#24 - bronchogenic carcinoma

Question 1

Smoking is what percent of the risk for lung cancer?

Answer 1

> 90%

Question 2

Which type of lung cancer is the most common

Answer 2

non-small cell lung cancer (adenocarcinoma is biggest chunk of this)

Question 3

Second most common type of lung cancer

Answer 3

small cell lung cancer - neuroendocrine tumors which can secrete hormones / proteins.

Question 4

biology / histology - which trumps which?

Answer 4

biology trumps histology

Question 5

What dooes TMN stand for?

Answer 5

T= tumor size
N= (lymph) nodes involved
M = metastasis

Question 6

Basic staging criteria for stage 1 lung cancer

Answer 6

only way you have stage 1 disease is a tiny tumor without anything else.

Question 7

basic staging for stage 4 lung cancer

Answer 7

any metastasis = stage 4 (worst stage)

Question 8

Which stages of lung cancer are surgically operable?

Answer 8

Stage 1 and 2 are surgically operable. A small portion of stage 3 tumors are operable.
Stage 4 is never operable, never curable.

Question 9

who is eligible to get screened for lung cancer w/ CT scan

Answer 9

• age 55 to 75
• > 30 pack yr smoker
• quite within 15 years, or current smoker.

Question 10

effects of screening

Answer 10

reduced lung cancer death rate 20%. Found more cancers, and found them earlier than in CXR group

Question 11

positive node on lung cancer screening- what to do?

Answer 11

surveillance! high rate of nodes found (40% of scans)

-repeat scans every 3 to 6 months, for 2-5 years depending on appearance.

Question 12

Characteristics of malignant tumors

Answer 12

• spiculated
• upper lobe
• mixed consistency
• > 6mm

Question 13

utility of PET CT for lung cancer

Answer 13

sensitive, not specific - granulomas and infections also show up.

Question 14

T/F one of the reasons lung cancer is deadly is that it metastasizes at an early stage

Answer 14

True.

Question 15

patient with cough and dyspnea over 3 to 4 months, plus absent breath sounds/fremitus. Xray shows a large pleural effusion, which then shows adenocarcinoma cells in the effusion. What is the stage?

Answer 15

stage 4 - any malignant effusion = automatic stage 4

Question 16

malignant effusion treatment

Answer 16

drainage, pleurodesis, indwelling catheter. all have risks/benefits

Question 17

treatment for stage 4 lung cancer

Answer 17

chemo- can add months to life
radiation - can relieve pain
NO ROLE for surgery
-early hospice intervention improves satifaction for patient and family, and IMPROVES SURVIVAL!

Question 18

how is small cell lung cancer staged?

Answer 18

limited vs. extensive (diff from non-small cell)

Question 19

in lung cancer, which is more important, gene expression patterns or histologic staging?

Answer 19

gene expression patterns

Question 20

what is the treatment for stage 2

Answer 20

surgery and adjuvant chemo