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DU PA Lung CA/pleura

Duke PA Lung Cancer and Pleural disease

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