Duke PA Lung Cancer and Pleural disease
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| 5 year survival rate for patients with lung cancer is less than __% | 15
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| leading cause of lung cancer | smoking
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| packs per day X years smoked | pack year
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| most common form of bronchogenic carcinoma | non-small-cell-carcinoma
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| includes squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma | non-small-cell-carcinoma
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| account for less than 20% of all bronchogenic carcinomas | small-cell-carcinomas
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| localized plueritic chest pain suggests | chest wall invasion
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| hoarseness inicates | involvement or compression of the left recurrent laryngeal nerve, and suggest mediastinal or hilar involvement
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| most common sites of metastases | lymph nodes, liver, brain, adrenal glands, kidneys and lungs
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| because of their slow growth rate these tumors are the least likely to be metastatic | squamous cell carcinoma
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| has a high propensity for metastases and is usually found in the lung periphery | adenocarcinoma
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| has a poor response to therapy, a poor prognosis, and is prone to malignant pleural effusions | adenocarcinoma
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| found in the central regions of the lung and rapidly metastasize | small-cell-carcinomas
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| a spheric lesion in the lung that is less than 3cm | solitary pulmonary nodule
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| about 50% of these are malignant | solitary pulmonary nodule
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| solitary pulmonary nodules with smooth edges and calcifications are usually | benign
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| solitary pulmonary nodules with irregular edges and without calcifications are usually | malignant
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| in the case of a solitary pulmonary nodule with low probability of malignancy what approach may be warranted | 2 years of observation
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| usually neurologic syndromes that are elicited by a patient's immune resonse to tumors | paraneoplastic syndromes
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| symptoms develop over weeks and may include difficulties in walking, swallowing, loss of muscle tone, loss of fine motor coordination, slurred speech, memory loss, vision problems, dementia, sleep disturbances, seizures and vertigo | paraneoplastic syndromes
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| include stiff person syndrome, encephalomyelitis, cerebellar degeneration, neuromyotonia, and sensory neuropathy | paraneoplastic syndromes
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| retinopathies, certain visual-loss syndromes, hyponatremia, hypercalcemia, and cushing's syndrome can all be manifestations of | paraneoplastic syndromes
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| these tumors may be cavitating with thick walls | squamous cell carcinoma
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| most common lung cancer in non-smokers and young people. | alveolar or bronchoalveolar cell carcinoma
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| is a subset of adenocarcinomas | alveolar or bronchoalveolar cell carcinoma
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| can develop as a lung infiltrate or as a solitary nodule and can be accompanied by bronchorrhea | alveolar or bronchoalveolar cell carcinoma
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| A ____ is recommended when evaluating a solitary lung nodule | chest CT
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| A _____ should be performed for patients with a solitary lung nodule if they have contraindications for thoracotomy | transthoracic needle aspiration biopsy
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| in general patients with lung nodules suggestive of malignancy should undergo ____ unless there are contraindications | thorocotomy for surgical resection
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| frequently develops as a peripheral lesion and may be associated with pneumonitis and hilar adenopathy | large-cell carcinoma
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| an anaplastic tumor that has a median survival of less than one year. subtype of large-cell carcinoma | giant cell carcinoma
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| subset of large cell carcinoma that resembles a renal cell carcinoma and has fewere malignant features | clear cell carcinoma
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| over 70% of patients with this type of lung cancer have metastases on clinical presentation | small-cell-carcinomas
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| most common cause of pleural effusion | congestive heart failure
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| when the cause for a pleural effusion is not evident | obtain pleural fluid for examination
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| frank pus defines an ______ | empyema
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| blood in an effusion suggests | malignancy, trauma, turburculosis, collagen vascular disorder, or thromboembolism
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| the life expectancy of a patient with pleural effusions from a malignancy is ____ | a few months
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| accumulation of air in the pleural space | pneumothorax
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| physical exam may show decreased breath sounds, hyperresonance, limited lateral excursion, and tracheal shift to the opposite side | pneumothorax
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| ______ infection can lead to pneumothorax | pneumocysitis carinii
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| refers to pneumothorax during time of menstruation | catamenial pneumothorax
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| accumulation of air in the plueral space creating positive pressure | tension pneumothorax
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| medical emergency requiring immediate decompression | tension pneumothorax
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| for a small pneumothorax _____ alone may be indicated | observation
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| larger pneumo's require ____ | aspiration, or chest tube placement
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| _____ can cause a pneumothorax because of the development of thin-walled cyst like lesions | pneumocystis carinii
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| pnuemothorax can be caused by ____ in the setting of mechanical ventilation | barotrauma
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| typically occurs in individuals over 55 years of age with a history of exposure to asbestos in the distant past | malignant mesothelioma
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| overall prognosis is poor with mean survival of 1-2 years | malignant mesothelioma
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| when obesity is associated with hypoventilation | pickwickian syndrome
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| paradoxic inward motion of the abdominal wall during inspiration is a classic finding of | bilateral diaphragmatic paralysis
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| is rarely idiopathic and is usually a manifestation of an acute or chronic generalized neuromuscular disease | bilateral diaphragmatic paralysis
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| aka "coin lesion" | solitary pulmonary nodule
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| with solitary pulmonary nodule a doubling time of < __ suggests infection | 30
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| with solitary pulmonary nodule a doubling time of > __ days suggests a benignity | 465
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| the first step in evaluation of a chest x-ray in the presence of a solitary pulmonary nodule is to | review old radiographs
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| sputum production is minimal, fine late inspiratory crackles at the lung bases, about 25-50% of the time clubbing is present | interstitial lung disease
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| ground glass, reticular, or reticulonodular infiltrates on x-ray | interstitial lung disease
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| localized, sharp, fleeting, made worse by sneezing, coughing, deep breathing, movement | plueritis
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| _____ should be performed whenever there is a new pleural effusion and no apparent clinical cause (CHF) | diagnostic thoracentesis
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| >90% of the cases of transudates are caused by | Congestive heart failure
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| the top three causes of exudates | pneumonia, cancer, pulmonary embolism
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| occur in the setting of normal capillary integrity and suggest the absence of local pleural disease | transudates
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| form as a result of pleural disease associated with increased capillary permeability or reduced lymphatic drainage | exudates
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| 2/3 of new lung cancer cases are in ___ | men
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| lung cancers come in 2 general forms which are | small cell, and non-small cell
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| small cell carcinomas make up __% of all lung cancers | 20%
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| Non-small cell carcinomas make up __% of all lung cancers | 80
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| small cell carcinomas are notorius for | paraneoplastic syndromes
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| examples of paraneoplastic syndromes | SIADH, Cushing's, CNS dysfunction, Eaton-Lambert
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| small cell cancers are generally ___ in origin | hilar/mediastinal
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| small cell cancers are generally treated with ___ | chemotherapy
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| non-small cell cancers are generally treated with ____ | surgery
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| associated with very early metastasis | small cell
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| >95% of patients with ____ are smokers | squamous cell
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| tend to be more central in origing | squamous cell
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| most likely cancer to create cavitation | squamous cell
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| may be associated with hypercalcemia | squamous cell
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| resectable if caught early, if not are radiosensitive, chemotherapy resistant | squamous cell
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| most common form of lung cancer at 30-40% | adenocarcinomas
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| weakest association with tobacco smoke | adenocarcinomas
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| bronchoalveolar subtype of adenocarcinomas may resemble ___ | pneumonia
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| resectable if caught early | adenocarcinomas
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| start in the periphery | adenocarcinomas
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| start in the periphery | large cell carcinomas
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| rapidly growing; aggressive | large cell carcinomas
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| poorer prognosis than other non-small cell tumors | large cell carcinomas
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| breast cancers will spread to the lungs ____ | first
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| generally unresectable | metastatic disease
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| the componant of cigarette smoke that has been identified as the major carcinogen | benzo-pyrene
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| occupational exposures that may cause lung cancer | asbestos, benzene, nickel, ionizing radiation
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| when a lung is irritated it doesn't hurt it ___ | coughs
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| lung pain comes from involvement of the ___ | pleura
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| tumors on the left are more associated with ____ than tumors on the right | hoarsness
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| ptosis, miosis, anhidrosis | Horner's syndrome
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| lung cancer spread to the brachial plexus can lead to | Horner's syndrome
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| a paralyzed hemidiaphragm can signal tumor involvement of the _____ | phrenic nerve
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| most common paraneoplastic syndrome | systemic-weight loss, fatigue, fever, anorexia
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| amount of lung cancers discovered on CXR or CT as an incidental finding | 10%
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| large randomized studies show ___ difference in survival from lung cancer when CXR screening is used | no
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| the incidence of false positive lung nodules with CT scan is ____ | high
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| if a central tumor is found on CT the next step is a | bronchoscopy
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| A histological specimen showing abnormal cell with pink cytoplasm and the presence of a keratin pearl is indicative of | squamous cell
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| A histological specimen with atypical cells that appear purple is indicative of | small cell
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| multiple nodules have a better chance of being ____ than solitary nodules | benign
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| a spiculated nodule is likely to be | malignant
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| uptake of radioactive sugar is taken up by metabolically active sites | PET scan
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| lesions <__ cm may lead to false negative PET scans | 1
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| contralateral mediastinal or hilar nodes, any scalene or supraclavicular node, generally non-resectable | N3
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| ipsilateral peribronchial or hilar nodes | N1
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| ipsilateral mediastinal or subcarinal nodes | N2
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| tumor <3cm | T1
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| 7cm>tumor>3cm or involves mainstem bronchus ro visceral pleura | T2
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| >7cm, tumor invading chest wall, diaphragm, mediastinal pleura, pericardium or <2 cm from carina | T3
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| tumor invading mediastinum, heart, trachea, carina, or satellite lesion in same lobe of lung | T4
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| any T or N with M1 | stage IV cancer
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| carcinoma in situ | stage 0
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| hot spots on a PET scan are ______ indicative of cancer | not always
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| Non-small cell treatmeent for stages I and II | resection, some chemo
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| small cell treatment | combination chemo, prophylactic brain irradiation or if mets are present
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| Occurs when pleural fluid formation exceeds reabsorbtion | pleural effusion
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| for a pleural effusion to be seen on CXR generally requires ____ | 300-400 cc fluid
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| protein rich pleural effusions are | exudative
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| usually/always bilateral, occasionally R>>L | effusions due to CHF
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| pus in pleural space (abcess) | empyema
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| how do you treat an empyema | chest tube drain
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| casues of hemothorax | TB, tumor, trauma, thromboembolism
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