Lung Nodule
Assumptions
Student has reviewed lung anatomy and normal physiology. Student is familiar with TNM classification of
lung neoplasms.
Objectives
1. Create an algorithm for the evaluation of a patient with a lung nodule on chest x-ray.
2. Discuss the common risk factors and clinical symptoms of lung cancer.
3. Describe the role of surgery in lung cancer
a) Describe pulmonary function tests and values that are predictive of severe risk of pulmonary
complications following thoracic surgery.
b) Identify conditions that preclude curative surgical resection for lung cancer.
4. List the most common sources of malignant metastases to the lungs.
5. Compare and contrast the management and prognosis of metastatic vs. primary lung malignancies.
6. Describe the most common diagnostic procedures used to evaluate pulmonary and mediastinal lesions.
7. List the common tumors of the anterior, posterior and superior mediastinum.
8. List the common chest wall tumors.
Problems
On a routine chest x-ray of a 65-year-old 30 pack per year smoker, a discrete 2 cm. nodule is found in the
right upper lobe.
 List diagnostic possibilities including neoplastic and non-neoplastic lesions.
 Write orders for the diagnostic tests in order of priority.
 Write orders for the tests needed to determine if the patient is a suitable operative candidate.
 Describe the operative and ancillary treatments assuming the nodule was a non small-cell and
undifferentiated neoplasm.
 Outline alternative treatment plans under the following conditions:
o patient had previously known soft tissue sarcoma of the extremity
o multiple lymph nodes found on CT scan of mediastinum
o patient found to have poor pulmonary function
o patient has hoarseness
 Outline a follow-up care plan if the patient had a lobectomy for non small-cell lung carcinoma.
 Compare the treatment plans and prognosis if the lesion were tuberculosis or sarcoidosis.
Prevention
1. Discuss smoking cessation.
2. Role of screening & disease transmission for tuberculosis.