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CPR Exam 2 > Cancer of the Respiratory System > Flashcards

Cancer of the Respiratory System Flashcards

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1
Q

Where do epithelial carcinomas of the head and neck arise from and what is their origin?

A

Mucosal surfaces

Squamous cell

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2
Q

What are the most significant risk factors for head and neck cancer?

When both are abused, what affect do they have?

A
  • Alcohol and tobacco
  • Synergistic
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3
Q

_______ is an etiologic agent for oral cancer.

A

Smokeless tobacco

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4
Q

Some head and neck cancers can be caused by viruses.

Nasopharyngeal cancer can be caused by _______

Oropharyngeal tumors can be caused by _______.

A
  • EBV, esp in Meditarrenan and Far East
    • Smoked fish
    • Indoor pollutants
  • _HPV (16** and 18),_ in younger patients.
    • more often in Men
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5
Q

What are other causes of head and neck cancers?

Salivary gland tumors?

A
  • Dietary factors
  • No specific risk factors or environmental carcinogens are assx with salivary gland tumors
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6
Q

Squamous cell head and neck cancers can be divided into ___________.

Which has the worst prognosis?

A
  1. Well differentiated
  2. Moderately well-differentiated
  3. Poorly differentiated ***
    • ​WORSE PROGNOSIS
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7
Q

What part of the pharynx is at risk for the development of premalignant or malignant lesions?

why.

A
  • Entire mucosal surface, because they are exposed to alcohol and tobacco.
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8
Q

How common are premalignant lesions in head and neck cancer?

A

MOST do not have premalignant lesions

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9
Q

Typically, what age to the following cancers present at

  • Tobacco-related head and neck cancers
  • EBV-related nasopharyngeal cancer
  • HPV-related cancers
A
  • Older than 60YO
  • All ages, even teens
  • 40-50s
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10
Q

What procedure should be performed in patients with nonspecific signs and symptoms of the head & neck?

A
  • Otolarygolic exam, if sx last longer than 2-4 weeks.
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11
Q

How do nasopharyngeal cancers present?

A
    • No early symptoms
    • Unilatereral serous otitis media d/t obstruction of eustachian tube.
    • Unilateral/bilateral nasal obstruction
    • Epistaxis
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12
Q

How do oral cavity carcinomas present?

A
  • Nonhealing ulcers,
  • changes in how dentures fit,
  • painful lesions.
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13
Q

What is the first sign of HPV-related tumors?

A

Neck lymphadenopathy

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14
Q

What is the earliest symptom if laryngeal cancer and how should we treat first?

A
  • Hoarsness
  • ABX
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15
Q

If a patient has enlarged LN in the upper neck and the tumor cells are squamous cells, where did the malignancy probably arise from?

A

Mucosal surface of head and neck

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16
Q

If a patient has enlarged supraclavicular LN, where did the malignancy probably arise from?

A

Chest or abdomen

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17
Q

PE of head and neck should include what?

A
  1. Inspect ALL visible mucosal surfaces
  2. Palpate floor of mouth, tongue and neck.
  3. Check for pre-malignant lesions: leukoplakia (white mucosal patch) and erythroplakia (red mucosal patch), which can represent hyperplasia, dysplasia, CIS and need biopsy.
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18
Q

Which imaging modalities are utilized to identify the extent of head/neck cancers; which modality is used to identify or exclude distant metastases?

A
  • CT of the head and neck to identify extent of the disease
  • PET scan can help identify or exlude distant metastases
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19
Q

What imaging modalities should patients with LN involment have to screen for distant metases?

Heavy smokers, to rule out a second lung primary tumor?

A
  • CT of chest and upper abdomen
  • CT of chest
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20
Q

What is the definitive staging procedure for head/neck malignancies?

A

Endoscopic examination under anesthesia (i.e., laryngoscopy, esophagoscopy, and bronchoscopy); obtaining multiple biopsy samples to establish primary diagnosis, extent and ID premalignant lesions

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21
Q

Head and neck cancers are classified with what system?

A

TNM system

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22
Q

Primary head and neck cancers are classified as ________ as size increases.

If another structure is invaded, it is classified as ____.

A
  • T1-3
  • T4
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23
Q

In patients with lymph node involvement and no visible primary tumor of the head and neck, how should diagnosis be made?

A

Lymph node excision

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24
Q

If results of a LN biopsy indicate squamous cell carcinoma, what should be performed?

A

Panendoscopy, with biopsy of all suspicious-appearing areas and biopsies of common primary sites, such as nasopharynx, tonsil, tongue base, and pyriform sinus

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25
How are patients with head and neck categorized into treatment groups?
* 1. Localized disease * 2. Locally or regionally advanced disease (LN +) * 3. Recurrent and/or metastic disease
26
How are patients with **localized disease and no LN involvement** (\_\_\_\_) treated?
* T1 and T2 * Curative intent by **surgery** or **radiation**, depending on location and insitution education.
27
What is the preferred tx for **laryngeal cancer** as to preserve voice function?
Radiation therapy
28
What is the preferred tx for **small lesions/malignancies** in the **oral cavity**?
**Surgery**, to avoid long-term complications of radiation, such as xerostomia and dental-decay
29
Most **recurrences** of **T1** and **T2** head and neck cancer happen in what time frame and are often what?
**First 2 years** after diagnosis and are usually **local**
30
How are patients with **locally** or **regionally advanced disease** (primary tumor + LN involvement) treated?
Curative intent: **combined modality therapy** (surgery, radiation, chemo). Chemo can be given as * 1. Inductive chemo (before surgery or radiation) * 2. **Concomitant** (same time as radiation), which is **most commonly used!**
31
Pts with **recurrent** or **metastatic head** and **neck tumors** are typically treated how?
With **palliative intent;** typically with **chemotherapy** for transient symptomatic benefit because they will die in 8-10 onths.
32
The addition of which drug to standard combination chemotherapy with [**cisplatin or carboplatin** and **5-FU**] has shown to result in significant increase in median survival in patients with **recurrent/metastic head** and **neck cancer**?
**Cetuximab (EGFR-directed therapy)**
33
About **50%** of patients who undergo tx for **head/neck cancer** develop decreased function of what organ?
**HYPOthyroidism**; thus, thyroid function should be monitored
34
What is the leading cause of **cancer-related deaths** in both M and W, but is less common than **breast**, **prostate** and **colon** combined?
**Lung cancer**
35
85% of lung cancers are due to \_\_\_\_\_\_.
**Smoking**
36
Majority of lung cancer is __________ (85%). The other 15% is \_\_\_\_\_\_\_\_\_\_\_\_.
* **Non-small cell lung cancer (85%)** * **Small cell lung cancer (15%)**
37
How does **small cell lung cancer** differ from non-small cell lung cancer?
* **Almost exclusively in smokers** * **More aggressive** and during intial presentation, **already metasized.**
38
best way to prevent lung cancer
**stop smoking**
39
Which patients should be considered for l**ow-dose CT screening** (LDCT) for lung cancer?
* - **Current** and **former** smokers (if quit within past 15 years) **55-80 y/o** who have a ≥30-pack-year smoking hx
40
What is a good starting point for imaging of lung cancer?
**CXR;** easy and cheap
41
How do we diagnose **lung cancer** in **smokers** and **former smokers**?
* **Evaluate** for **new pulmonary** or **chest complaints** * hemoptysis, pulmonary infections, dyspnea, cough, chest pain
42
Patients with **small cell lung cancer** often present with what?
* **Metastasis** * **Paraneoplastic syndrome**
43
**Hypercalcemia** as a paraneoplastic process is most common with which lung cancers?
**Adenocarcinoma** or **Squamous cell carcinoma**
44
**Hypertrophic pulmonary osteoarthropathy** is most common with what lung cancer?
**Adenocarcinoma**
45
**Distention of superficial veins** and **edema** in the **head** and **neck** is characteristic of what paraneoplastic process of lung cancer?
**SVC syndrome**
46
What are 3 **paraneoplastic syndromes** commonly assx with **small cell lung cancer?**
**1. Acromegaly** **2. Cushings** **3. Lambert-Eaton myasthenic syndrome**
47
If a patient comes in with **new** or **persistant lung symtpoms** come in, what is examined?
* 1. **Primary tumor** * 2. **Intrathoracic thread** (hoarse voice, Horner, chest wall tenderness) * 3. **Extrathoracic spread** (wasting, lymphenopathy, neuro findings, bone tenderness) * 4. **Paraneoplastic syndrome** * 5. CXR * 6. If small cell lung cancer, CT.
48
What is NECESSARY for diagnosis of cancer?
**Histology** by a way that furthers staging.
49
What is the best approach for histological confirmation in a pt with a lung mass that is **losing weight** and **unilateral supraclavicular LN enlargement**?
**Peripheral node biopsy;** allows for diagnosis and staging
50
Which diagnostic method for lung cancer is reserved for pt's with poor pulmonary function who cannot tolerate invasive procedures?
**Sputum cytology**
51
When staging **non-small cell lung cancer,** what is the task?
* Find out if it metasized. If so, surgery is NOT an option. * Do so by conducing: **CT of chest and abdomen**, a **combined PET-CT**, which assess for malignant mediastinal lemphadenoopathy.
52
What diagnosing method is performed to ID **advanced disease** and can prevent unneccesary **thoracotomy**?
* **PET CT**
53
Which imaging modality may be indicated if pt has **bone pain** or an **elevated serum Ca2+ or AlkPhos?**
**Bone scan**
54
When diagnosed, **small cell lung cancer** is viewed how? How does it respond to radiation and chemo?
**- Systemic disease**, because most patients have WIDESPREAD organ involvement. ## Footnote **- SENSITIVE**
55
How is **small-cell carcinoma** staged?
**By whether or not the tumor is in a field where radiation can be performed.** * - Limited stage stage: tumor is in one port site * - Extensive-stage disease: tumor has metasized to liver, bone, bone marrow,
56
What tests are performed to evaluate a m**etastatic disease?**
1. CT of chest and abdomen 2. PET-CT 3. MRI of bone 4. Bone scan 5. Serum electrolytes, aminotranferase, lactate DH.
57
What are 2 features which define **benign pulmonary nodules**?
1) **No growth** in 2 years AND 2) **Calcification** in a diffuse, central, or laminar pattern
58
What is the _size_, _morphology_, and _location_ characteristic of **malignant pulmonary nodules**?
**\>2 cm** w/ **spiculated edges** and located in the **upper lobes**
59
What is the best strategy in patients with **incidentally discovered pulmonary nodules**?
Obtain **prior CXR's** or **imaging scans** to determine stability over time
60
What is the recommendation for incidentally discovered **pulmonary nodules \< 4cm** in pt who have _never smoked_ and who have _no other known risk factors for malignancy_?
**No follow-up recommended**
61
Which size pulmonary nodule **requires follow-up** at an interval determined by whether the patient is considered to be at high or low risk for malignany?
**Nodules \>4cm**
62
What is the recommendation for pt's with solid pulmonary nodules **≥1.5 - 2 cm** who are considered high-risk or low-risk?
**Immediate biopsy**; _close interval CT scanning_ is option in low-risk pt's
63
In **non-small cell lung cancer,** what determines the best options for treatment?
* **Staging from I-IV**; examine **size of tumor (T)**, **regional node status (N)** and prescence or absence of **metastatic disease (M)**
64
**Stage 1** _non-small cell_ lung cancer: **Description** and **treatment**
* **Cancer is small** (1A is less than 3cm; 1B is less than 5cm) and has **not spread to LN.** * **Tx**: Surgery; if 1B, adjuvant chemo can help
65
**Stage 2 Non-small cell lung cancer:** **Description** and **treatment**
* **Tumor** is in between **5- 7cm** and may have spread to LN. * **Tx**: Surgery and adjuvent chemo
66
**Stage 3** Non-small cell lung cancer: **Description** and **treatment**
* Cancer has grown, spread into surrounding tissue and most have same-side mediatinal lymphanopathy, which dictate survival rate. * Tx: * Potentially resectable cancer with minimal mediatinal lymphenopathy: * Neoadjuvent chemotherapy is done to shrink tumor B4 surgery * Unresectable cancer: * Chemoradiation + surgery
67
**Stage 4** Non-small cell lung cancer: **Description** and **treatment**
Cancer has spread and formed new tumors in **bone**, **brain**, **liver** and **adrenal glands.** **Tx:** Inoperable; Combination therapy (radiation of symptomatic mass and palliative chemotherapy)
68
What is the superior tx for pt's with **unresectable** **non-small** cell lung cancer?
**Chemo-radiation**
69
What is the **tx** of choice for **small-cell lung cancer**? Does this work well?
- **Combination chemotherapy** w/ platinum based agent (i.e., cisplatin) + etoposide - **Radiation** is given concurrently or sequentially - Most patients relapse and die of disease, even though responding well at first.
70
A patient **being treated** for head and neck cancer presents with substantial weight loss (\>10% of body weight), would benefit from what?
**Placement of a feeding tube.**

CPR Exam 2 (29 decks)

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