PULMONARY NEOPLASMS QUESTIONS AND ANSWERS A+
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Solitary Pulmonary Nodule - description
Sometimes referred to a "coin lesion"
Rounded, isolated opacities seen on CXR less than 3 cm in size
Surrounded by normal lung and not associated with infiltrates, lymphadenopathy, or
symptoms of illness
Most are completely asymptomatic and found incidentally
Solitary Pulmonary Nodule - differential diagnosis
Important to work up
Infectious granuloma (most common)
- Old TB
- Fungal
- Other infection
Malignancy
Hamartoma (benign neoplasm / growth of tissue)
Solitary Pulmonary Nodule - goal of evaluation
Identify and resect malignant tumors while avoiding unnecessary invasive
procedures in benign disease
Solitary Pulmonary Nodule - clues for high risk of malignancy
Age - rare in patients under 30
Smokers - increased risk with increasing pack year history
Prior history of any malignancy - should be assumed to be metastatic
Radiographic clues
- Indistinct borders
- Rapid increase in size
- Rarely have calcification
- Spiculated margins (finger-like projections)
- Peripheral halo
Solitary Pulmonary Nodule - first step in evaluation
Compare to older images
,If the lesion has remained unchanged in 2 years or more, it is likely a benign
infectious granuloma
Solitary Pulmonary Nodule - treatment
High probability of malignancy
- Resection ASAP
- Biopsy is not recommended
Moderate probability of malignancy
- Needle biopsy
- False positives are high, so a PET scan and high-res CT can help delineate need for
biopsy
Low probability of malignancy
- Watch
- CT every 3 months for a year
- If stable, CT can be reduced to every 6 months for another year
What is the leading cause of death due to malignancy for both men and women?
Bronchogenic Carcinoma
27% of all cancer deaths
Bronchogenic Carcinomias - risk factors
- Smoking tobacco or marijuana
- Exposure to industrial carcinogens (radon, asbestos, heavy metals)
- Exposure to ionizing radiation
- Recurrent severe lung inflammation (significant TB)
- Genetics may play a role
Bronchogenic Carcinomias - epidemiology
Median age at diagnosis is 70 years in the US
Rare and unusual in patients under 40
Combined relative 5-year survival rate is only 16%
Bronchogenic Carcinomias - categories and 5 main types
Small Cell Lung Cancer
Non-Small Cell Lung Cancer
- Squamous Cell Carcinoma
- Adenocarcinoma
- Bronchioloalveolar Carcinoma
- Large Cell Carcinoma
Small Cell Lung Cancer - alternate name
"Oat Cell" Cancer
, Small Cell Lung Cancer - description
Bronchial epithelial tumor that exhibits neuroendocrine function
Can produce a variety of paraneoplastic syndromes
Infiltrates the submucosa and can cause narrowing of bronchial lumen
Prone to early hematogenous spread, often involving the hilar lymph nodes very early
Rarely amenable to surgery and has a very aggressive clinical course
Untreated - 6-18 weeks median survival
Squamous Cell Carcinoma - description
Type of NSCLC
Arises from ciliated bronchial epithelium
More likely to present with hemoptysis as it is often centrally located and involving
the bronchi
Can often be diagnosed with sputum cytology, which is unique to this type of lung
cancer
Often more centrally located and spread locally first, involving lymph nodes
Adenocarcinoma of the Lung - description
Type of NSCLC
Most common form of lung cancer - 35-40% of cases
Arises from bronchial glandular cells
Often appears in the periphery of the lung and typically metastasizes to distant
sites (liver and brain)
Subtype of lung cancer that is observed most commonly in those that do not
smoke (still common in smokers, too)
Bronchioloavleolar Carcinoma - description
Subtype of Adenocarcinoma
Uncommon
Arises from epithelial cells within or distal to terminal bronchioles, often involving
the alveoli
Seems to spread along the alveoli without significant evidence of invasion (slow
growing)
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Solitary Pulmonary Nodule - description
Sometimes referred to a "coin lesion"
Rounded, isolated opacities seen on CXR less than 3 cm in size
Surrounded by normal lung and not associated with infiltrates, lymphadenopathy, or
symptoms of illness
Most are completely asymptomatic and found incidentally
Solitary Pulmonary Nodule - differential diagnosis
Important to work up
Infectious granuloma (most common)
- Old TB
- Fungal
- Other infection
Malignancy
Hamartoma (benign neoplasm / growth of tissue)
Solitary Pulmonary Nodule - goal of evaluation
Identify and resect malignant tumors while avoiding unnecessary invasive
procedures in benign disease
Solitary Pulmonary Nodule - clues for high risk of malignancy
Age - rare in patients under 30
Smokers - increased risk with increasing pack year history
Prior history of any malignancy - should be assumed to be metastatic
Radiographic clues
- Indistinct borders
- Rapid increase in size
- Rarely have calcification
- Spiculated margins (finger-like projections)
- Peripheral halo
Solitary Pulmonary Nodule - first step in evaluation
Compare to older images
,If the lesion has remained unchanged in 2 years or more, it is likely a benign
infectious granuloma
Solitary Pulmonary Nodule - treatment
High probability of malignancy
- Resection ASAP
- Biopsy is not recommended
Moderate probability of malignancy
- Needle biopsy
- False positives are high, so a PET scan and high-res CT can help delineate need for
biopsy
Low probability of malignancy
- Watch
- CT every 3 months for a year
- If stable, CT can be reduced to every 6 months for another year
What is the leading cause of death due to malignancy for both men and women?
Bronchogenic Carcinoma
27% of all cancer deaths
Bronchogenic Carcinomias - risk factors
- Smoking tobacco or marijuana
- Exposure to industrial carcinogens (radon, asbestos, heavy metals)
- Exposure to ionizing radiation
- Recurrent severe lung inflammation (significant TB)
- Genetics may play a role
Bronchogenic Carcinomias - epidemiology
Median age at diagnosis is 70 years in the US
Rare and unusual in patients under 40
Combined relative 5-year survival rate is only 16%
Bronchogenic Carcinomias - categories and 5 main types
Small Cell Lung Cancer
Non-Small Cell Lung Cancer
- Squamous Cell Carcinoma
- Adenocarcinoma
- Bronchioloalveolar Carcinoma
- Large Cell Carcinoma
Small Cell Lung Cancer - alternate name
"Oat Cell" Cancer
, Small Cell Lung Cancer - description
Bronchial epithelial tumor that exhibits neuroendocrine function
Can produce a variety of paraneoplastic syndromes
Infiltrates the submucosa and can cause narrowing of bronchial lumen
Prone to early hematogenous spread, often involving the hilar lymph nodes very early
Rarely amenable to surgery and has a very aggressive clinical course
Untreated - 6-18 weeks median survival
Squamous Cell Carcinoma - description
Type of NSCLC
Arises from ciliated bronchial epithelium
More likely to present with hemoptysis as it is often centrally located and involving
the bronchi
Can often be diagnosed with sputum cytology, which is unique to this type of lung
cancer
Often more centrally located and spread locally first, involving lymph nodes
Adenocarcinoma of the Lung - description
Type of NSCLC
Most common form of lung cancer - 35-40% of cases
Arises from bronchial glandular cells
Often appears in the periphery of the lung and typically metastasizes to distant
sites (liver and brain)
Subtype of lung cancer that is observed most commonly in those that do not
smoke (still common in smokers, too)
Bronchioloavleolar Carcinoma - description
Subtype of Adenocarcinoma
Uncommon
Arises from epithelial cells within or distal to terminal bronchioles, often involving
the alveoli
Seems to spread along the alveoli without significant evidence of invasion (slow
growing)
