Pathogenesis / Etiology
A clump of cells that forms due to an infection or illness that inflames the lung tissue and can eventually calcify or harden the lung, causing a noncancerous lung nodule: ____.
Granuloma
What is the role of a Chest X-ray in the diagnosis of lung nodules, including the benefits?
First step screening test for lung disease; provides a 2D image based on density so the lung nodules will appear as round white shadows. Benefits include: low cost and low radiation
What does TNM stand for?
T: tumor size, N: spread to nearby lymph nodes, M: metastasis
What was the name of the surgery indicated for our patient, Ms. Eaglehorse?
Right upper lobectomy with mediastinal lymph node sampling
What nodule features are most important to assess when predicting malignancy risk in patients with Solitary Pulmonary Nodules?
size, border, and location
A multisystem autoimmune disorder characterized by noncaseating granulomas with giant cells that causes lung nodules: ___
Sarcoidosis
What is the next step after a CXR in diagnosing lung nodules and why?
CT scan ; to assess nodule size, location, and signs of malignancy.
What was the likely stage of our patient, Kachina Eaglehorse, when she returned 5 months post op? Describe TNM of her stage
Stage IV; T: any size N: any nodal involvement and M: can be M1a,b,c depending on the extent of metastasis. Her stage is characterized as palliative.
In what stages of NSCLC is surgical resection indicated (if patient is a surgical candidate)?
Curative stages: stage I and II; Surgery can be performed in Stage IIIA if tumor size decreases significantly after intial treatment (usually polychemotherapy + radiation)
Other than nodule features, patient history can be used to predict malignancy risk in patients with lung nodules. What are the 3 most important predictive factors in patient history?
age, smoking history, and prior cancer history
Most lung nodules are caused by granulomas. What is the most common clinical presentation of a common fungus that is often found in bird and bat droppings? (also name the fungal disease)
Histoplasmosis; usually asymptomatic
What are the two features a lung nodule must have to indicate that no follow up CT is needed?
Solid nodule <4mm and low probability of malignancy
List the corresponding TNM for Stage IA and IB in NSCLC?
IA: T1 and IB: T2a
For SCLC, what is the treatment approach for Limited Disease and for Extensive Disease.
Limited: Curative and Extensive: Palliative
What part of the lung is associated with high risk for malignancy in regard to the location of a lung nodule?
upper lobe
A chronic systemic autoimmune disorder that primarily affects the joints that can lead to the formation of lung nodules.
Rheumatoid Arthritis
When is a biopsy of a lung nodule indicated? (3)
When there are changes to the nodule when compared to a prior CT, when a nodule is > 8mm with intermediate risk of malignancy with positive PET scan, or when a nodule is > 8mm with high risk of malignancy
What is the corresponding TNM for the extensive stage (palliative treatment approach) for SCLC?
M1a-c
What stages of NSCLC is prophylactic cranial irradiation not usually indicated as it does not improve survival; and when is it indicated in SCLC?
Stage IIIA; In SCLC: in both curative and palliative treatment approaches when a patient responds to initial chemotherapy treatment
Many things can cause benign lung nodules, including infections and scarring. What percent of lung nodules are benign?
About 95%
Tobacco smoking is associated with the development of ___ of lung nodules/cancers, with a weaker association with ______.
80-90% ; lung adenocarcinoma
Walk through the most important points of Ms. Eaglehorse’s diagnostic process starting after the physical exam and up until surgery.
1. Labs, CXR, and CT scan ordered
2. Imaging reports discussed at follow up appointment
3. Referral for CT guided needle biopsy
4. PET scan
5. PFT
6. Surgery
In our case CT and PET scans were used. What are the sensitivity and specificity of CT and PET scan in the process of staging?
PET more sensitive and specific than CT
What stages in NSCLC correspond to Curative treatment approaches and which stages correspond to Palliative approaches?
Curative: Stage I, II, IIIA, and pancoast tumors up to Stage IIIB
Palliative: Stage IIIB and IV
Low risk lung nodules are ____mm and high risk lung nodules are ___mm.
<4 mm ; >8-10mm