Lec 23 Lung Cancer Flashcards Preview

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Flashcards in Lec 23 Lung Cancer Deck (71):
1

What is epidemiology of lung cancer?

leading cause of cancer death in US and the world

2

What is risk of cancer smokers vs non-smokers?

smokers 20x increase risk

3

What are some smoking related carcinogens?

- polycyclic aromatic hydrocarbons
- tobacco specific nitrosamines

4

What percent of lung cancers occur in non-smoking females vs males?

9-13% of lung cancer in females is non-smokers

2-6% of lung cancer in males is non-smokers

5

What are some other risk factors for cancer besides active cigarette smoking?

- environmental/passive tobacco smoke
- radiation/radon gas exposure
- air pollution
- cooking oil fumes and indoor coal/biomass burning
- prior lung disease [COPD]
- family history

6

What are some occupational exposures associated with lung cancer?

- asbestos
- silica
- arsenic

7

What are genetic determinants of lung cancer susceptibility?

- locus at 15q24-25
- gene codes for nicotinic ACh receptor subunits
- confers 30% increased risk of lung cancer

8

What is most common presentation of lung cancer?

pulmonary nodules

9

What should you think if pulm nodule in smoker?

cancer until proven otherwise

10

Are majority of pulm nodules cancer or benign?

mostly benign

11

What are some possible causes of small pulm nodules?

- lung cancer
- bronchial carcinoid tumor
- hamartoma
- metastasis
- granuloma
- abscess
- inflammatory nodule

12

How can you tell benign from cancerous nodule?

- stability vs growth over time
- calcification pattern if present
- appearance of lesion
- metabolic characteristics

13

What does calcification of a nodule tell you?

tells you the nodule is old/has been around for a while

14

What does a perfectly round nodule suggest?

suggests benign

15

What does a popcorn calcification pattern suggest?

hamartoma

16

What does dense central calcification suggest?

granuloma

17

What does a spiculated border of small pulm nodule suggest?

suggets lung cancer

18

What does a cavitated pulm nodule tell you?

can be benign or malignant

19

How do you diagnose primary lung cancer?

-cytology on sputum, bronchoscopy, transthoracic needle aspiration

biopsy

20

What are two main histologic types of cancer?

small cell = 15%
non-small cell = 85%

21

What are 3 types of non small cell lung cancer?

- squamous cell carcinoma
- adenocarcinoma
- large cell carcinoma

22

What type of non small cell lung cancer is most common?

adenocarcinoma

23

What are features of squamous cell carcinoma?

- central location -- mainstem or lobar bronchi
- may be cavitary
- strong association with smoking
- often bulky; fast doubling time

24

What are features of adenocarcinoma?

- peripheral location

25

What is most common type of lung cancer in non-smokers?

adenocarcinoma

26

What is new name for bronchioalveolar carcinoma?

lepidic adenocarcinoma

27

What are features of lepidic adenocarcinoma?

- non-mucinous adenocarcinoma
- lines alveolar spaces
- slow progression
- looks like pneumonia

28

What should you think if non-resolving pneumonia?

might be lepidic adenocarcinoma

29

What are features of large cell lung cancer?

- may present as bulky tumors
- aggressive w/ poor prognosis

30

What are features of carcinoid tumors?

- well differentiated
- neuroendocrine tumor
- arise in central airways

31

What are features of small cell carcinoma?

- poorly differentiated
- neuroendocrine tumor
- central
- perihilar masses; mediastinal lymphadenopathy
- paraneoplastic syndromes

32

How do carcinoid tumors present?

wheezing, cough, obstructive pneumonia

33

What is prognosis carcinoid vs other tumors?

carcinoid = better survival than small cell or non small cell

34

Which lung cancer has the highest association with smoking?

small cell carcinoma

35

What type of cells does small cell carcinoma arise from?

pulmonary neuroendocrine cells

36

What is survival for small cell carcinoma?

poor --> 5 year survival rate 6.2%

37

How do lung cancers usually present?

- often present at advanced stage
- early lung cancers often asymptomatic

38

What are airway symptoms of lung cancer? Most common w/ what type?

most common with squamous cell

- cough
- hemoptysis
- dyspnea

39

What are symptoms of mediastinal spread of cancer?

- hoarseness [recurrent laryngeal nerve involvement]
- diaphragm paralysis [phrenic nerve]
- SVC syndrome

40

What are symptoms of distant spread of lung cancer?

- headache
- localized weakness
- seizure
- bone pain
- abdominal pain

41

What is a pancoast tumor? signs?

lung cancer originating in apex of lung

signs = arm pain/weakness due to brachial involvement; horner's

42

What cancer should you think if have hypercalcemia?

squamous cell carcinoma

hyper-Ca from ectopic PTH

43

What cancer should you think if have clubbing?

non small cell lung cancer

44

What cancer should you think if have cushing's syndrome?

due to cortisol production by small cell carcinoma

45

What cancer should you think if have SIADH?

due to ADH production by small cell carcinoma

46

What cancer should you think if have Eaton-lambert syndrome?

SCC due to autoantibodies to voltage sensitive Ca channels

47

What does sputum cytology tell you about lung cancer?

tells you cellular diagnosis

48

What does bronchoscopy tell you about lung cancer? best for what kind of tumor?

tells you tissue diagnosis and extent/location of tumor

best for central tumors

49

CT guided biopsy is best for what type of lung tumors?

peripheral lesions

50

What are the 3 TNM stages of non small cell lung cancer?

T = site, size, local invasion of primary tumor

N = whether spread to local or regional lymph nodes

M = whether or not spread of lung cancer to distant metastatic sites

51

How do you stage small cell lung cancer?

limited stage = confined to single hemothorax

extensive stage = spread beyond hemithorax

52

How do you stage cancer non-invasively?

CT = assess size, location of tumor and sites of metastasis

PET = metabolic activity that could represent sites of metastatic disease

53

Is positive or negative PET most helpful?

negative most helpful = tells you probably not cancer;

positive is less specific

54

What is stage 1 NSCLC?

- no nodes
- no metastases
- no local invasion

55

What is prognosis of stage 1 NSCLC post resection?

60-70% 5 year survival post resection

56

What is stage 2 NSCLC cancer?

ipsilateral peribronchial or hilar nodes
or limited local invasion w/ no nodal involvement

57

What is 5 year survival stage 2 NSCLC?

30-50%

58

What is stage 3 NSCLC?

positive ipsilateral mediastinal nodes; greater local invasion

59

What is 5 year survival stage 3 NSCLC?

10-20%

60

What is stage 4 NSCLC?

distant metastases or metastasis to any lung lobe other than lobe w/ primary tumor

61

What is 5 year survival stage 4 NSCLC?

< 10%

62

What is treatment of NSCLC?

surgery is only cure
chemo is life extending by months

63

What is treatment of small cell lung cancer?

chemo +/- radiation

dramatic initial response then often recurs

64

What is treatment stage 1/2 NSCLC?

resection of area or entire lobe

65

What is treatment stage 3a NSCLC?

surgery and adjuvant chemo + radiation

66

What is treatment stage 3b NSCLC?

chemo +/- radiation

67

What is treatment stage 4 NSCLC?

chemo or palliative care

68

What is treatment limited vs extensive small cell lung cancer?

limited = chemo + radiation
extensive = chemo

69

Who gets EGFR mutation? What does it predict?

more common in non smokers
predicts response to EGFR tyroskine kinase inhibitor [gefitinib, erlotinib]

70

Who gets KRas mutation? What does it predict?

more common in smokers

predicts poor response to TKI/chemo and poor prognosis

71

EML4-ALK mutation predicts what?

predicts response to ALK inhibitors