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What is the first step in the evaluation of a pulmonary nodule?
Review of previous imaging studies
A pulmonary nodule that does not show enhancement on CT and/or PET scanning is likely, what?
After smoking cessaton, what happens to the risk of lung cancer?
After smoking cessation, the risk of lung cancer decreases for about 15 years and then it remains about twice that of a never-smoker.
What are the three most important factors in the treatment and prognosis of lung cancer?
- cell type
- cancer stage
- performance status of the patient.
What is the treatment fo Stages I or II NSCLC?
- Surgical resection whenever possible
- If the postoperative predicted FEV1 and DLCO are greater than 40%, surgery is generally well tolerated.
What is a cost effective procedure for preop staging of pts with known or suspected NSCLC?
PET scanning (or integrated CT-PET) is cost effective for preoperative staging of patients with known or suspected non–small cell lung cancer
In staging lung cancer, what is an accurate alternative to mediastinoscopy?
Endoscopic ultrasound-guided needle aspiration through either the trachea or esophagus
What is a solitary pulmonary nodule?
A solitary pulmonary nodule is defined as a nodular opacity that is up to 3 cm in diameter and surrounded by normal lung and not associated with lymphadenopathy.
What is the most important feature that increases the likelihood that a nodule is malignant?
size of the nodule
What autoantibodies point to paraneoplastic neurologic syndromes associated with lung cancer?
- Paraneoplastic neurologic syndromes are thought to be immune-mediated based on the identification of various autoantibodies, most commonly antineuronal nuclear antibodies ANNA-1 (formerly anti-Hu), ANNA-2 (formerly anti-Ri), and ANNA-3. Purkinje cell cytoplasmic antibodies include PCA1 (formerly anti-Yo) and PCA2.
- The finding of a paraneoplastic autoantibody in a patient presenting with a neurologic syndrome should expedite the evaluation for malignancy
When is brachytherapy used in the treatment of lung cancer?
Brachytherapy is the intraluminal application of radiation and is generally used in patients who have previously received maximal doses of external-beam radiation. Brachytherapy is appropriate for both intrinsic and extrinsic malignant airway obstruction when functioning lung may be maintained or regained by achieving airway patency. Response rates range from 30% to 80%, with success more likely in patients who had a favorable response to previous external-beam radiation. Hemorrhage or fistula formations are the most frequent complications
What is the therapy of choice for bronchial carcinoid tumors?
The 5-year survival rate for patients with atypical carcinoid tumors is approximately 60% to 70%, and, when feasible, surgery is the therapy of choice.
What is the usual approach to metastatic neoplasms to the lung?
Depending on the size and location of the nodules, a diagnosis may be obtained by transthoracic needle aspiration or bronchoscopy. Surgical resection may be appropriate for a solitary pulmonary metastasis when evidence of other sites of metastatic disease have been excluded.
What paraneoplastic processes are associated with thymomas?
Thymoma is associated with various paraneoplastic effects, the most common being myasthenia gravis (Figure 12 ). Approximately 35% to 50% of patients with a thymoma have myasthenia gravis, and approximately 15% of patients with myasthenia gravis have a thymoma. Other paraneoplastic syndromes associated with thymoma include pure red cell aplasia and hypogammaglobulinemia.
What are the possible etiology of masses in the anterior mediastinum?
Thyroid (or parathyroid) tumors, Thymoma (or thymic carcinoma), Teratoma (or germ cell tumors), Thomas Hodgkin disease, and T-cell lymphoma.
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