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IM - Lung Neoplasms

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tonystep1's version from 2017-08-31 02:17

Risk factors and causes of lung cancer

Question Answer
Risk factors for lung cancera. Cigarette smoking-accounts for >85% of cases
• There is a linear relationship between pack-years of smoking and risk of lung
cancer.
• Adenocarcinoma has the lowest association with smoking of all lung cancers.
b. Passive smoke
c. Asbestos
• Common in shipbuilding and construction industry, car mechanics, painting
• Smoking and asbestos in combination synergistically increase the risk of lung
cancer.
d. Radon-high levels found in basements
e. COPD-an independent risk factor after smoking is taken into account
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lung cancer types

Question Answer
Squamous cell carcinoma location and CXR findingsCavitation on CXR
Adenocarcinoma location and associationsOften Peripheral
associated with pulmonary scars/fibrosis and less closely associated with smoking than other types
Large cell carcinoma locationUsually found in peripheral lung
Small cell lung cancer locationCentral
How is Non Small Cell Lung Cancer staged?SCLC is staged differently:
• Limited-confined to chest plus supraclavicular nodes, but not cervical or
axillary nodes
• Extensive-outside of chest and supraclavicular nodes
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Clinical features of lung cancer

Question Answer
Symptoms suggestive of airway involvementcough, hemoptysis, obstruction, wheezing, dyspnea, recurrent pneumonia
Symptoms indicative of advanced diseaseAnorexia, weight loss, weakness
Local invasion to Superior vena cava findings includefacial fullness, facial and arm edema, dilated veins over anterior chest , arms, and face; jugular venous distention
Local invasion causing Phrenic Nerve palsy causesResultsin hemidiaphragm paralysis
Local invasion causing Recurrent laryngeal nerve palsycauses hoarsness
Invasions to cervical sympathetic chain causesHorner's syndrome - unilateral facial anhidrosis, ptosis, and miosis.
Pancoast's tumor findingsSuperior sulcus tumor - an apical tumot involving C8 and T1-T2 nerve roots, causing shoulder pain radiating down the arm // pain ; upper extremity weaknesss due to brachial plexus invasion
Most common sites for metastatic diseasebrain, bone, adrenal glands, and liver
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Paraneoplastic syndromes

Question Answer
SIADH is commonly associated withsmall cell carcinoma
Ectopic ACTH secretion is commonly seen withsmall cell carcinoma
PTH-like hormone secretion most commonly seen withsquamous cell carcinoma
Eaton-Lambert syndrome is most commonly seen withsmall cell carcinoma
What are the features of digital clubbingloss of normal angle between the fingernail and nail bed due to thickening of subungal soft tissue
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Diagnosis

Question Answer
CXR role in diagnosisCXR
a. Most important radiologic study for diagnosis, but not used as a screening test
b. Demonstrates abnormal findings in nearly all patients with lung cancer
c. Stability of an abnormality over a 2-year period is almost always associated
with a benign lesion
CT scan role in diagnosisCT scan
a. Very useful for staging
b. Can demonstrate extent of local and distant metastasis
c. Very accurate in revealing lymphadenopathy in mediastinum
Usefulness of Cytologic examination of sputumCytologic examination of sputum
a. Diagnoses central tumors (in 80%) but not peripheral lesions
b. Provides highly variable results; if negative and clinical suspicion is high, further
tests are indicated
What is the limitation of Fiberoptic bronchoscopea. Can only be inserted as far as secondary branches of bronchial tree; useful for
diagnosing central visualized tumors but not peripheral lesions
b. The larger and more central the lesion, the higher the diagnostic yield; for visible
lesions, bronchoscopy is diagnostic in >90% of cases.
When is transthoracic needle biopsy typically used?Always perform a biopsy for intrathoracic lympadenopathy (specificity for metastasis is 60%)
Mediastinoscopy indication?Identifies patients with advanced disease who would not benefit from surgical resection
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Treatment of Lung Cancer

Question Answer
Which patients with NSCLC are candidates for surgery?Patient without metastasis outside the chest
What is the adjunct to surgery in NSCLC patients ?Radiation therapy is an important adjunct to surgery.
What is the treament of choice in SCLC limited disease?Chemotherapy
What is the treatment of choice in SCLC extensive disease?Chemotherapy
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Causes of Mediastinal Masses

Question Answer
Anterior Mediastinal Massesthyroid, teratogenic tumors, thymoma, lymphoma
Middle Mediastinal Massesung cancer, lymphoma, aneurysms, cysts, Morgagni hernia
Posterior Mediastinal Massesneurogenic tumors, esophageal masses, enteric cysts,
aneurysms, Bochdalek's hernia
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Clinical features of Mediastinal Masses and Diagnosis

Question Answer
Compression of recurrent laryngeal nerveHoarseness
Compression of sympathetic gangliaHorner's syndrome
Compression of phrenic nerveDiaphragm paralysis
Compression of esophagusDysphagia
General symptoms of Mediastinal MassesUsually asymptomatic
a. When symptoms are present, they are due to compression or invasion of adjacent
structures
b. Cough (compression of trachea or bronchi), sometimes hemoptysis
c. Chest pain, dyspnea
d. Postobstructive pneumonia
What is the test of choice for Mediastinal MassesChest CT is test of choice.
How are Mediastinal Masses usually discovered?Usually discovered incidentally on a CXR performed for another reason
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