74 - Neoplasms of the Lung Flashcards by Guy Schachter

A smoker is ___ more likely to suffer from lung cancer compared to a non smoker

X10

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A former smoker is ___ more likely to suffer from lung cancer compared to a non smoker

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If you quit smoking, and you are not yet in ___ there’s a ___ less chance to suffer from lung cancer

Middle age

90%

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There’s not a lot of risk reduction in _____ the amount of cigarettes you smoke

reducing

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First degree family genetic polymorphism of ____ have ___ more chance to suffer from lung cancer and other malignancies

P450 - CYP1A1

X2-3

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What are the two main groups of lung cancer?

What does the latter include? (3)

Small Cell Lung Cancer (SCLC)
Non Small Cell Lung Cancer (NSCLC)
Adenocarcinoma
Large Cell Carcinoma 
Squamous Cell Carcinoma

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What is the histological origin of lung cancer? ___ (__, __, __)

Respiratory epithelium (Bronchi, Bronchiole, Alveoli)

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Which type of lung cancer is most linked to smoking?

SCLC

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What are the markers of SCLC? (4)

CD56
Neural Cell Adhesion Molecule (NCAM)
Synaptophysin
Chromogranin

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What is the most common type of lung cancer in the US?

Adenocarcinoma

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Adenocarcinoma is most common in ___ under the age of __ which are ___ ___

Women
60
Non-Smokers

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What is the histological origin of adenocarcinoma?

Epithelia type II- Alveolar epithelium

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In adenocarcinoma, lipid type has ____ prognosis, while ____, ____, and ____ have worse prognosis

Good
Acinar
Papillary
Solid

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Most lung cancer patients are diagnosed in ___ stage of the disease

late

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CXR is __ __ as a ___ test

Not recommended

Screening

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Low Dose Spiral Chest CT (LDCT) has shown some efficiency for discovering ___ stage tumors in ___ and ____

Early
Smokers
>60

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In LDCT there’s a high ____ rate leading to more invasive procedures and ___. Nevertheless, this examination leads to an ___ in survival and complication of lung cancer

False Positive
Complications
improvement

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More than ___ of patients with lung cancer present with an advance stage or even ____ disease

50%

Metastatic

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Patients with lung cancer are usually with the following characteristics: (4)

> 60
Former smoker
Coughing (+/- hemoptysis)
COPD

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Central/endobronchial tumors will present with: (4)

Coughing (+/- hemoptysis)
Stridor/ Wheezing
Dyspnea
Post obstructive pneumonia

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Peripheral tumors will present with: (3)

Localized pain (pleural involvement)
Restrictive dyspnea
Lung abscess

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Regional spread of tumor in the thorax (by contiguous growth or by metastasis to regional lymph nodes) may cause: __ obstruction, esophageal __+__, recurrent __ paralysis with hoarseness, __ nerve palsy with dyspnea, sympathetic nerve paralysis with __ syndrome. Malignant pleural effusions can cause pain, dyspnea, cough.

1) Tracheal
2) compression + dysphagia
3) laryngeal
4) Phrenic
5) Horner’s syndrome (enophthalmos, ptosis, miosis, anhydrosis).

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Pancoast syndrome (superior sulcus tumor) results from:___ extension of a tumor growing in the ___ of the lung, involving the __ cervical and __+__ thoracic nerves. It presents with ___ pain that radiates in the ___ distribution of the arm, often with the destruction of the first and second __

Local
apex
eighth
first+ second
Shoulder
Ulnar
ribs

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Pancoast syndrome often coexist with ___ syndrome

Horner’s

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SVC syndrome in lung cancer is caused by ___ obstruction and may lead to: __ and __ extension resulting in tamponade, arrhythmia, or cardiac failure

Vascular Pericardial cardiac

Metastasis are found in ____ of patients with SCC, ___ of patients with adenocarcinoma, and ____ of patients with SCLC

50% 80% 95%

The most common sites for metastatic spread of lung cancer tumors are: (5)

``` Brain Bones BM Liver Adrenal ```

Paraneoplastic syndrome is especially common in patients with ____

SCLC

Paraneoplastic endocrine symptoms include: (3)

Hypercalcemia (PTHrP related) Hyponatremia (SIADH related) Ectopic secretion of ACTH

What is the best type of biopsy for diagnosing LC

Core biopsy

What are the two component of LC staging?

Anatomical | Physiological

Anatomical staging of NSCLC is based on __ . We will look for nodules >__ mm

PET CT | 15

FN in PET CT can be caused by: (3)

Diabetes <8 mm nodules Slow growing tumors

Brain metastasis will require ____ imaging

MRI

The main C/I for curative surgery are: ___ metastases, __ syndrome, __ and or __ paralysis, malignant pleural __, cardiac __, tumor within __ cm of the __, metastasis to the __ lung.

1. Extrathoracic 2. SVC syndrome 3. Vocal cord and or phrenic nerve 4. effusion 5. tamponade 6. 2 cm of the carina 7. contralateral

What is the best predictor in the evaluation of metastasis of NSCLC?

History and physical examination

מבוטל

How will you treat NSCLC in the occult/stage 0 phase? locate the ___ with ___ examination of the __ __ -> __ surgery ->___.

``` tumor fiberoptic bronchiole tree curative follow up ```

Solitary pulmonary nodule is an __ density completely surrounded by normal __ lung with margins, of any shape, usually _-_ cm in greatest diameter.

XR aerated circumscribed 1–6 cm

What are the radiological predictors for a benign solitary pulmonary nodule? ___________, _______ (4)

Lack of growth over a period >2 years patterns of calcification (dense central nidus, popcorn ball, bulls eye, multiple punctate foci)

Which risk factors will suggest an additional histological examination of a nodule? (4): __ mass, lack of ___, __ symptoms, positive ___

Big calcifications Chest PET CT

What is the best treatment for patients with NSCLC stage 1/2?

Pulmonary resection

For patients with NSCLC stage 1A the best curative surgery is:

Lobectomy. Better than wedge resection

Patients with NSCLC stage 1/2 and a central tumor are best treated with:

Pneumonectomy. Make sure they have sufficient lung reserve

Patients with NSCLC stage 1/2 who do not have sufficient lung reserve will be treated with

Wedge resection or segmentectomy

Patients with NSCLC stage 1/2 who refuse/cannot go through surgery will be treated with:

Radiation but not chemotherapy

What is the only case where chemotherapy is recommended for NSCLC patients in stage <3?

Stage 1B after removing a tissue > 4 cm. | Adjuvant therapy in 4 cycles with Cisplatin + Vinorelbine

Pancoast tumors are a subtype of stage 3 NSCLC. Treatment without N2 will include ____. Patients with N2 involvement will include

Neoadjuvant chemotherapy or post surgery radiation | Radiation, chemotherapy, no surgery

____ of NSCLC patients are presented with metastatic (stage 4) disease. They will have a life expectancy of ___ months in average

40% | 4-6

SCLC is a more ____ disease with a dramatic response for ____

Aggressive | 1st line of chemotherapy and radiation

Generally speaking, SCLC patients will not benefit from ____, due to _____

Surgery | Occult micrometastases

The main combination of chemotherapy in NCLC patients contains:

Irinotecan/Etoposide + Cisplatin/Carboplatin

Paraneoplastic syndrome is very common in __ and can be the first sign of the disease/relapse

SCLC

Systemic signs for neoplastic syndrome include: (4)

anorexia weight loss -> cachexia fever immune depression

The common endocrine symptoms caused by neoplastic syndrome include: hyper___ due to __, hypo__ due to __, and ectopic secretion of __

``` calcemia PTHrP natremia SIADH ACTH ```

Hypercalcemia due to paraneoplastic syndrome may present itself with: 5

``` nausea + vomiting abdominal pain constipation polyuria + polydipsia mental status changes ```

How will you treat hyponatremia due to SIADH when restricting drinking is not sufficient?

demeclocycline

What will be the common sign for ectopic secretion of ACTH?

hypokalemia

What are the 3 skeletal signs in lung cancer?

clubbing periostitis hypertrophic primary osteoarthropathy

Neurological symptoms are found in __% of patients with lung cancer. What are the common clinical signs? 3

1 Eaton Lambert encephalomyelitis peripheral neuropathy

Eaton Lambert is a type of ___. It is an __ disease leading to ___ muscles weakness in the __ limbs, __ dysfunction, and decreased reflexes. Unlike MG strength returns when exercising. Treatment- ___

``` MG AI proximal lower automimic chemotherapy ```

Coagulation/thrombosis disorders appear in _-_% of patients with lung cancer. Common problems include: 5

``` 1-8 Trousseau's syndrome (migratory thrombophlebitis) DIC anemia bleeding granulocytosis ```

74 - Neoplasms of the Lung Flashcards

(62 cards)