| What are solitary lung nodules? | • “Coin lesion”:
- Defined as < 3 cm.
- Completely surrounded by lung parenchyma.
• Lesions > 3 cm called “masses” and often malignant
• Risk Factors:
- Smoking:
• Lung cancer is 10 times more common in smokers compared to non-smokers.
- History of lung cancer in a first degree relative.
- Exposure to asbestos, uranium and radon.
- Rare in under 35 years of age
• Incidence of cancer from 10 – 70%.
• 90% incidental findings.
• Increased with incidental findings on CT.
• Patients with best prognosis are stage IA (T1N0M0) |
| What are common etiologies of solitary pulmonary nodules? | . |
| What are radiologic features suggestive of benign/malignant nodules? | . |
| What are radiologic margins of lung nodules? | • Corona radiata sign. Fine linear strands extending 4-5 mm outward. 84 – 90% are malignant)
• Scalloped border (Intermediate probability of cancer. Smooth border suggestive of benign diagnosis)
Air bronchogram sign of malignancy
Calcification sign of benign disease
Popcorn calcification sign of hamartoma
Eccentric calcification (might be malignant) |
| How is management of solitary nodules <8mm? | . |
| How is management of solitary nodules >8mm? | . |
| What are imagings used? | PET scan, CT guided biopsy |
| How is incidence of lung cancer? | An estimated 2 million new cases of lung cancer are
expected globally in 2020, 84% NSCLC
• Cancer is the second leading cause of death
globally.
• 1 in 6 deaths is due to cancer.
• Approximately 70% of deaths from cancer occur
in low- and middle-income countries.
• Tobacco use is responsible for approximately
22% of cancer deaths.
• The total annual economic cost of cancer in
2010 was estimated at approximately US$ 1.16
trillion.
It is the most frequent cancer WW, has highest mortality |
| What are types of lungs cancers? | . |
| How is staging of lung cancer? | . |
| What are sx of lung cancer? Casue? Prevention? | Most are asx
10% sx (cough, hemoptysis, SoB, weight loss, clubbing)
Major cause: smoking, others (radiation, pollution, asbestos)
Best prevention stop smoking, second best screening by low dose CT
Imaging enables visualisation of the size and location
of tumours, and potential nodal involvement
Chest X-ray is often used first due to its widespread availability
More detailed imaging of lymph nodes, soft tissues and tumours is performed through MRI and/or PET/CT scans due to their increased sensitivity
Low dose radiation CT scanners induce 20% reduction in lung cancer mortality |
| What are dx procedures of lung cancer? | • Flexible bronchoscopy (and biopsy).
• EBUS.
• CT guided biopsy.
• Surgical lung biopsy (Thoracotomy side 5th intercostal space/ thoracoscopy, exisional biopsy of nodes, nodule resection excisional biopsy, Uniportal VATS)
• Directly to surgery (resection GOLD STD, lobectomy or pneuomonectomy (used normal), wedge/segmentectomy (abnormal use) |
