pulmonary neoplastic disease

Question 1

lung cancer screening for high risk individual with negative chest x-ray

Answer 1

low dose chest CT detects lung cancer at earlier stage

-dx earlier allow more opportunity of effective treatment

Question 2

most common type of cancer

Answer 2

bronchogenic cancer is most common
small cell lung cancer
nonsmall cell lung cancer

Question 3

risk factors

Answer 3

• cigarette smoking
• occupation exposure (Asbestos, arsenic,hexavalent chromium)
• appears higher in adults who are low in fruit and veggies
• ionized radiation (miners and survivors or atom bombs)
• lung disease (COPD ect)

Question 4

lung cancer presentation

Answer 4

cough, weight loss, dyspnea, chest pain, hemoptysis, bone pain, clubbing, fever, night sweats, weakness, anorexia

Question 5

central endobronchial growth of primary tumor symptoms

Answer 5

cough, hemoptysis

dyspnea, wheeezing

Question 6

peripheral growth of primary tumor symptoms

Answer 6

pain from pleura or chest wall involvement
dyspnea
lung abscess from tumor cavitation

Question 7

regional spread of tumor in thorax symptoms

Answer 7

tracheal obstruction, esophageal compression, laryngeal paralysis (hoarseness)
horner’s syndrome: ptosis, endopthalmos, miosis & anhydrosis

Question 8

malignant pleural effusion symptoms (advanced disease)

Answer 8

pain, dyspnea or cough

Question 9

primary tumor

Answer 9

tumors arising from the respiratory epithelium bronchi, bronchioles and alveoli

Question 10

NSCLC primary tumor most common

Answer 10

adenocarcinoma 42%

mucous glands or epithelial cells within/distal/terminal bronchials

Question 11

NSCLC primary tumor second most common

Answer 11

squamous cell carcinoma 22%

bronchial epithelium- most common presentation hemoptysis

Question 12

small cell lung cancer percentage and origin

Answer 12

13% bronchial origin begins centrally

Question 13

locations of lung cancer metastisis

Answer 13

regional lymph nodes
liver
bone and bone marrow
central nervous system

Question 14

5 mechanisms for metastasis

Answer 14

• pulmonary or bronchial artery
• lymphatic system
• pleural space
• airway
• direct neoplastic invasion

Question 15

most common route for metastasis is

Answer 15

hematogenous

reaching arterioles and capillary beds

Question 16

horners syndrome

Answer 16

miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face)

Question 17

imaging for lung cancer dx

Answer 17

CXR: initial diagnosis
CHEST CT: aids in confirmation of suspected lesion
PET scanning: defines the nature of primary lesion and extent of disease

Question 18

other methods of dx for lung cancer

Answer 18

Sputum cytology: 25-75% sensitive

Percutaneous transthoracic fine needle biopsy: 30% risk of pneumothroax

Video-assisted thoracoscopic surgery: for pts not tolerating pneumothorax

Question 19

TNM lung cancer staging

Answer 19

Tumor: Size of the tumor

Node: Regional node involvement

Metastasis: The presence or absence of distant metastasis

Question 20

non-small cell lung cancer treatment

Answer 20

surgery: 35-45% have resectable disease

radiation used preoperatively with chemo

Question 21

small cell lung cancer treatment

Answer 21

more sensitive to chemo and thoracic radiation

surgery usually not possible in 85% with extensive disease

surgery is only an option in early stages

Question 22

types of NSCLC

Answer 22

adenocarcinoma
squamous cell carcinoma
large cell carcinoma

Question 23

patters of adenocarcinoma and prognosis

Answer 23

Lepidic predominant - has favorable prognosis

Acinar & Papillary - have intermediate prognosis

Solid predominant -has a poor prognosis

Question 24

squamous cell carcinoma

Answer 24

centrally located 2nd most common lung cancer

morphology similar to extrapulmonary squamous cell. tumors show karatinization and or intercellular bridges that arise from bronchial epithelium

tumors consist of sheets

Question 25

squamous cell is associated with

Answer 25

tobacco use and is usually centrally located and producing bronchial obstruction

Question 26

large cell carcinoma

Answer 26

frequently located in periphery tumors lack cytologic and architectual features of small cell carcinoma and grandular and sqamous

Question 27

large cell carcinoma tends to

Answer 27

metastasize hematogenously in early stages of disease which leads to bone, liver and brain disease

Question 28

small cell lung cancer can produce ectopic hormone production leading to

Answer 28

cushings | inappropropriate secretion of ADH

Question 29

small cell lung cancer is strongly associated with

Answer 29

heavy tobacco use and accounts for 15% lung cancer

Question 30

rapid and aggressive cancer

Answer 30

small cell lung cancer | 50-75% patients present with metastatic presentation

Question 31

carcinoid tumors arist

Answer 31

from the small bowel (53%), colon (12%), esophagus through duodenum (6%), or lung (bronchial carcinoid [5%]).

Question 32

carcinoid symptoms

Answer 32

symptom complex characterized by paroxysmal vasomotor disturbances, diarrhea, and bronchospasm

Question 33

bronchial carcinoid tumors dx

Answer 33

fiberoptic bronchoscopy | These lesions have a well-vascularized stroma, and biopsy may be complicated by significant bleeding.

Question 34

bronchial carcinoid tumor symptoms

Answer 34

Common symptoms include hemoptysis, cough, focal wheezing, and recurrent pneumonia. Carcinoid syndrome (flushing, diarrhea, wheezing, hypotension) is rare.

Question 35

benign pulmonary nodules

Answer 35

- lack of growth for 2 yrs - calcification within the nodule - 99% of noncalcified lesions less than 4 mm - 94% of noncalcified lesion 4-8 mm

Question 36

malignant pulmonary nodules

Answer 36

- growth of 1-18 months - 50% of lesions greater than 8mm are malignant - CT finding of small ground glass opacities

Question 37

malignant mesothelioma

Answer 37

A neoplasm that originates from the mesothelial surfaces of the pleural cavities - 80% Or peritoneal cavities – 20% Both related to asbestos exposure from 20-40 years after asbestos

Question 38

malignant mesothelioma presentation

Answer 38

Dyspnea *, Cough *, Nonpleuritic chest pain* Fever, Weight Loss, Sweats, Fatigue, Anorexia Horner syndrome in advances stages Auscultation may reveal unilateral loss of breath sounds Dullness to percussion

Question 39

malignant mesothelioma produces a

Answer 39

pleural fluid accumulations (effusion) Fluid may be bloody & often contain malignant cells Right sided involvement is more common

Question 40

diagnosis of malignant mesothelioma

Answer 40

CXR: pleural plaques or calcification in the diaphragm CT: chest and abd use to assess extent of disease BONE SCAN: used to assess extend of disease

Question 41

superior sulcus tumors

Answer 41

pancoast tumors arist from the apex of the lung and may invade the second or third rib, the brachial plexus, the subclavian vvessels, the stellate ganglion and adjacent vertebral bodies

Question 42

superior sulcus tumors

Answer 42

pancoast syndrome: characterized by pain that arise in the shoulders or chest wall and radiates to the neck radiates to the ulnar surface of the hand