Pulmonology
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| What is the leading cancer killer of women and men? | Lung
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| Most aggressive type of lung cancer. Not surgically treated. Highest rate of mets. Usually systemic disease = | Small cell lung ca (16% of lung cancers)
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| Most common type of lung cancer | non-small cell (85%)
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| Most common types of non-small cell lung cancer | Squamous cell (30-35%), adenocarcinoma (30-35%), large cell (3-5%)
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| Squamous cell lung cancer usually originates where in the lung? | central
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| Adenocarcinoma lung cancer usually originates where in the lung? | peripheral
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| What is the presentation of stage 1 lung cancer? | Predominately asymptomatic (while more advanced is symptomatic)
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| What fraction of patients present to PCP with stage 3-4 lung cancer? | 2/3
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| Most frequent symptoms associated with advanced lung cancer | Cough, wt loss, dyspnea, chest pain, hemoptosis, bone pain, lymphadenopathy, hepatomegaly, clubbing, horseness, SVC syndrome
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| In which population is there an increasing incidence in lung cancer? | Young, white, non-smoking females
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| What is the most common cause of death in lung cancer? | distant metastases
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| Which stages of lung cancer are resectable? | stages I-IIIa
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| Initial imaging modality for suspicion of lung cancer | chest x-ray
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| A __ lesion on chest x-ray is considered malignant until proven otherwise | non-calcified
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| RFs for lung cancer include: | smoking, air pollution, ionizing radiation, asbestosis, heavy metals,industrial carcinogens
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| Most common etiologic factor in lung cancer: | smoking (85% of cases overall M>F)
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| Imaging used to evaluate for mets: | PET, brain CT, MRI
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| Imaging modality considered the standard of care in proper staging of lung tumors | Bronchoscopy
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| Gold standard for lymph node evaluation with lung cancer = | cervical mediastinoscopy
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| Lung cancer type more easily detected early: | SCLC (in sputum) - bc it often originates in central bronchi
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| Tends to be glandular & mucus-producing; associated with pleural effusions = | adenocarcinoma
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| In lung cancer, local mets may cause symptoms associated with what anatomic area? | Mediastinal structures (phrenic nerve, SVC, recurrent laryngeal nerve)
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| Common distant mets sites in lung cancer: | bone, brain, adrenals, kidney, liver
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| Lung cancer is often associated with paraneoplastic syndromes grouped as: | endocrine, systemic, neuro, cutaneous, hematologic, renal
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| Lung ca workup | CXR, CT, CBC, LFTs, lytes, Ca. Bronchoscopy; sputum cyto & pleural fluid; LN bx
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| 5 year survival rate for SCLC & NSCLC = | NSCLC = 15%. Limited-stage SCLC = 7%; extensive-stage dz = 1%
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| What % of mediastinal masses, originating in mediastinum, are benign? | 75%
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| Most common anterior mediastinal mass = | thymoma
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| Anterior mediastinal mass DDx | Thymoma, lymphoma, thyroid/PT, teratoma (germ cell tumor)
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| Middle mediastinal mass DDx | Hiatal hernia & mets cancer most common; also sarcoid, AAA, pericardial cyst (most common mediastinal cyst), bronchogenic cyst, LAD
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| Posterior mediastinal mass DDx | Neurogenic tumor (20% of all primary mediastinal tumors)
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| 50% of patients with thymoma initially present with: | myasthenia gravis
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| Complications of lung cancer (SPHERE) | SVC syndrome, Pancoast tumor, Horner syndrome, Endocrine (carcinoid), Recurrent laryngeal nerve (hoarseness), Effusions
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| Common endocrine syndrome/effect of SCLC | Cushing/SIADH
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| Common endocrine syndrome/effect of SCC | Hypercalcemia/PTH dz
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| Common endocrine syndrome/effect of large cell lung cancer | Gynecomastia
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| Common endocrine syndrome/effect of adenocarcinoma | thrombophlebitis
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