advertisement

Lung cancer and pulmonary nodules

57 %
43 %
advertisement
Information about Lung cancer and pulmonary nodules
Entertainment

Published on February 14, 2008

Author: Michelino

Source: authorstream.com

advertisement

Lung cancer and pulmonary nodules: Lung cancer and pulmonary nodules Resident’s seminar 02/01/2006 Elsa B. Valsdottir Lung nodules: Lung nodules In the general population, what percentage of asymptomatic solitary lung nodules are carcinoma? 5% 20% 35% 50% 75% Lung nodules: Lung nodules In the general population, what percentage of asymptomatic solitary lung nodules are carcinoma? 5% 20% 35% 50% 75% Benign nodules: Benign nodules Hamartoma 8% (popcorn lesion) Granuloma Scarring Hemangioma Schwannoma Fibroma Lipoma Leiomyoma Clear cell tumor Teratoma Pulmonary nodule: Pulmonary nodule A healthy 59 yoM with 40 pack year hx has a new 1 cm nodule in the RUL on routine CXR. CT confirmes a spikulated lesion with lymphadenopathy. His PFTs are normal. The most appropriate management would be: chemotherapy CT guided needle bx thoracoscopic wedge resection RU lobectomy radiotherapy Algorithm from Greenfield: Algorithm from Greenfield Pulmonary nodule: Pulmonary nodule A healthy 59 yoM with 40 pack year hx has a new 1 cm nodule in the RUL on routine CXR. CT confirmes a spikulated lesion with lymphadenopathy. His PFTs are normal. The most appropriate management would be: chemotherapy CT guided needle bx thoracoscopic wedge resection RU lobectomy radiotherapy Lung cancer: Incidence, epidemiology: Lung cancer: Incidence, epidemiology Leading cause of cancer death (28%) 2nd most common cancer >173,000 cases/year Overall 5 year survival 12% Decreasing incidence and mortality in men Incidence plateaued in women but mortality still rising Cause: TOBACCO (85-90%) arsenic, asbestos, genetics, COPD, CLL, AIDS Lung cancer: Classification: Lung cancer: Classification Small cell carcinoma 20% Non-small cell carcinoma: Adenocarcinoma 40% Squamous cell carcinoma 20-25% Adenosquamous carcinoma Large cell carcinoma Carcinoid Carcinoma of salivary gland type Unclassified Small cell lung cancer: Small cell lung cancer Which of the following statements about small cell lung cancer is NOT true? Surgical therapy is rarely indicated The etiology is unknown Paraneoplastic endocrine syndromes are common Chemotheraputic agents are generally effective Prophylactic radiotion therapy can reduce brain metastasis Small cell lung cancer: Small cell lung cancer Which of the following statements about small cell lung cancer is NOT true? Surgical therapy is rarely indicated The etiology is unknown Paraneoplastic endocrine syndromes are common Chemotheraputic agents are generally effective Prophylactic radiotion therapy can reduce brain metastasis Signs and symptoms: Signs and symptoms Cough Hemoptysis Dyspnea Pain Dysphagia Horner’s syndrome Pancoast’s syndrome SVC obstruction Staging: Staging Lung cancer: nodal stations: Lung cancer: nodal stations Nodal stations, cont: Nodal stations, cont Survival: Survival Resectable tumors: Resectable tumors Stages I and II Stage IIIA? N2 dz Downstaging with neoadjuvant tx Selected cases of IIIB (T4) Lung cancer: Pre-operative workup: Lung cancer: Pre-operative workup CT (brain) PET: 97% sensitive, 78% specific Bronchoscopy Mediastinoscopy PFTs FEV1 DLCO (diffusing capacity for carbon monoxide) Oxygen consumption PFTs: PFTs Which one of the following inducates a high risk for RF after pulmonary resection? Preoperative FEV1 = 500 ml Preoperative PaCO2 = 38 mm Hg V/Q scan showing 30% perfusion to operative side Predicted postop FEV1 = 1.1L PFTs: PFTs Which one of the following inducates a high risk for RF after pulmonary resection? Preoperative FEV1 = 500 ml Preoperative PaCO2 = 38 mm Hg V/Q scan showing 30% perfusion to operative side Predicted postop FEV1 = 1.1L Lung cancer: Surgical options: Lung cancer: Surgical options VATS Segmentectomy Lobectomy Sleeve resection Pneumonectomy VATS for Stage 1 lung cancer: VATS for Stage 1 lung cancer Pros: Cons: less pain oncologic validity less LOS tech. difficult better cosmesis seeding of tumor Better survival due to less immunologic response (IgG, CRP, IL-6, TNF etc)? Roviaro et al: Long-term Survival After VATS Lobectomy for Stage 1 Lung Cancer. CHEST 2004;126:725-732 Lung cancer screening: Lung cancer screening Lung cancer screening: Lung cancer screening Take home message: New CT techniques detect suspicious nodules 3x more than CXR, malignant tumors 4x and stage 1 tumors 6x Henschke et al: Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet, 1999;354:99-105 Surgery after Chemo/XRT for Stage IIIA: Surgery after Chemo/XRT for Stage IIIA Can be considered in fit patients but does not neccessarily increase overall survival Albain et al: Phase III study of consurrent chemotherpy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA (pN2) non-small cell lung cancer (NSCLC): Outcomes update of NOrth American Intergroup 0139 (RTOG 9309). ASCO Annual Meeting 2005 Adjuvant chemo for resected Stages IB-II lung ca : Adjuvant chemo for resected Stages IB-II lung ca Newer adjuvant chemo prolongs overall and recurrence free survival Winton et al: A prospective randomised trial of adjuvant vinorelbine (VIN) and cisplatin (CIS) in completely resected stage IB and II non small cell lung cancer (NSCLC) Intergroup JRB.10. J Clin Onc 2004;22:7018

Add a comment

Related presentations

Related pages

Pulmonary Nodules | Seattle Cancer Care Alliance

In general, a “pulmonary nodule” is a small, roundish growth on the lung that measures three centimeters in diameter or less. If the growth is larger ...
Read more

Pulmonary Nodules (Lung Nodules) | Cleveland Clinic

Learn about pulmonary nodules from the ... If the nodule is from a lung cancer, ... How are pulmonary nodules treated? If the pulmonary nodule is ...
Read more

Solitary pulmonary nodule: MedlinePlus Medical Encyclopedia

Primary lung cancer is the most common cause of cancerous ... Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer?
Read more

Lung nodules: Can they be cancerous? - Mayo Clinic

Most lung nodules are noncancerous, ... An effective treatment for lung cancer? ... Lung nodules Can they be cancerous;
Read more

Benign Lung Tumors and Nodules: Symptoms and Causes

The causes of benign lung tumors and nodules are poorly understood. ... Lung Cancer; Pulmonary Hypertension; Smoking Cessation; Tuberculosis; Tuberous ...
Read more

What Are the Chances a Lung Nodule Is Cancer? - Verywell

The most common cause of malignant lung nodules includes lung cancer or ... et al. Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?
Read more

Lung cancer - Wikipedia

Lung cancer, also known as lung ... Lung cancer often appears as a solitary pulmonary nodule ... Separate tumor nodule in the other lung: Tumor ...
Read more

Pulmonary Nodules - Health Encyclopedia - University of ...

What are Pulmonary Nodules? A pulmonary nodule is a small, ... brought on by smoking or any other common cause of lung cancer.
Read more

Evidence for the Treatment of Patients With Pulmonary ...

1. Chest. 2007 Sep;132(3 Suppl):94S-107S. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based ...
Read more

Lung Cancer

Professional oncology social workers provide free emotional and practical support for people with lung cancer, caregivers, and their loved ones. Counseling
Read more