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ABIM > Lung-and-head-neck-cancer > Flashcards

Lung-and-head-neck-cancer Flashcards

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1
Q

Which ethnic group has the highest incidence rates for lung cancer?

A

African American males

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2
Q

Asbestos: Increases risk of ____ carcinoma and ___

A

Asbestos: Increases risk of bronchogenic carcinoma and mesothelioma

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3
Q

Exposure to which metals increases risk of lung cancer?

A

Nickel, chromium, uranium

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4
Q

Lung cancer: types

A

Non–small cell lung cancer Small cell Mesothelioma Comment: Non-small cell is the commonest principal type

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5
Q

Non–small cell lung cancer: Subtypes

A
  • Adenocarcinoma - Squamous - Large cell Comment: 60-80%
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6
Q

Adenocarcinoma of the lung is a subset of:

A

Non–small cell lung cancer

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7
Q

Most common type lung cancer in nonsmokers

A

Adenocarcinoma Comment: subset of NSCL

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8
Q

Where are adenocarcinomas of the lung usually located?

A

Peripherally Comment: with the exception of BAC which can present diffusely

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9
Q

BAC is a subtype of ___ which is a subtype of ___.

A

BAC is a subtype of adenocarcinoma which is a subytpe of NSCLL.

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10
Q

Which lung cancer can be associated with hypercalcemia, located centrally and may cavitate?

A

Squamous cell Comment: 10% undergo cavitation, hypercalcemia typically represents advanced disease.

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11
Q

Lung cancer hierarchy

A

I Non-small cell lung cancer —- 1.1 Adenocarcinoma ——–1.1.1 BAC —- 1.2 Squamous —- 1.3 Large cell 2 Small cell lung cancer 3 Mesothelioma

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12
Q

Which lung cancers tend to be centrally located?

A
  • Squamous cell - Small cell
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13
Q

Historically, adenocarcinoma was more often seen ___ located in the lungs than small cell lung cancer and squamous cell lung cancer, both of which tended to be more of ___ located.[9][10].

A

Historically, adenocarcinoma was more often seen peripherally in the lungs than small cell lung cancer and squamous cell lung cancer, both of which tended to be more often centrally located.[9][10] - recent studies suggest that the “ratio of centrally-to-peripherally occurring” lesions may be converging toward 1

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14
Q

Which lung cancer: - Small primary tumors, but adenopathy may be bulky - Associated with paraneoplastic syndromes - most common SIADH

A

Small cell lung cancer (15–20% of cases)

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15
Q

Which is the commonest lung cancer?

A

Non-small cell Explanation: Small cell lung cancer (15–20% of cases)

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16
Q

__ % to __ % of lung cancer cases result from cigarette smoking

A

80% to 90% of lung cancer cases result from cigarette smoking

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17
Q

When does mesothelioma present in relation to exposure?

A

20-30 years Exp: Disease manifests 20–30 yr after initial exposure; usually around age 60 yr

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18
Q

Which lung cancer is associated with hypercalcemia?

A

Squamous cell

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19
Q

Asbestosis Chest imaging: pleural abnormality with a large pleural effusion

A
  • pleural abnormality - large pleural effusion
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20
Q

Asbestosis: PresentingPattern

A
  • 60 male - Cough, dyspnea - asbestos exposure - pleural abnormalities - Large pleural effusion
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21
Q

Lung cancer: PresentingPatterns

A
  • Cough, dyspnea, and chest pain commonest - Hemoptysis - Recurrent or unresolving pneumonia - Hoarseness: recurrent laryngeal nerve compression - Horner syndrome: - Paraneoplastic syndromes - Shoulder pain: Pancoast tumors
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22
Q

What is the cause of hoarseness in patients with lung cancer?

A

recurrent laryngeal nerve compression

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23
Q

What is the cause of shoulder pain in lung cancer?

A

Pancoast tumors invading C8-T2 plexus

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24
Q

Pancoast tumors

A

— apical tumors — locally invading the lower brachial plexus (C8-T2) and chest wall — shoulder pain and plexopathy — may be missed on chest radiograph

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25
Shoulder pain, negative CXR: which cancer?
Pancoast
26
BPT
Bleomycin pulmonary toxicity
27
Bleomycin pulmonary toxicity
— Months to years after exposure — Interstitial pneumonitis
28
All patients with suspected lung cancer should have a history and physical examination, complete blood count, chemistry profile, liver function tests, and CT scan of
— chest — abdomen
29
Bronchoscopy: __ % to \_\_% effective in establishing a diagnosis for centrally located tumors
80% to 85% effective in establishing a diagnosis for centrally located tumors
30
Approach to establishing a diagnosis for peripherally located lung tumors
CT-guided biopsy is about 90% effective for establishing a diagnosis for peripherally located tumors
31
Role of mediastinoscopy
Mediastinoscopy: diagnosis or staging (especially for anterior mediastinal lymph nodes)
32
Currently recommended to confirm the presence of resectable non–small cell cancer
PET-CT
33
RoleOf: Bone scan and head CT in lung cancer
For non–small cell cancers: Obtain if symptoms are suggestive of bony metastasis or neurologic disease For small cell cancers: Routine
34
RoleOf: Bone scan and head CT in small cell lung cancer
Routine
35
RoleOf: Bone scan and head CT in non-small cell lung cancer
Only if there are suggestive symptoms
36
Staging for Non–Small Cell Lung Cancer
I, II, IIIa, IIIb, IV Explanation: I = local II = I + intrabronchial lymphnode IIIa = .. + (non-lung OR mediastinal node OR hilar node) IIIb = .. + (mediastinal invasion OR contralateral node OR supraclavicular node) IV = distant Stage, Definition, 5 year survival I Any size tumor with or without extension into visceral pleura, at least 2 cm from carina, no nodal involvement 60–80 II Any size, extension into intrabronchial lymph nodes 40–50 IIIa Any size, extension into parietal pleura, chest wall, or mediastinal pleura, or into hilar or ipsilateral mediastinal lymph nodes 20–30 IIIb Any size, extension into mediastinal structures, contralateral hilar, mediastinal, or supraclavicular lymph nodes 10–20 IV Evidence of distant metastasis
37
Staging: Small Cell Lung cancer
— Limited — Extensive Limited stage: Disease confined to one hemithorax and can be encompassed within a single radiation therapy port Extensive stage: Disease spread outside of the preceding area
38
Non-small cell lung cancer: Stage Any size tumor with or without extension into visceral pleura, at least 2 cm from carina, no nodal involvement
I Exp: 5-year survival 60–80% IIIa 20–30 IIIb Any size, extension into mediastinal structures, contralateral hilar, mediastinal, or supraclavicular lymph nodes 10–20 IV Evidence of distant metastasis
39
NSCL: Stage Any size, extension into intrabronchial lymph nodes 40–50
II Exp: 5-year survival 40-50%
40
NSCL: Stage Any size, extension into parietal pleura, chest wall, or mediastinal pleura, or into hilar or ipsilateral mediastinal lymph nodes
IIIa 5-year survival 20-30%
41
Non-small cell lung cancer: Stage I I = local
- Local - Any size
42
Non-small cell lung cancer: Stage II
+ intrabronchial node
43
Non-small cell lung cancer: Stage IIIa
.. + (non-lung structures OR mediastinal node OR hilar node)
44
Non-small cell lung cancer: Stage IIIb
IIIb = .. + (mediastinal structure invasion OR contralateral node OR supraclavicular)
45
Non-small cell lung cancer: Stage IV
Distant metastasis
46
What is the functional definition of the term limited in limited disease with respect to SCLC staging?
single radiation therapy port Limited stage: Disease confined to one hemithorax and can be encompassed within a single radiation therapy port
47
Rx: NSCLC Stage I
Surgery Explanation: Surgery is the treatment of choice if performance status is good and postresection pulmonary reserve adequate( [FEV1] \>0.8 L)
48
Rx: NSCLC Stage II, IIIa
Surgery +/- chemo +/- radiation Explanation: Adjuvant chemotherapy or radiation may be beneficial for stage II and IIIa disease, but not for stage I disease
49
Qualifications for surgery for NSCLC
- Good performance status - FEV1 \> 0.8L
50
Rx: NSCLC Stage IIIb
- Radiation +/- chemo
51
Rx: NSCLC Stage IV
- Erlotinib - Bevacimuzab Explanation Erlotinib, a small molecule inhibitor of EGFR; first-line for non-squamous NSCLC with activating mutations in EGFR Bevacizumab, a monoclonal targets VEGF, in conjunction with chemotherapy nonsquamous NSCLC
52
Erlotinib: Indications
first-line for non-squamous NSCLC with activating mutations in EGFR
53
Bevacizumab
conjunction with chemotherapy nonsquamous NSCLC
54
Bevacizumab target
VEGF
55
Rx: Small cell lung cancer Limited stage
Chemo+radiation Explanation: (platinum-/etoposide-based regimen) plus concurrent radiation Consider prophylactic cranial irradiation Surgical resection in a small subset of patients after chemoradiation Median survival is 18 months
56
Rx: Small cell Extensive stage
Chemotherapy Explanation: Chemotherapy with platinum/etoposide or irinotecan/etoposide Median survival is 9 months
57
Chemotherapy choices in small cell lung cancer
- platinum/etoposide - irinotecan/etoposide Explanation: Limite stage: platinum-/etoposide-based regimen Extensive stage: platinum/etoposide or irinotecan/etoposide
58
Risk factors for head and neck cancers
- Smoking - Heavy alcohol - Plummer-Vinson - EBV - HPV
59
EBV is associated with this type of head and neck cancer
nasopharyngeal Explanation: Strong association with nasopharyngeal carcinoma, which has a high incidence in southern China
60
Most head and neck cancers in the US are histopathologically:
squamous Explanation: Most cancers in the United States are squamous cell carcinomas
61
HPV Type _ most strongly associated with invasive tumors of the oral cavity and oropharynx Presence of HPV may confer a _ prognosis
HPV Type 16 most strongly associated with invasive tumors of the oral cavity and oropharynx Presence of HPV may confer a better prognosis
62
Leukoplakia
Hyperkeratosis: low malignant potential (\<5% of cases) Explanation: Oral leukoplakia, WHO definition: a white patch or plaque that cannot be characterized clinically or pathologically as any other disease Analogous red lesions are called erythroplakia, and combined red and white lesions are known as speckled leukoplakia or erythroleukoplakia.
63
Erythroplakia
- Red, superficial patches adjacent to normal mucosa - Associated with dysplasia - Significant malignant potential (40% of cases) Explanation: Dysplasia - Presence of mitoses and prominent nucleoli - Can involve entire mucosa (carcinoma in situ) - Commonly progresses to invasive cancer
64
Dysplasia in oral mucosa: significance
- Commonly progresses to invasive cancer
65
Pre-cancerous oral lesions
- Leukoplakia - Erythroplakia - Dysplasia
66
Lung cancer commonest in smokers
Adenocarcinoma (subtype of NSCLC, peripheral lesion except brocheoalveolar which can present diffusely)
67
PTHrP induced hypercalcemia malignancy is most often due to:
squamous cell carcinoma of lung
68
Paraneoplastic syndromes associated with small cell lung cancer
1. Paraneoplastic Cushing 2. SIADH
69
Thymoma associated paraneoplastic syndrome
Myasthenia gravis
70
Myasthenia gravis: Trigger: OnDx
Look for thymoma
71
Paraneoplastic syndrome: lung adenocarcinoma
hypertrophic osteoarthropathy
72
Horner's syndrome: associated malignancy, rx
Apical bronchogenic cancer (Pancoast tumor) cisplatin+radiotherapy followed by surgery
73
unilateral miosis, ptosis and anhidrosis
Horner
74
75
Mx: T2a NSCLC with hilar and subcarinal lymph nodes that are not FDG avid
Lymph node biopsy via mediastinoscopy
76
Mx: T2aN0M0 stage 1b NSCLC
Surgical resection
77
NSCLC: 3.6 cm tumor with ipsilateral positive node Stage and rx?
T2aN2M0 == Stage IIIa Rx: (chemotherapy+/-radiation) followed by surgical resection
78
3.6 cm tumor with positive contralateral node
T2aN3M0 == Stage IIIb Mx: chemoradiation
79
Neoadjuvant therapy
Neoadjuvant therapy is the administration of therapeutic agents before a main treatment. Eg: neoadjuvant hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate. Goal: reduce the size or extent, thus making procedures easier and more likely to succeed.
80
Neoadjuvant vs adjuvant therapy
Neoadjuvant therapy, in contrast to adjuvant therapy, is given **before** the main treatment. For example, systemic therapy for breast cancer that is given before removal of a breast is considered neoadjuvant chemotherapy. Radiotherapy or systemic therapy is commonly given as adjuvant treatment after surgery for breast cancer.
81
SVC syndrome caused by NSCLC: first Rx
Radiation
82
Usual cause of SVC syndrome
Mediastinal tumors, usually broncogenic carcinoma
83
84
SVC syndrome: efficacy of XRT
Effective palliation in 70% in lung cancer, 95% in lymphoma related SVC
85
SVC syndrome: is emergency intervention needed?
Only rarely If life threatening: intravascular stent
86
Acanthosis nigrans: which cancer?
Gastric
87
Leser-Trelat sign
Gastric cancer + diffuse seborrheic keratoses
88
Oral EGFR inhibitors: efficacy
1. EGFR mutations identify cancers that are ultrasensitive to EGFR-specific oral TKIs. 2. EGFR mutations cause the tumor to become dependent on signals from EGFR. 3. The response rate is ~ 75%, 4. Duration of the response is about 10 to 12 months. 5. Standard Chemo: 30% responders, mean response time: 4 months.
89
90
Erlotinib: life threatening SideFx
ILD

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