PANCE Blueprint Pulmonary (10%)

Pulmonary Neoplasms (PEARLS)

The NCCPA™ PANCE  Pulmonary Content Blueprint covers three types of pulmonary neoplastic diseases

Carcinoid tumors Carcinoid tumors are a GI tract cancer that has metastasized to the lungs

  • Cancer of the appendix is the most common cause.  The appendiceal cancer travels from the appendix then to the liver where it metastasizes to the lungs.

Presents with hemoptysis, cough, focal wheezing or recurrent pneumonia, carcinoid syndrome (the hallmark sign) is actually quite rare.

Most common type: Adenoma - Slow growing, rare metastasis

Presentation:

  • Carcinoid syndrome = Cutaneous flushing, diarrhea, wheezing and low blood pressure. This is the hallmark sign!

Diagnostics studies:

  • Bronchoscopy- pink/purple central lesion, well vascularized. Pedunculated or sessile
  • Elevated 5-HIAA

Treatment: Surgical removal

Lung cancer Small Cell (15% of cases) (central mass) - 99% smokers, does not respond to surgery and metastases at presentation

  • Location: Central, very aggressive
  • Treatment: Combination chemotherapy needed
  • Paraneoplastic syndromes: Cushing's, SIADH

Non Small Cell  (85 percent of lung cancer cases)

  • Squamous cell (central mass) with hemoptysis, 25-35% of lung cancer cases
    • Location: central
    • May cause hemoptysis
    • Paraneoplastic syndrome: hypercalcemia
    • Elevated PTHrp
  • Large cell - fast doubling rates - responds to surgery rare (only 5%)
    • Location: Periphery 60%
    • Paraneoplastic syndrome: Gynecomastia
  • Adenocarcinoma - most common (peripheral mass), 35-40% of cases of lung cancer
    • Most common
    • Associated with smoking and asbestos exposure
    • Location: Periphery
    • Paraneoplastic syndrome: Thrombophlebitis

Treatment:

Non Small Cell can be treated with surgery

  • Treatment depends on staging:
    • Stage 1-2 surgery
    • Stage 3 Chemo then surgery
    • Stage 4 palliative

Small Cell: CAN NOT be treated with surgery will need chemotherapy

Associated manifestations:

  • Superior vena cava syndrome (facial/arm edema and swollen chest wall veins)
  • Pancoast tumor (shoulder pain, Horner’s syndrome, brachial plexus compression)
  • Horner’s syndrome (unilateral miosis, ptosis and anhidrosis)
  • Carcinoid syndrome (flushing, diarrhea and telangiectasia)
Pulmonary nodules < 3 cm is a nodule (coin lesion) > 3 cm the lesion is considered  a "mass"

Steps to dealing with a pulmonary nodule:

  1. Incidental finding on CXR →
  2. Send for CT →
  3. If suspicious (depending on radiographic findings below) will need a biopsy
    • Ill-defined lobular or spiculated suggests cancer
  4. If not suspicious < 1 cm it should be monitored at 3 mo, 6 mo, and then yearly for 2 yr
    • Calcification, smooth well-defined edges, suggests benign disease
Tuberculosis (ReelDx) (Prev Lesson)
(Next Lesson) Carcinoid tumors
Back to PANCE Blueprint Pulmonary (10%)

NCCPA™ Content Blueprint

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