Pulmonary Oncology Flashcards
(100 cards)
SPN
isolated rounded opacity <30 mm on CXR
outlined by normal lung tissue (not in hilar lN)often found incidentally
malignant causes of SPN
primary lung CA (adenoCA)
carcinoid tumor
Metastatic dz (melanoma, colon, breast, kidney, testicular)
benign causes of SPN
Granuloma (infectious process)
benign tumor (hamaratoma, bronchiole adenoma )
SPN lesion characteristics indicative of malignancy
- increasing size - rapidly increasing likely CA
- SPN composition - solid/subsolid
- border characteristics - rougher edges = more likely (corona radiate most)
SPN risk of malignancy pt characteristics (7)
- increasing age
- smoking
- prior malignancy
- occupation
- female sex
- upper lobe lesion
- family history
risk factors for SPN infection
- immunocompromised
- history of TB or other mycosis
- residence or extensive travel in areas of endemic mycosis
work up of SPN
- non-contrast CT (thin cuts)
2. PET/CT scan
CT SPN imaging
looking for:
benign patterns of calcification
estimation of VDT
malignant patterns
SPN CT
benign patterns
diffuse homogenous calcification
central calficiation
lamellate calcification
popcorn calficiation
estimation of VDT - benign
fast ( <30) suggests infection
slow (>480 days)
malignant patterns of SPN CT
peripheral halo
cavitary lesions
Lymphadenopathy
solid nodules SPN
dense and homogenous
<8mm = too small for bx, less likely to be malignant
subsolid nodules SOB
less attenuation on imaging
normal parenchymal structures can be seen through them
part solid or ground glass (no solid components)
difficult to bx
PET/CT SPN
greater than 8 mm
assesses metabolic activity of nodule (most glucose uptake) via SUV
high SUV indicates high FDG, suggestive of malignancy
can exclude cancer
management of SPN
growing nodule should always be surgically removed ( > 2mm increase)
when is SPN growth considered stable?
solid: stable after 24 months no growth
subsolid: 5 yrs no change
what can we use to determine SPN management?
Fleischer guidelines
SPN biopsy
sampling to obtain tissue diagnosis
BAL, brushing, directed
indications for resection of SPN
- growing legion
- high probability of malignancy
- metabolically active on PET scan
- prior sampling nodule has proven malignant
bronchogenic lung carcinoma
second most common type of CA diagnosed but number one killer of persons (more than colorectal + breast + prostate CA)
lung CA screening
should benefit but hard to screen
annual low dose CT screen for HR individuals
high risk lung cancer defined:
who gets the screening
men or women ages 55-79 yrs with 30 pk year history
quit in last 15 yrs
risk factors for bronchogenic lung cancer
- smoking (90%)
- prior h.o. radiation tx (HL or brest)
- environmental exposure (second hand smoke, radon)
- Other lung dx, 5. HIV, 6. family history, 7. alcohol and diet
epidemiology of bronchogenic lung cancer
men > women, lower rates of survival
women: adenoma, high likelihood of local dz, younger age
AA = Caucasian women
AA > men (13% lower)