Lung mass resident survival guide
Lung mass (also known as "Pulmonary mass") is defined as any area of pulmonary opacification that measures more than 30 mm (3 cms) in the lung. Lung mass are abnormal growths found in the lung which can be either be benign or malignant. The most common cause of a pulmonary mass is lung cancer. Other less common causes of lung mass include granuloma, lipoma, tuberculosis, and aspergillosis.
Lung mass may be classified on the basis of histopathology into benign lung mass and malignant lung mass. In addition, lung mass can be sub-classified according to the location, imaging features, size, and distribution.
|•Hyperdense pulmonary mass|
•Cavitating pulmonary mass
Life Threatening Causes
- Lung abscess
- Rheumatoid arthritis
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of lung mass.
|Advise chest x ray (CXR)|
|Lung opacity on chest X ray (CXR)|
|Size >3 cms; classified as lung mass||Size <3 cms; classified as pulmonary nodule|
|High resolution chest CT scan||Check previous CXR|
|Imaging features||Previous CXR normal; suggesting new growth||Previous CXR shows opacity but stable in size since then|
|Hyperdense pulmonary mass|
|Cavitating pulmonary mass|
❑ Gas-filled area
❑ Thick/spiculated wall (must be greater than 2-5 mm)
|Follow up every 2-3 yrs|
| Other diagnostic studies|
❑ Sputum cytology
❑ Endobronchial ultrasound
❑ Endoscopic ultrasound
|High resolution chest CT scan|
|Highly suspicious for malignancy|
|Moderately suspicious for malignancy|
|Low suspicion of malignancy or benign features|
|PET or biopsy||Serial CT scans|
|PET with biopsy|
|Malignancy||No evidence of malignancy|
|Surgical excision/Chemotherapy or Radiotherapy depending upon histopathology||No growth over time||Lesion grows over time|
|Surgical excision/Chemotherapy or Radiotherapy depending upon histopathology||Serial CT scans|
|No further workup||PET with or biopsy|
|Surgical excision/Chemotherapy or Radiotherapy depending upon histopathology|
Complete Diagnostic Approach
Characterize the symptoms:
❑ Previous primary infection of tuberculosis
❑ Previous or current lung disease, such as:
❑ Medication history
Examine the patient:
❑ Patients look older than actual age
High resolution chest CT scan
Staging of disease; TNM Classification:
❑ Stage IA
The following table depicts the TNM classification for lung cancer:
Prevention of Lung mass
Effective measures for the primary prevention of lung mass include smoking cessation and avoidance of second hand smoking. In general, lifestyle changes with diet rich in vitamins and antioxidants such as healthy diet rich with fruits and vegetables and regular exercise, may decrease the risk of tumorigenesis and malignancy.
- According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose CT scan is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).</nowiki>
- According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for suspected lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years.
Treatment of Lung mass
- The treatment of patients with lung mass varies and depends upon the underlying histology and staging of the disease (Note: Around 95% lung mass cases are lung cancer).
- Widespread and malignant disease is treated with chemotherapy or with/without radiotherapy, as surgery is not an option in patients with advanced disease.
- Patients with benign and resectable tumors are generally treated with surgical excision.
- Surgical excision is considered the mainstay therapy for malignant lung mass.
- In lung mass, surgical procedure selection will depend on the size, margins, and invasion of the tumor.
- Common surgical procedures for the treatment of lung mass include wedge resection, segmentectomy, lobectomy, and lung volume reduction surgery.
- The medical therapy for lung cancer on the basis of staging is given below:
|Stage I||Radiation therapy AND consider chemotherapy for high risk stage IB|
|Stage II (T2a, N0 OR T3, N0)||Consider chemotherapy for high risk stage II AND radiation therapy|
|Stage II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1)||Chemoradiation|
- For details on medical therapy of lung cancer, click here.
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