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Lung tumors
Clinical Medicine Module 4
79
Medical
Graduate
07/11/2009

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Cards

Term
most common cause of lung ca
Definition
adenocarcinoma-38%
Term
large central tumor (may obstruct). pnp syndrome=hypercalcemia
Definition
scc
Term
peripheral tumor, most associated w/smoking but higher percent non-smokers than other lung tumors. radon exposure
Definition
adenocarcinoma
Term
*large amts of mucoid secretions* (boards), may be multifocal
Definition
bronchoalveolar subtype of adenocarcinoma
Term
del 3p
Definition
90% of sclc, 50%nsclc
Term
affect of screening test on lung ca mortality
Definition
no reduction in mortality- cxr sputum cytology, or ct. recommendations often change
Term
bronchogenic carcinoma arise from
Definition
epithelium
Term
lung cancer no of deaths
Definition
no 1, more than colorectal, breast, prostate combined. declining in men, rising in women
Term
1 ppd 40 yrs increases risk how much. stop, 15 years later risk is what.
Definition
20x. 2x. 90% lung ca associated w/smoking
Term
female non-smoker- what kind of lung ca
Definition
adenocarcinoma
Term
arises from neuroendocrine cells. may be small primary w/prominent adeonpathy. may be bulky primary. often metastasizes early. what are the pnp sx?
Definition
sclc. acth, siadh
Term
BQ?: How do most pts w/ primary lung ca present at dx? secondary lung ca?
Definition
primary: most pts symptomatic. anorexia, weight loss, or asthenia occus in 55-90% of cases. up to 60% have new cough/change in chronic coug. Less than 1/2 have hemoptysis, pain, or pleural effusion or pnp sx. secondary: sx are uncommon but include cough hemoptysis dyspnea and hypoxemia. sx are more often referable to the site of the primary tumor.
Term
BQ: what is the most important imaging modality for staging nsclc pts for resection?
Definition
ct
Term
BQ: what do all nsclc pts considered for surgery require?
Definition
spirometry
Term
BQ: How do mets to the lung typically occur and present?
Definition
usually occur via pulmonary a and typically present as multiple nodules or masses on cxr
Term
BQ: Where in the lung are most mets to the lung found?
Definition
most are intraparenchymal
Term
BQ: what are the most likely primary tumors that met to lungs?
Definition
breast, kidney, colon, cervix
Term
BQ: how is the dx of secondary lung ca most often established?
Definition
identifying primary tumor
Term
BQ: are nodules in mets to lungs most often: large or small, unilateral or bilateral, pleural subpleural or alveolar, and in upper middle or lower lungs?
Definition
nearly all are less than 5 cm, usually bilateral, pleural or subpleural, and more common in lower lung zones.
Term
How is prognosis different w/tumors closer or further from carina?
Definition
closer to carina, harder to resect
Term
Why might the diaphragm be elevated in ca?
Definition
whack the phrenic n, raised diaphragm
Term
What is the most common sx of lung ca?
Definition
cough-50-75%
Term
What type of ca is suggested by lg amts of clear mucoid sputum?
Definition
bronchoalveolar ca
Term
why might lung ca present w/hoarseness?
Definition
recurrent laryngeal n involved
Term
Pt presents w/cough, hemoptysis, chest pain, dyspnea, hoarseness, weight loss, anorexia, asthenia (loss of physical strength), and pleural effusion. What leads your d/d?
Definition
lung ca
Term
Pt presents w/dilated neck vv, facial edema, prominent vv in arms and torso. What do you suspect?
Definition
superior vena cava syndrome, more common in scls than nsclc
Term
What type of lung ca is located in the superior sulcus, is more commonly present in nsclc, and presents w/pain in shoulder and arm and horners sx?
Definition
pancoast tumor. horners: ptosis, miosis, anhydrosis
Term
4 places lung ca mets to
Definition
liver bone adrenal brain: BLAB.
Term
What pnp sx of lung ca is like myasthenia in that the pt gets weaker as the day goes on?
Definition
neurologic: lambert-eaton
Term
What are 2 pnp sx from lung ca that involve the blood?
Definition
anemia, hypercoaguable states
Term
What pnp sxs from lung "disease of muscle featuring inflammation of the muscle fibers" and/or skin?
Definition
polymositis, dermatomyositis
Term
What pnp from lung ca involves cortisol?
Definition
cushings
Term
What pnp sx from lung ca involves bone?
Definition
hypertrophic osteoarthropathy, hypercalcemia due to PTHrP
Term
What pnp sx from lung ca involves changes in fluid retention?
Definition
siadh
Term
What lung ca sequelae involves the hands?
Definition
clubbing
Term
Pt w/copd develops hemoptysis and weight loss. How do you proceed?
Definition
cxr
Term
What "scopy" methods are useful for tissue dx in lung ca? what are some needle methods? what is another method?
Definition
bronchoscopy, mediastinoscopy, thoracoscopy. needle aspiration of palpable lesion, thoracentesis. image guided sampling
Term
What is an image guided method for tissue sampling and what is its risk?
Definition
ct dir bx. pneumothorax and bleeding
Term
what should be asked for tx localized nsclc? how should locally advanced or mets be tx? how is chemo used?
Definition
is it resectable? can pt tolerate sx? team approach, palliation. no terribly effective chemo at this time
Term
How is a preop eval done?
Definition
can pt tolerate pneumonectomy? pfts, exercise testing
Term
How is sclc tx?
Definition
localized may be resected, usually needs chemo
Term
How advanced is sclc generally at time of dx? how does it respond to chemo? what is the reported range of median survival for ls-sclc and es-sclc?
Definition
often met at time of dx. responds to chemo fro 6-8 mos then recurs. survival at recurrence 4 mos. from time of dx, median survival for ls-sclc is 14-20 mos. es-sclc 8-13 mos.
Term
What are 2 platinum comp's for tx sclc?
Definition
cisplatin, carboplatin
Term
What are 2 podophyllotoxins for tx sclc?
Definition
etoposide, teniposide
Term
What are 2 camptothecins for tx sclc?
Definition
irinotecan, tetotecan
Term
What are 2 alkylating agents for tx sclc?
Definition
ifosfamide, cyclophosphamide
Term
What are 2 anthracyclines for tx sclc?
Definition
doxorubicin, epirubicin
Term
What are 2 taxanes for tx sclc?
Definition
paclitaxel, docetaxel
Term
What is a mitotic inhibitor for sclc?
Definition
vincristine
Term
What are neuroendocrine tumors that arise from various other sites in body? what percent of lung malignancies in adults are caused by this and what is the incidence per 100,000 population?
Definition
pulmonary carcinoid tumor. 1-2% of lung malignancies in adults. incidence 0.2-2 per 100,000
Term
What is the most common primary lung neoplasm in children, mostly late teens?
Definition
pulmonary carcinoid tumor
Term
Are carcinoids typical or atypical? what is the average age at presentation
Definition
may be typical(ave age 45yo) or atypical (ave age 55yo)
Term
In what part of the lungs do most pulmonary carcinoids arise?
Definition
3/4 proximal bronchi, 1/4 peripheral
Term
What is the association btwn carcinoids and genetics and smoking?
Definition
slight association w/smoking but not enough for cause/effect. some familial sx
Term
Pt presents w/cough, obstruction, hemoptysis, focal wheezing, recurrent infections. What might the pt have?
Definition
carcinoid tumor- proximal. peripheral tumors are usually asymptomatic
Term
How common is carcinoid sx in pulmonary lesions? if it is present, usually how large, and what is usually involved?
Definition
rare-1-5%. if present, primary usually >5cm and/or liver involvement.
Term
Pt presents w/cough, obstruction, hemoptysis, focal wheezing, recurrent infections, flushing, diarrhea, and right sided heart disease
Definition
carcinoid disease, proximal bronchi tumor. most peripheral tumors asymptomatic
Term
is cushings syndrome seen more often in small or large carcinoid tumors?
Definition
more often in small tumors
Term
if tissue's the issue, what's the answer?
Definition
if tissue's the issue, ca's the answer: must determine cell type
Term
What lung ca sequelae presents w/flushing, wheezing diarrhea?
Definition
right sided heart diesease
Term
How should you NOT confirm dx for carcinoid?
Definition
don't bx-bleeds.
Term
What can met to lungs from "you name it- breast, colon, renal cell, etc"?
Definition
carcinomas
Term
What does sarcomas met to lungs include?
Definition
kaposi in aids
Term
What met to lungs is called the great mimicker?
Definition
melanoma
Term
What pulmonary met comes from cells that "normally occur inside the gonads (ovary and testis)"?
Definition
germ cell tumors
Term
What pulmonary met comes from the circulatory system?
Definition
hematopoietic malignancy
Term
What met to lungs is esp known to spread lymphangitically?
Definition
esp breast
Term
Which part of lungs is often involved w/mets to lungs?
Definition
pleural involvement
Term
how can mets to lungs be tx?
Definition
some resected, also chemo/xrt
Term
What is aka "coin lesion" found incidentally on xray? what is the first question you ask?
Definition
solitary pulmonary nodule, ask: "when was your last xray and how do we get it?"
Term
What are neoplastic lung tumors?
Definition
hamartoma, rare pulmonary tumors
Term
What lung tumor is nml tissue that forms a mass- fat, cartilage, mm, myxomatous tissue?
Definition
hamartoma
Term
BQ: what are most benign nodules in lung?
Definition
infectious granulomas
Term
BQ: what is important in determining malignancy of lung tumors?
Definition
age. malignant nodules rare in pts under 30. over 30 likelihood increases w/age.
Term
BQ: in which compartment are most mediastinal masses located?
Definition
anterior or middle
Term
radon exposure.
Definition
adenocarcinoma
Term
are pancoast tumors more common in sclc or nsclc?
Definition
nsclc
Term
pt presents w/drooping right eyelid, right pupil constriction, and lack of perspiration on right side of face. what type of lung tumor is most likely?
Definition
pancoast
Term
hypercalcemia occurs w/what lung tumor?
Definition
scc
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