PULMONARY NEOPLASMS QUESTIONS AND ANSWERS A+
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what causes 90% of lung cancers
cig smoking
what diseases are associated with increased risk of lung cancer (3)
copd
pulmonary fibrosis
HIV
what is the mean age @ dx of lung cancer
71
lung cancer is unusual under what age
40
<3 cm isolated, rounded opacity on the chest radiograph outlined by normal lung
tissue
solitary pulmonary nodule
what size lesions have a high likelihood of malignancy and should be treated
immediately
>3 cm
solitary pulmonary nodules are associated with what 3 things
infiltrate
atelectasis
adenopathy
are most solitary pulmonary nodules symptomatic?
no --> incidental findings
what are factors that increase the risk of a SPN becoming malignant (4)
age (rare under 30)
smoker
pack history (greatest factor)
prior malignancy
what are most benign SPNs termed
infectious granulomas
why do you do radiographic comparison with SPNs
allows estimation of doubling time, which is an important marker of malignancy
doubling time of SPN <30 days often indicates infectious process
rapid progression
what does a rapid progression of SPN (<30 days) often indicate
infectious process
SPN unchanged greater than 2 years and is likely benign
long-term stability
what does a stable long term SPN often indicate
that it is benign
what risk of malignancy? 2- 5 mm SPN on CT
1%
,what risk of malignancy? 6-10 mm SPN on CT
24%
what risk of malignancy? 11-20 mm SPN on CT
33%
what risk of malignancy? 21-45 mm SPN on CT
80%
benign or malignant? SPN with smooth, well-defined edge
benign
benign or malignant? SPN with more dense calcification
benign
benign or malignant? ill-defined margins or a lobular apprearance
malig
benign or malignant? spiculated margins and a peripheral halo
malig
benign or malignant? sparse, stipples or atypical pattern
malig
benign or malignant? cavitary lesions with thick (>16 mm walls)
malig
what imaging study helps distinguish the characteristics of benign and malig
SPNs?
what doesn't it show?
HRCT
doesn't show mediastinal lymphadenopathy as well as CT with contrast
how do we follow up a <4 mm SPN according to the fleischner society pulmonary
nodule surveillance if..
low risk
high risk
low risk: no f/u needed
high risk: CT f/u at 12 months, if unchanged no further follow up
how do we follow up a >4-6 mmSPN according to the fleischner society
pulmonary nodule surveillance if..
low risk
high risk
low risk: CT f/u @ 12 months if no change then no f/u needed
high risk: initial CT f/u at 6-12 months, then at 18-24 months if no change
how do we follow up a >6-8mmSPN according to the fleischner society pulmonary
nodule surveillance if..
, low risk
high risk
low risk: initial CT f/u @ 6-12 months, then @ 18-24 months if no changes
high risk: initial CT f/u @ 3-6 months and then at 12-24 months if no changes
how do we follow up a >8 mmSPN according to the fleischner society pulmonary
nodule surveillance
one or more of the following: f/u @ 3, 9, 24 months/ Dynamic CT/ PET scan/bx
how do we treat high risk pts with SPNs (3)
1. high prob of malig should undergo staging/resection
2. pft and split function V/Q
3. PET to r/o malig somewhere else
is bx necessary for high risk pts with SPN? why or why not
no because even if it is negative the recommendations are still the same
how do we treat intermediate risk pts with SPNs (2)
bronchoscopy
TTNA (transthoracic needle aspiration) aka CT guided FNA
what is there a risk for with TTNA
ptx
what type of tumors could cause a false negative PET scan?
low metabolic tumors like bronchioalveolar carcinoma
what does a PET scan detect
increased glucose metabolism
resolution below what is poor on a PET
1 cm
what procedure/surgery is recommended in most cases of SPNS
video-assisted thoracoscopic surgery
what are some signs and symptoms of lung cancer (11)
anorexia
weight loss
cough/change in chronic cough
exertional dyspnea
hemoptysis
non specific chest pain
hoarseness
headache/N/V
fever/night sweats
what causes hoarseness in lung cancer
compromise of the laryngeal nerve
compromise of the laryngeal nerve in lung cancer is more common on what side?
why?
left
longer track of nerve
GRADED .Buy Quality Materials!
what causes 90% of lung cancers
cig smoking
what diseases are associated with increased risk of lung cancer (3)
copd
pulmonary fibrosis
HIV
what is the mean age @ dx of lung cancer
71
lung cancer is unusual under what age
40
<3 cm isolated, rounded opacity on the chest radiograph outlined by normal lung
tissue
solitary pulmonary nodule
what size lesions have a high likelihood of malignancy and should be treated
immediately
>3 cm
solitary pulmonary nodules are associated with what 3 things
infiltrate
atelectasis
adenopathy
are most solitary pulmonary nodules symptomatic?
no --> incidental findings
what are factors that increase the risk of a SPN becoming malignant (4)
age (rare under 30)
smoker
pack history (greatest factor)
prior malignancy
what are most benign SPNs termed
infectious granulomas
why do you do radiographic comparison with SPNs
allows estimation of doubling time, which is an important marker of malignancy
doubling time of SPN <30 days often indicates infectious process
rapid progression
what does a rapid progression of SPN (<30 days) often indicate
infectious process
SPN unchanged greater than 2 years and is likely benign
long-term stability
what does a stable long term SPN often indicate
that it is benign
what risk of malignancy? 2- 5 mm SPN on CT
1%
,what risk of malignancy? 6-10 mm SPN on CT
24%
what risk of malignancy? 11-20 mm SPN on CT
33%
what risk of malignancy? 21-45 mm SPN on CT
80%
benign or malignant? SPN with smooth, well-defined edge
benign
benign or malignant? SPN with more dense calcification
benign
benign or malignant? ill-defined margins or a lobular apprearance
malig
benign or malignant? spiculated margins and a peripheral halo
malig
benign or malignant? sparse, stipples or atypical pattern
malig
benign or malignant? cavitary lesions with thick (>16 mm walls)
malig
what imaging study helps distinguish the characteristics of benign and malig
SPNs?
what doesn't it show?
HRCT
doesn't show mediastinal lymphadenopathy as well as CT with contrast
how do we follow up a <4 mm SPN according to the fleischner society pulmonary
nodule surveillance if..
low risk
high risk
low risk: no f/u needed
high risk: CT f/u at 12 months, if unchanged no further follow up
how do we follow up a >4-6 mmSPN according to the fleischner society
pulmonary nodule surveillance if..
low risk
high risk
low risk: CT f/u @ 12 months if no change then no f/u needed
high risk: initial CT f/u at 6-12 months, then at 18-24 months if no change
how do we follow up a >6-8mmSPN according to the fleischner society pulmonary
nodule surveillance if..
, low risk
high risk
low risk: initial CT f/u @ 6-12 months, then @ 18-24 months if no changes
high risk: initial CT f/u @ 3-6 months and then at 12-24 months if no changes
how do we follow up a >8 mmSPN according to the fleischner society pulmonary
nodule surveillance
one or more of the following: f/u @ 3, 9, 24 months/ Dynamic CT/ PET scan/bx
how do we treat high risk pts with SPNs (3)
1. high prob of malig should undergo staging/resection
2. pft and split function V/Q
3. PET to r/o malig somewhere else
is bx necessary for high risk pts with SPN? why or why not
no because even if it is negative the recommendations are still the same
how do we treat intermediate risk pts with SPNs (2)
bronchoscopy
TTNA (transthoracic needle aspiration) aka CT guided FNA
what is there a risk for with TTNA
ptx
what type of tumors could cause a false negative PET scan?
low metabolic tumors like bronchioalveolar carcinoma
what does a PET scan detect
increased glucose metabolism
resolution below what is poor on a PET
1 cm
what procedure/surgery is recommended in most cases of SPNS
video-assisted thoracoscopic surgery
what are some signs and symptoms of lung cancer (11)
anorexia
weight loss
cough/change in chronic cough
exertional dyspnea
hemoptysis
non specific chest pain
hoarseness
headache/N/V
fever/night sweats
what causes hoarseness in lung cancer
compromise of the laryngeal nerve
compromise of the laryngeal nerve in lung cancer is more common on what side?
why?
left
longer track of nerve
