Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

922 Lung Cancer

tests

Imaging

■Basic studies: CXR and CT (contrast; cuts through upper abdomen

and adrenals); lymph nodes >1 cm abnormal

■Advanced: bone scan and/or brain MRI if symptoms/signs present;

PET scanning for mediastinal staging

Laboratory

■Suggestive but nondiagnostic:

➣CBC, platelets, PT, PTT: for anemia, marrow involvement, biopsy

risk

■Electrolytes, BUN/CR: assess SIADH, renal function for CT

■LFTs: assess hepatic metastasis.

■Alk phos, Ca++: for bony mets, hypercalcemia

■LDH: some prognostic features

Biopsy

■Bronchoscopy: 60–80% yield for central airway tumors, postobstruc-

tive changes or accessible mediastinal nodes

■FNA: 80% yield if lesion≥2 cm and peripheral

■Sputum cytology: low yield (20%), but useful with bilateral involve-

ment, cavitary disease and/or relative contraindications to bron-

choscopy

■Mediastinoscopy: sample mediastinal nodes for staging; normal

nodes on chest CT and normal PET reduces need for mediastino-

scopy

■Biopsy of suspected metastasis crucial for accurate staging

differential diagnosis

■TB: most cancers occur in upper lobes; cavitary squamous cell can

look like TB

■Pneumonia: repeat CXR in 6–8 wks in high-risk patients

■Benign pulmonary tumors (hamartoma)

■Cancer metastatic to lung

■Other cancers (lymphoma, KS)

■Lung inflammatory disorders (sarcoid, Wegener)

■Lymphangitic spread can mimic CHF or ILD

management

What to Do First

■Assess oxygenation, infection, anemia if hemoptysis present

■Aggressively manage symptoms (wheezing, infection, bone pain)