q

list characteristics of adenocarcinoma

A 
40% of lung cancers
most common type in non-smokers
from mucus glands
usually peripheral nodules or masses
slow growing
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17
Q

what is the characteristic of adenosquamous carcinoma?

A

composed of >10% malignant glandular and squamous components

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18
Q

list characteristics of squamous cell carcinoma?

A 
20% of lung cancers
centrally located
associated with hypercalcemia
mets out of the chest later
central necrosis
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19
Q

list characteristics of large cell carcinoma

A

epithelial neoplasm lacking both glandular and squamous differentiation
10-15% of lung CA
aggressive, rapid doubling times
large, peripheral mass but can be central

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20
Q

list characteristics of small cell lung cancer

A

bronchial origin
begin centrally, infiltrate submucosally to cause narrowing of the bronchus
aggressive poor prognosis
regional or distant mets at diagnosis

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21
Q

list characteristics of bronchial carcinoid tumors

A

pedunculated or sessile growths in central bronchi
derived from neuroendocrine cells
M=F
< 60 y/o

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22
Q

what is the clinical presentation of bronchial carcinoid tumors?

A

hemoptysis, cough, focal wheezing, recurrent PNA
peripherally located
grow slow
mets rarely

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23
Q

list symptoms of carcinoid syndrome

A

rare

flushing, diarrhea, wheezing, and hypotension

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24
Q

what can you see on CXR of bronchial carcinoid tumors, centrally vs peripherally?

A

central: pneumonitis, atelectasis, bronchiectasis, collapse

peripheral (rare): SPN that is 4 cm or less and slightly lobulated

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25
Q

what is the purpose of CT of bronchial carcinoid tumors?

A

to evaluate for endobronchial lesions and mets

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26
Q

what is the purpose of octeotide scitigraphy of bronchial carcinoid tumors?

A

localization of tumor

27
Q

how to definitely diagnose bronchial carcinoid tumors?

A

biopsy

28
Q

how to treat bronchial carcinoid tumors?

A

surgical excision with mediastinal lymph node sampling or dissection
*most resistant to radiation and chemo

29
Q

what are the complications of bronchial carcinoid tumors?

A

bleeding and airway obstruction

30
Q

what is the prognosis of bronchial carcinoid tumors?

A

excellent, 87-100% 5-year survival after resection

31
Q

what is in the spectrum of clinical presentation of lung cancer?

A

asymptomatic
symptoms of local disease
symptoms of mets disease
symptoms of paraneoplastic syndrome

32
Q

what symptom is usually associated with squamous and small cell cancers?

A

cough (most common presentation)

33
Q

what are other common symptoms of lung cancer?

A

hemoptysis, dyspnea, and pain (more common in younger pts)

34
Q

list details of superior vena cava syndrome

A

most common in small cell lung cancer
bulky upper lobe tumor
snesation of fullness in the head
dyspnea

35
Q

what do you find on physical exam for super vena cava syndrome?

A

dilated neck veins
facial edema
plethoric appearance

36
Q

what do you find on CXR of superior vena cava syndrome?

A

widening of mediastinum

R hilar mass

37
Q

list details of pancoast syndrome

A

common in squamous NSCLC
shoulder pain
Horner’s syndrome (right pupil more mitotic and right upper lid is ptotic)

38
Q

mets to the liver, bone, adrenal, and brain cause what?

A

liver: liver enzyme abnormalities
bone: pain (back, chest, and extremity), elevated alk phos and calcium, involves vertebral bodies
adrenal: asymptomatic
brain: h/a, vomiting, visual field loss, hemiparesis, CN deficit, seizure

39
Q

list details of paraneoplastic syndromes/extrathoracic effects

A

effects of tumor not related to direct invasion, obstruction or mets
10-20% of lung cancer pts
common with SCLC and squamous cell cancer

40
Q

what is a classic benign lesion distinct appearance on CXR?

A

hamartoma

41
Q

if nodule <6mm, what is your next step?

A

assess likelihood of malignancy, F/U not required, but could get chest CT

42
Q

if nodule 6-8 mm, what is your next step?

A

chest CT, and do another one in the next 6-12 months

43
Q

if nodule >8mm, what is your next step?

A

chest CT or biopsy/resection

44
Q

what labs for lung cancer?

A

CBC, electrolytes, calcium, creatinine, liver tests, LDH, and albumin

45
Q

what imaging do you start with in lung cancer?

A

CXR

46
Q

can you diagnose with imaging of lung cancer?

A

no

47
Q

what is the gold standard diagnosis for lung cancer?

A

tissue biopsy (bronchoscopy, needle biopsy, thoracotomy)

48
Q

what is the gold standard for mediastinal staging?

A

mediastinoscopy

49
Q

what is the most common site of NSCLC distant mets?

A

brain

50
Q

for advanced stages of lung cancer, what scan do you use?

A

bone scan, brain imaging

51
Q

what is treatment in early stages of NSCLC?

A

resection

52
Q

if nonsurgical candidate, what is the NSCLC treatment?

A

chemoradiation

sterotactic body radiation therapy

53
Q

how to treat limited SCLC?

A

chemo and radiation

54
Q

how to treat extensive SCLC?

A

chemo alone initial treatment

55
Q

what are the SE of chemo?

A 
N/V, fatigue, anorexia, weight loss
anemia, neutropenia, risk for infection
nephrotoxicity
neurotoxicity
dermatologic rash
visual disturbances
56
Q

what should you do for lung cancer post-treatment surveillance?

A

H&P & chest CT every 6 months x2 years and annually thereafter

57
Q

what are complications of lung cancer post-treatment surveillance?

A 
chronic pain, dyspnea, fatigue, impaired sleep, distressed mood, sexual dysfunction, QoL decrease
neuropathy
hearing loss
neurocognitive changes
skin changes
radiation pneumonitis
esophagitis
CVD
58
Q

list details of mesothelioma

A

primary tumor arising from the surface lining of the pleura
men > women
linked to asbestos exposure

59
Q

what is the latent period of mesothelioma?

A

20-40 years

60
Q

what are clinical findings of mesothelioma?

A 
insidious onset SOB
nonpleuritic CP
weight loss
dullness to percussion
diminished breath sounds
digital clubbing
61
Q

how do you evaluate mesotheliomas?

A

look at pleural fluid (exudative and hemorrhagic)
cytology
VATS biopsy
Ct/PET-CT scan

62
Q

how to treat mesothelioma?

A

chemotherapy

63
Q

who should get an annual LDCT screening?

A

55-74 y/o that is a current smoker and former smoker (within 15 years) with a 30 or greater pack-year history

64
Q

what groups of people do not need a CT screen?

A

<30 pack-years
<55 y/o or > 74 y/o or quit > 15 years ago or severe comorbidities that would preclude potentially curative and/or limit life expectancy

foundations pulm exam (10 decks)

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