Lung Cancer

Question 1

What cancer is the leading cause of cancer death in the US?

Answer 1

lung

Question 2

lung cancer is more common than what three types of cancers combined?

Answer 2

colorectal, breast, and prostate

Question 3

what is the 5 yr survival rate for lung cancer?

Answer 3

15%

Question 4

what is the 5 yr survival rate range for lung cancer if detected at an early stage and tx surgically?

Answer 4

20-80%

Question 5

why is the 5 yr survival rate for lung cancer so low?

Answer 5

Because the disease is usually advanced at presentation

Question 6

What percent of lung cancer cases are attributed to primary smoking?

Answer 6

80-90%

Question 7

what percent of lung cancer cases are attributed to second hand smoke?

Answer 7

30%

Question 8

what screening test has evidence that it doesn’t improve outcome in patient survival?

Answer 8

CXR

Question 9

What screening test is shown to improve survival outcomes in selected pt populations?

Answer 9

low dose helical CT

Question 10

According to the NLST, what was the result of death reduction between CXR and CT screening?

Answer 10

20% death reduction in pts with low dose CT screening compared to CXR

Question 11

what does the USPST recommend for annual screening of lung cancer?

Answer 11

low dose CT in adults 55-80 who have 30 pack/yr smoking hx and currently smoke or have quit within the past 15 years

Question 12

What type of infection can affect your lung cancer screening CT and therefore is a exclusion criteria for screening?

Answer 12

pneumonia or acute resp tract infection treated with ABX in the past 12 weeks

Question 13

what is a frequent symptom of lung cancer with sudden onset?

Answer 13

hemoptysis

Question 14

What are some early presentation symptoms/signs for lung cancer?

Answer 14

cough, hemoptysis, dyspnea, wheezing, stridor, fever

Question 15

what are some later presentation signs/symptoms for lung cancer?

Answer 15

weight loss, pleural effusion, chest wall pain, hoarseness, dysphagia, horner’s syndrome (impingement of sympathetic nerves)

Question 16

what percent of lung cancer pts have symptoms at time of diagnosis? what type of scan does a symptomatic pt get first and then second?

Answer 16

90-95%

CXR and then CT with IV contrast

Question 17

what percent of lung cancer pts are asymptomatic at presentation? what scan would this patient get?

Answer 17

up to 10%

would skip the CXR and get a low dose CT scan

Question 18

Besides a CT with IV contrast for a symptomatic patient what other type of CT might you order? what two body parts would this evaluate?

Answer 18

abdominal CT to evaluate the liver and adrenal glands (2 of the most common sites of intra-abdominal metastasis)

Question 19

what test should be done on a lung cancer patient who might be a surgical candidate?

Answer 19

PFTs- important for anesthesia

Question 20

when are quantitative V/Q scans performed?

Answer 20

when PFTs don’t give a clear picture of how surgical excision will impact the patient’s pulm function

Question 21

what scan for lung cancer helps detect actively growing tissues and therefore staging of cancer?

Answer 21

PET (positron emission tomography)

Question 22

what are the two main types of lung cancer? what is each’s percent prevalence? discuss surgery and chemo for both. which one is “better” to have?

Answer 22

small cell- 15%, surgery only beneficial for stage 1, chemo and radiation therefore main treatment, disease is quickly fatal (usually within 6 months without tx)
non small cell- 85%, stages I-IIIA are operable, IIIb and IV are given chemo/radiation but not as effective (better cancer to have)

Question 23

What are the three subtypes of Non small cell lung cancer? which is the worst one to have?

Answer 23

1) . adenocarcinoma- most common (women and non smokers)
2) . squamous cell
3) . large cell- poorly differentiated, behave aggressively, poorer prognosis

Question 24

what is a carcinoid tumor? describe its metastatic nature

Answer 24

less aggressive and well differentiated, tends to arise from major bronchi, metastasis is rare and easily resected

Question 25

what size does a solitary lung nodule become very suspicious?

Answer 25

greater than 3 cm

Question 26

what is the maintenance after detecting a solitary lung nodule?

Answer 26

depends on size for specific interval CXR or CT time frame (4-6 mm then 12 month CT, > 6 mm then 6 month CT) BUT followed up to 2 years

Question 27

describe characteristics of benign lung nodules versus malignant ones

Answer 27

benign: rounded, calcified (degenerated- been there awhile), little growth over time
malignant- stellate (irregular in shape), no calcium, central necrosis, increasing in size

Question 28

what are three main things PAs can do to help aid suspected or confirmed lung cancer patents?

Answer 28

1) . get CXR/CT as early as possible
2) . advise pt to quit smoking
3) . maximize pulm function by inhaler, nebulizer, or ABX when appropriate

Question 29

What is the worst adult onset abnormality for a patient to present with?

Answer 29

wheezing (plus hemoptysis in an elderly person)