Characteristics of SPN
- Well circumscribed
- Isolated
- Round opacity
- Surrounded by normal lung
- ≤ 3 cm
What are the most common causes of SPN?
- Bronchogenic carcinoma
- Metastatic lesion
- Granuloma
- Calcification
What is the clinical presentation of SPN?
Usually asx
Found incidentally on CXR
What are RFs for SPN?
- Older age
- Smoking
- Recent travel
- Recreational activities
- Occupational
How do you evaluate imaging for SPN?
Compare to old films, looking for rate of growth
What can be seen on CXR?
- Cavitation
- Calcification (dense calcification = benign, less calcification = malignancy)
- Hamartoma = “popcorn”
What are concerning features for malignancy on CT?
- Spiculated margins
- Peripheral halo
- Density
What type of people are considered low risk for malignancy?
- Age < 30
- Stable lesion ≥ 2 years
- Benign calcification pattern
SPN: How do you manage low risk pts?
Watchful waiting
SPN: How do you manage intermediate risk pts?
- Biopsy
- PET
SPN: How do you manage high risk pts?
Resection
What are the most common types of lung CA?
- Adenocarcinoma
- Squamous cell carcinoma
What are the 2 main groups of lung CA?
- Non-small cell
2. Small cell
What are RFs for lung CA?
- Tobacco smoke #1
- Exposure to radon, asbestos, or other carcinogens
- Pollution
- Arsenic drinking H2O
- Previous radiation to chest
- Personal or family hx
What group of cancer is most common?
Non-small cell
What categories does non-small cell cancer include?
- Adenocarcinoma (most common)
- Adenosquamous
- Squamous cell
- Large cell
What are characteristics of adenocarcinoma?
- Associated w/ smoking, but most common type in non-smokers
- Mucus gland origin
- Located peripherally
- Slow growing
What are characteristics of squamous cell?
- Bronchial epithelium origin
- Associated w/ hypercalcemia
- Metastasize later on
- Central necrosis
What are characteristics of large cell?
- Agressive, rapid
- Peripheral w/ prominent necrosis (but can be central)
What are characteristics of small cell?
- Bronchial origin
- Begin centrally, infiltrate submucosally –> narrowing of bronchus
- Aggressive, poor px
- Distant metastasis at time of dx
Describe bronchial carcinoid tumors
Pedunculated or sessile growths in central bronchi
What are bronchial carcinoid tumors derived from?
Neuroendocrine cells
What is the clinical presentation of bronchial carcinoid tumors?
- Hemoptysis, cough, focal wheezing, recurrent pneumonia
- Grow slowly & rarely metastasize
What sx indicate carcinoid syndrome?
Flushing, diarrhea, wheezing, hypotension
What imaging is used for bronchial carcinoid tumors?
- CXR
- CT
- Octeotide scintigraphy
What is definitive dx of bronchial carcinoid tumors?
Biopsy
How do you tx bronchial carcinoid tumors?
Excision w/ mediastinal lymph node sampling
What are 2 complications of bronchial carcinoid tumors?
- Bleeding
- Airway obstruction
What are characteristics/sx of superior vena cava syndrome?
- Most common SCLC
- Bulky upper lobe tumor
- Fullness in head
- Dyspnea
What are PE findings in SVC syndrome?
- JVD
- Facial edema
- Plethoric appearance
What do you see on CXR in SVC syndrome?
- Widening of mediastinum
- R hilar mass
What are characteristics/sx of Pancoast syndrome?
- Common in squamous NSCLC
- Shoulder pain
- Horner’s syndrome
What labs can you use to dx lung CA?
- CBC
- Electrolytes
- Ca2+
- Creatinine
- Liver
- LDH
- Albumin
What imaging can you use to dx lung CA?
- CXR
- CT scan
- PET
- CT-PET combined
- MRI brain
What other tests can you use to dx lung CA?
- Sputum
- FNA or cytology
- Biopsy
- Spirometry
What system do oncologists use to stage cancer?
TNM staging
How do you tx early stage pts w/ NSCLC?
- Resection w/ MLN eval
- Standard therapy for 1a & 1b
- Consult oncology
How do you tx nonsurgical candidates for NSCLC?
- Chemoradiation
- Stereotactic radiation
How do you classify SCLC?
- Limited: up to unilateral hemithorax
- Extensive: beyond hemothorax
How do you tx limited vs extensive SCLC?
- Limited: chemo & radiation
- Extensive: chemo alone
What are side effects of chemo?
- N/V, anorexia, wt loss
- Fatigue
- Hematologic
- Nephrotoxicity
- Neurotoxicity
- Rash
- Visual disturbances
What are complications of lung CA?
- Pancoast
- Horner
- Recurrent laryngeal nerve compression
- Pleural effusion
- SVC syndrome
- Endocrine dz (carcinoid syndrome)
How do you continue to monitor pts who were treated for lung CA?
- H&P, chest CT every 6 mos for 2 yrs. Annual thereafter
- Annual LDCT ≥ 5 years
What are complications that can be seen after tx for lung CA?
- Chronic pain, dyspnea, fatigue, impaired sleep, sexual dysfunction
- Chemotherapy sequelae
- Radiation sequelae
Describe: mesothelioma. What is it linked to?
Primary tumor arising from surface lining of pleura
- Linked to asbestos
What are clinical findings of mesotheliomas?
- Insidious onset SOB
- Nonpleuritic CP
- Wt loss
- Dullness to percussion
- Diminished breath sounds
- Clubbing
How do you evaluate mesotheliomas?
- Pleural fluid: exudative, hemorrhagic
- Cytology
- VATS biopsy
- Imaging (CT, PET-CT): unilateral thickening & pleural effusion
How do you tx mesotheliomas?
Chemo
What are USPSTF guidelines regarding lung CA screening?
Annual LDCT screening in: - Age 55-74: current/former smoker w/ ≥ 30-pack-yr hx