pulmonary neoplasms Flashcards by Stefan Khensouri

define solitary pulmonary nodule (SPN) “coin lesion”

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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what are the most common etiologies of SPN?

bronchogenic carcinoma
metastatic lesion
infectious granuloma
calcification

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what is the clinical presentation of SPN?

asymptomatic

found incidentally on CXR

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what are important history components to obtain for SPN?

age of pt
smoking
recent travel
recreational activities
occupation

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what are CXR features of SPN

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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what CT features for SPN = malignancy?

spiculated margins
peripheral halo
density on CT scan

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

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

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

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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what are the steps to take when evaluating a SPN?

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

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define lung cancer

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

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what are the two most common lung cancers?

adenocarcinoma

squamous cell carcinoma

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what are the two groupings of lung cancer?

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

small cell lung cancer (SCLC)

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what is the average age of a lung cancer pt?

65+ y/o

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what is the most common risk factor of lung cancer?

tobacco smoke
radon exposure (second most common)

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what are the NSCLCs?

adenocarcinoma
adenosquamous carcinoma
squamous cell carcinoma
large cell carcioma

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list characteristics of adenocarcinoma

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

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what is the characteristic of adenosquamous carcinoma?

composed of >10% malignant glandular and squamous components

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list characteristics of squamous cell carcinoma?

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

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list characteristics of large cell carcinoma

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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list characteristics of small cell lung cancer

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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list characteristics of bronchial carcinoid tumors

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

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what is the clinical presentation of bronchial carcinoid tumors?

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

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list symptoms of carcinoid syndrome

rare

flushing, diarrhea, wheezing, and hypotension

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

central: pneumonitis, atelectasis, bronchiectasis, collapse

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

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what is the purpose of CT of bronchial carcinoid tumors?

to evaluate for endobronchial lesions and mets

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

localization of tumor

how to definitely diagnose bronchial carcinoid tumors?

biopsy

how to treat bronchial carcinoid tumors?

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

what are the complications of bronchial carcinoid tumors?

bleeding and airway obstruction

what is the prognosis of bronchial carcinoid tumors?

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

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

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

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

cough (most common presentation)

what are other common symptoms of lung cancer?

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

list details of superior vena cava syndrome

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

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

dilated neck veins facial edema plethoric appearance

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

widening of mediastinum | R hilar mass

list details of pancoast syndrome

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

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

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

list details of paraneoplastic syndromes/extrathoracic effects

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

what is a classic benign lesion distinct appearance on CXR?

hamartoma

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

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

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

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

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

chest CT or biopsy/resection

what labs for lung cancer?

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

what imaging do you start with in lung cancer?

CXR

can you diagnose with imaging of lung cancer?

what is the gold standard diagnosis for lung cancer?

tissue biopsy (bronchoscopy, needle biopsy, thoracotomy)

what is the gold standard for mediastinal staging?

mediastinoscopy

what is the most common site of NSCLC distant mets?

brain

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

bone scan, brain imaging

what is treatment in early stages of NSCLC?

resection

if nonsurgical candidate, what is the NSCLC treatment?

chemoradiation | sterotactic body radiation therapy

how to treat limited SCLC?

chemo and radiation

how to treat extensive SCLC?

chemo alone initial treatment

what are the SE of chemo?

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

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

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

what are complications of lung cancer post-treatment surveillance?

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

list details of mesothelioma

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

what is the latent period of mesothelioma?

20-40 years

what are clinical findings of mesothelioma?

``` insidious onset SOB nonpleuritic CP weight loss dullness to percussion diminished breath sounds digital clubbing ```

how do you evaluate mesotheliomas?

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

how to treat mesothelioma?

chemotherapy

who should get an annual LDCT screening?

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

what groups of people do not need a CT screen?

<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

pulmonary neoplasms Flashcards

(64 cards)