LUNG CANCER Flashcards
(30 cards)
Which enzyme system is associated with genetic polymorphisms linked to lung cancer development?
A) P450 enzyme system
B) Telomerase enzyme system
C) Acetylcholine nicotinic receptors
D) Epidermal growth factor receptor (EGFR)
Answer: A) P450 enzyme system
Rationale: Polymorphisms in the P450 enzyme system, particularly CYP1A1, are associated with an increased risk of lung cancer.
Which of the following genetic mutations is associated with lung cancer susceptibility in never smokers?
A) CYP1A1 polymorphism
B) T790M mutation in EGFR
C) Mutations on chromosome 15q25
D) Li-Fraumeni syndrome
Answer: B) T790M mutation in EGFR
Rationale: The rare germline mutation T790M in EGFR is linked to lung cancer susceptibility in never smokers.
Which genetic syndrome is associated with a predisposition to lung cancer?
A) Turner syndrome
B) Li-Fraumeni syndrome
C) Down syndrome
D) Marfan syndrome
Answer: B) Li-Fraumeni syndrome
Rationale: Li-Fraumeni syndrome, involving mutations in the p53 gene, increases susceptibility to lung cancer.
Which of the following markers is a reliable indicator of primary lung cancer, provided a thyroid primary has been excluded?
A) Synaptophysin
B) Napsin-A (Nap-A)
C) Thyroid transcription factor-1 (TTF-1)
D) Wilms tumor gene-1 (WT-1)
Correct Answer: C) Thyroid transcription factor-1 (TTF-1)
Rationale: TTF-1 is expressed in tumors of pulmonary and thyroid origin and is a reliable indicator of primary lung cancer when a thyroid origin has been excluded. TTF-1 positivity is found in more than 70% of pulmonary adenocarcinomas.
What is the role of Napsin-A (Nap-A) in diagnosing lung adenocarcinoma?
A) It is used to verify neuroendocrine differentiation.
B) It is expressed in type II pneumocytes and is useful in identifying primary lung adenocarcinoma.
C) It differentiates squamous cell carcinoma from adenocarcinoma.
D) It helps identify mesothelioma.
Correct Answer: B) It is expressed in type II pneumocytes and is useful in identifying primary lung adenocarcinoma.
Rationale: Napsin-A (Nap-A) is an aspartic protease expressed in the cytoplasm of type II pneumocytes and plays an important role in surfactant maturation. It is reported to be positive in more than 90% of primary lung adenocarcinomas.
Which combination of immunohistochemical markers is helpful in distinguishing primary lung adenocarcinoma from squamous cell carcinoma and small cell lung carcinoma (SCLC)?
A) CK7 and CK20
B) Napsin-A (Nap-A) and TTF-1
C) p63 and TTF-1
D) CK5/6 and Wilms tumor gene-1 (WT-1)
Correct Answer: B) Napsin-A (Nap-A) and TTF-1
Rationale: A combination of Nap-A and TTF-1 is useful in distinguishing primary lung adenocarcinoma (Nap-A positive, TTF-1 positive) from primary lung squamous cell carcinoma (Nap-A negative, TTF-1 negative) and small cell lung carcinoma (Nap-A negative, TTF-1 positive).
Which of the following is a helpful marker for identifying squamous differentiation in non-small cell lung cancer (NSCLC)?
A) Cytokeratin 20 (CK20)
B) p63
C) Calretinin
D) Napsin-A (Nap-A)
Correct Answer: B) p63
Rationale: p63 is a useful marker for detecting NSCLCs with squamous differentiation, particularly in cytologic pulmonary samples.
Which of the following markers is helpful in identifying mesothelioma?
A) Napsin-A (Nap-A)
B) TTF-1
C) CK5/6, calretinin, and Wilms tumor gene-1 (WT-1)
D) p63
Correct Answer: C) CK5/6, calretinin, and Wilms tumor gene-1 (WT-1)
Rationale: CK5/6, calretinin, and Wilms tumor gene-1 (WT-1) are markers that show positivity in mesothelioma and can be helpful in distinguishing it from other tumors, such as adenocarcinoma.
What is lead-time bias in the context of cancer screening?
A) Detecting cancer earlier without actually improving survival
B) Diagnosing cancers that would never affect a patient’s life
C) Detecting only aggressive cancers that cause symptoms earlier
D) Failing to detect cancers that do not cause symptoms
Correct Answer: A) Detecting cancer earlier without actually improving survival
Rationale: Lead-time bias refers to the phenomenon where detecting cancer earlier does not necessarily lead to improved survival, as the patient may still die from the disease at the same time, but the survival time appears longer due to earlier detection.
What is length-time bias in cancer screening?
A) The tendency to detect cancers that are more aggressive
B) The tendency to detect cancers that are less likely to affect survival
C) The ability to detect all cancers before symptoms appear
D) The detection of cancers that would have led to death within a short time
Correct Answer: B) The tendency to detect cancers that are less likely to affect survival
Rationale: Length-time bias occurs when slower-growing (indolent) cancers are more likely to be detected through screening, whereas aggressive cancers may cause symptoms before they are detected, making them less likely to benefit from screening.
What is overdiagnosis in the context of cancer screening?
A) Diagnosing cancers that are too aggressive to be treated effectively
B) Diagnosing cancers that are so slow-growing that they would not affect survival
C) Detecting cancer too late to provide any effective treatment
D) Diagnosing all forms of cancer before symptoms appear
Correct Answer: B) Diagnosing cancers that are so slow-growing that they would not affect survival
Rationale: Overdiagnosis refers to identifying cancers that are unlikely to affect a patient’s health because they grow so slowly or are unlikely to cause death during the patient’s lifetime.
Which group of individuals was considered high-risk for lung cancer in the NLST?
A) Individuals under 55 years of age
B) Individuals with a family history of lung cancer only
C) Individuals between 55 and 74 years of age with a ≥30 pack-year history of cigarette smoking
D) Individuals who had previously undergone a chest CT
Correct Answer: C) Individuals between 55 and 74 years of age with a ≥30 pack-year history of cigarette smoking
Rationale: High-risk patients in the NLST were defined as individuals between 55 and 74 years of age with a history of smoking ≥30 pack-years, and former smokers who had quit within the last 15 years.
Which of the following individuals was excluded from the National Lung Screening Trial (NLST)?
A) Individuals with a history of asthma
B) Individuals with a previous lung cancer diagnosis
C) Individuals aged 50-55 years
D) Individuals with a history of controlled hypertension
Correct Answer: B) Individuals with a previous lung cancer diagnosis
Rationale: Individuals with a previous lung cancer diagnosis, a history of hemoptysis, unexplained weight loss of >15 lbs in the preceding year, or a recent chest CT (within 18 months) were excluded from the NLST
What age group was targeted for lung cancer screening in the National Lung Screening Trial (NLST)?
A) 40-50 years old
B) 50-60 years old
C) 55-74 years old
D) 65-80 years old
Correct Answer: C) 55-74 years old
Rationale: The target population for the NLST was individuals between the ages of 55 and 74, with a significant smoking history.
What is the treatment of choice for patients with clinical stage I and II non-small cell lung cancer (NSCLC)?
A) Chemotherapy
B) Radiation therapy
C) Surgical resection
D) Immunotherapy
Correct Answer: C) Surgical resection
Rationale: Surgical resection is the treatment of choice for patients with clinical stage I and II NSCLC, provided they are able to tolerate the procedure.
For patients with stage I NSCLC, which type of resection is superior to wedge resection in terms of local recurrence rates?
A) Segmentectomy
B) Pneumonectomy
C) Lobectomy
D) Limited resection
Correct Answer: C) Lobectomy
Rationale: In patients with stage I NSCLC, lobectomy is superior to wedge resection, as it results in lower rates of local recurrence and a trend toward improved overall survival.
Which surgical procedure is reserved for patients with central tumors in NSCLC and should only be performed in those with excellent pulmonary reserve?
A) Wedge resection
B) Segmentectomy
C) Lobectomy
D) Pneumonectomy
Correct Answer: D) Pneumonectomy
Rationale: Pneumonectomy, the removal of an entire lung, is reserved for patients with central tumors and should only be performed in those with excellent pulmonary reserve due to its more invasive nature.
Which of the following may be considered a reasonable surgical option for patients with comorbidities, compromised pulmonary reserve, and small peripheral lesions?
A) Pneumonectomy
B) Lobectomy
C) Wedge resection or segmentectomy
D) Chemotherapy
Correct Answer: C) Wedge resection or segmentectomy
Rationale: For patients with comorbidities, compromised pulmonary reserve, and small peripheral lesions, a limited resection, such as wedge resection or segmentectomy (potentially via video-assisted thoracoscopic surgery), may be reasonable surgical options.
In patients with stage I or II NSCLC who have undergone surgical resection with negative margins, what is the role of postoperative radiation therapy?
A) It is routinely used to improve survival
B) It is used for all patients to reduce the risk of recurrence
C) It is not indicated
D) It is used only for patients with stage II disease
Correct Answer: C) It is not indicated
Rationale: There is no role for postoperative radiation therapy in patients who have undergone resection of stage I or II NSCLC with negative margins, as surgery is typically curative in these cases.
For patients with stage I and II NSCLC who refuse or are not suitable candidates for surgery, what treatment option should be considered?
A) Chemotherapy
B) Radiation therapy with curative intent
C) Immunotherapy
D) Palliative care only
Correct Answer: B) Radiation therapy with curative intent
Rationale: Patients with stage I and II NSCLC who refuse or are not suitable candidates for surgery should be considered for radiation therapy with curative intent, as it can be an alternative treatment option for these patients.
What is Stereotactic Body Radiation Therapy (SBRT) used for in the treatment of NSCLC?
A) To treat stage IV NSCLC with widespread metastases
B) To treat patients with isolated pulmonary nodules who are not candidates for surgery
C) To treat patients with stage I and II disease after surgical resection
D) To manage symptoms of advanced lung cancer
Correct Answer: B) To treat patients with isolated pulmonary nodules who are not candidates for surgery
Rationale: Stereotactic body radiation therapy (SBRT) is used for patients with isolated pulmonary nodules (≤5 cm) who are not candidates for or refuse surgical resection, offering a non-invasive alternative treatment.
How is Stereotactic Body Radiation Therapy (SBRT) typically administered for patients with NSCLC?
A) In a single, high-dose fraction
B) In three to five fractions delivered over 1–2 weeks
C) Daily over several weeks
D) In two fractions delivered over 4–6 weeks
Correct Answer: B) In three to five fractions delivered over 1–2 weeks
Rationale: SBRT is typically administered in three to five fractions delivered over 1–2 weeks, making it a relatively short treatment regimen compared to traditional radiation therapy schedules.
Which of the following driver mutations is associated with the use of Osimertinib as a treatment option?
A. ALK fusion
B. EGFR mutation
C. ROS1 fusion
D. MET exon 14 skipping mutation
Answer: B
Rationale: The figure specifies that Osimertinib is used for patients with EGFR mutations, a common target in NSCLC.
What is the approved second-line therapy for ROS1 fusion-positive NSCLC?
A. Selpercatinib
B. Crizotinib
C. Osimertinib
D. Capmatinib
Answer: B
Rationale: Crizotinib is marked as an approved second-line therapy for patients with ROS1 fusion-positive NSCLC in the figure.
