Pulmonary Neoplastic Deck Flashcards Preview

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Flashcards in Pulmonary Neoplastic Deck Deck (60):
1

What conditions are included in pulmonary neoplastic disease?

Bronchogenic Carcinoma
Solitary pulmonary nodule
Carcinoid tumors

2

What is the epidemiolgy of Bronchogenic Carcinoma?

Second most common cause of cancer in men and women
Overall 5 year survival rate is 15%

3

What types of cancer are included in Bronchogenic carcinoma?

1. Divided into 2 categories based on staging and treatment options:
A. Small Cell Lung Cancer (SCLC)
B. Non-SCLC (NSCLC)

4

What are the characteristics of small cell lung cancer?

More likely to spread early in disease
Rarely amenable to surgery
Mean survival 6-18 weeks
Poor prognosis

5

What are the characteristics of non small cell lung cancer?

1. Grows slower with ‘better’ prognosis
A. Depends on cytology & timing of diagnosis

6

What is the pathophys of bronchogenic cancer?

Lung cancer commonly results from repeated tissue trauma from inhalation of irritants or carcinogens

7

Where in the lungs do most cancers originate?

1. Almost all lung cancers begin in epithelial cells of lungs
A. In normal lungs, epithelium lines and protects tissue below it
B. When exposed to carcinogens, epithelium constantly replaces itself until cells develop chromosomal changes and become dysplastic

8

What are the 3 types of Non small cell lung cancer?

Squamous Cell Carcinoma (SCC)
Adenocarcinoma
Large cell carcinoma

9

What is the percentage of Squamous Cell CA in all lung cancer cases?

Represents 25-35% of lung cancer cases

10

Where does squamous cell carcinoma originate? Where does it go?

1. Originates in central bronchi and metastasizes to regional lymph nodes
2. Prone to early mets with aggressive course

11

What are the sxs of squamous cell carcinoma?

1. Cough
2. Hemoptysis
Later sxs:
1. Chest Pain
2. Weight loss
3. Dyspnea
4. Usually Hx of smoking

12

What are the CXR results in Squamous cell carcinoma?

1. Hilar masses
2. Peripheral masses
3. Atelectasis: precursor to pneumonia
4. Infiltrates
5. Pleural Effusion

13

What are the histologic diagnoses in Squamous cell carcinoma?

1. Sputum cytology
2. Bronchoscopy
3. Pleural fluid analysis
4. Tissue biopsy

14

What is the treatment of choice for squamous cell carcinoma? What is the 5 yr survival rate?

Surgery
Treatment of choice
5 year survival rate after resection is 35-40%
Only if mets no present

15

What are the other treatment options in squamous cell carcinoma?

Radiation Therapy
Chemotherapy

16

What is the most common type of bronchogenic carcinoma?

Adenocarcinoma

17

What is the percentage of adenocarcinoma in all lung cancer cases?

35-40%

18

True/false: adenocarcinoma typically does not metastasize.

Typically metastasize to distant organs

19

What is the pathophys of adenocarcinoma?

Tumors arise from mucus glands

Most located in periphery of lung
Few tumors are bronchoalveolar

Not amenable to early detection through sputum analysis

20

What are the sxs of adenocarcinoma?

1. Cough
2. Lymphadenopathy
3. Hepatomegaly
4. Weight loss
5. Hx smoking

21

What are the CXR results in adenocarcinoma?

CXR (PA & Lat)
Reveal small peripheral masses

22

What are the Carcinoembryonic antigen results in adenocarcinoma?

Positive, but not diagnostic

23

How is adenocarcinoma treated?

1. Disease often metastatic when diagnosed
2. Symptomatic lung cancer is usually advanced
A. Usually not amenable to surgery
3. If amenable to surgery, bronchoalveolar tumor has most favorable prognosis

24

How is adenocarcinoma diagnosed?

Cytology from a biopsy

25

What is the time frame between development of adenocarcinoma and presentation of sxs?

Interval between development of lung cancer and clinical presentation of disease estimated at 5-10 years

26

Define large cell carcinoma?

1. Heterogenous group of undifferentiated types that do not fit elsewhere

27

What is the percentage of large cell carcinoma in all lung cancer cases?

3-5% of lung cancers

28

What are the characteristics of large cell carcinoma?

1. Cytology usually reveals large cells

2. May be central or peripheral masses

3. Tends to grow and spread quickly in comparison to other NSCLC

29

What percentage of all lung cancers is small cell carcinoma?

10-15% of lung cancers

30

True/false: small cell carcinoma is the most aggressive cancer.

1. Most aggressive type
2. Small cells that metastasize early
Lymphatic and hematogenous spread

31

What is the pathophys of small cell carcinoma?

1. Tumor of bronchial origin that usually begins centrally, causing narrowing or obstruction of bronchus
2. Hilar & mediastinal abnormalities are common

32

What are the sxs of small cell carcinoma?

1. Anorexia
2. Weight loss
3. New cough or change in chronic cough
4. +/- hemoptysis
5. +/- atelectasis
6. Significant polyuria
7. Syndrome of Inappropriate ADH (SIADH)
A. 10-15% of pts with SCLC can develop this syndrome
B. Paraneoplastic syndrome

33

What are the most important sxs of small cell carcinoma?

1. Significant polyuria
2. Syndrome of Inappropriate ADH (SIADH)
A. 10-15% of pts with SCLC can develop this syndrome
B. Paraneoplastic syndrome

34

What are the paraneoplastic syndromes in small cell carcinoma?

Incompletely understood patterns of organ dysfunction related to immune mediated or secretory effects of tumor

35

What systems are included in paraneoplastic syndromes?

Endocrine
Neuromuscular
Cardiovascular
Hematologic
Cutaneous

36

What are the CXR results in small cell carcinoma?

Hilar adenopathy and mediastinal widening

37

What is the treatment of small cell carcinoma?

1. Combination chemotherapy
A. 2 year survival rate is 20-40% in limited diseases and < 5% in extensive disease

38

What are the complications for bronchogenic carcinoma?

1. SVC Syndrome
A. Compression SVC: plethora (↑ body fluid), H/A, mental status changes
2. Pancoast Tumor
A. Tumor of lung apex: causes Horner’s Syndrome & shoulder pain
3. Horner's syndrome
A. Unilateral facial anhidrosis, ptosis, miosis
4. Endocrine
A. Carcinoid tumor: flushing, diarrhea, telangiectasias
5. Recurrent Laryngeal Nerve
A. Hoarseness
6. Effusions
A. Exudative

39

What is the neumontic for bronchogenic carcinomas?

SPHERE

40

What is the most common primary tumor of the small bowel and appendix?

Carcinoid tumor

41

What are the characteristics of carcinoid tumors?

Considered low grade malignant neoplasms

Grow slowly and rarely metastasize

42

What hormones are activated in carcinoid tumors?

Neuroendocrine tumors producing a variety of biologically active peptides and hormones
Serotonin
Adrenocorticotropin hormone (ACTH)
Antidiuretic hormone (ADH)
Melanocyte-stimulating hormone (MSH)

43

What are the serum results for carcinoid tumors?

Serotonin (5-HT)
ACTH
ADH
Chromogranin A (CgA)
Glycoprotein

44

What are the urine results in carcinoid cancer?

5-HIAA
Serotonin metabolite

45

What are the tumor markers in carcinoid cancer?

Serum and urine

46

What are the sxs of carcinoid cancer?


Often asymptomatic
Tachycardia
Flushing
Bronchoconstriction
Hemodynamic instability
Diarrhea
Acidosis

47

What is the prevalence of bronchial carcinoid tumors?

Bronchopulmonary carcinoid ≈ 10% of all carcinoid tumors

48

What percentage of all lung cancers are carcinoid tumors?

1-6% of lung tumors are carcinoid tumors

49

What are the complications of bronchial carcinoid tumors?

Bronchial obstruction
Atelectasis
Recurrent pneumonia
Pulmonary abscess
Bronchiectasis
Bleeding
SIADH < common than in SCLC
Cushing Syndrome
Hypoglycemia

50

What is the treatment of bronchial carcinoid tumors?

Surgical resection

51

What are the characteristics of solitary pulmonary nodules?

1. Coin lesions
A. < 5 cm in diameter, round or oval, & sharply circumscribed

2. Most are infectious granulomas
A. Old or active TB
B. Fungal infection

52

What percentage of solitary pulmonary nodules are malignant?

40%

53

Who is at a risk of malignant nodules?

Smokers

54

What are the sxs of solitary pulmonary nodules?

1. Most are asymptomatic

2. Nodules are found incidentally on CXR

55

What are the cxr results in solitary pulmonary nodules?

Round or oval, well circumscribed lesion
Solid vs Subsolid

56

What study is indicated after cxr in solitary pulmonary nodules?

CT scan

57

How are high suspicion for solitary pulmonary nodule pts managed?

thoracic sugeon

58

How are indeterminate suspicion for solitary pulmonary nodule pts managed?

PET scan

59

How are low suspicion for solitary pulmonary nodule pts managed?

Low suspicion → CT q 6 mo x 2-3 yrs

60

When is a solitary pulmonary nodule most likely benign?

Solid nodule that has been stable for two yr
Subsolid nodule that is stable for three yr