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Spr2015_Week7 > Lung Cancer > Flashcards

Lung Cancer Flashcards

(53 cards)

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1
Q

Overall, e-cigarettes are a new source of ____

A

Voltaile Organic Compounds (VOCs) and ultrafine/fine particles in the indoor environment

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2
Q

Compared to other cancers (except notably pancreatic cancer), ____ has seen the least improvement in 5 year survival compared to other common cancers

A

lung cancer (17%)

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3
Q

Causes and risk factors for cancer

A

• Smoking – the vast majority of all lung cancer is attributable to this single factor (up to 85-90% of lung cancers) = 85-87%

  • Passive/Environmental smoke inhalation
  • Radon Gas
  • Asbestos
  • Metals (chromium, arsenic, iron oxide)
  • Industrial chemicals
  • Polycyclic aromatic hydrocarbons
  • Genetic causes
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4
Q

Over 2/3 of patients present with ___

A

stage IIIA cancer or worse

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5
Q

Risk assessment of lung cancer patient

A

Bach Index

1) age
2) gender
3) asbestos exposure history or coal miner or radon history
4) smoking history
5) previous history of tobacco related cancer (head and neck, renal, esophagus cancer, colon
6) airflow obstruction
7) serum cytologic atypia

yearly incidence = 2% in highest risk

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6
Q

higher GOLD 3 or 4 is assoc with higher risk of ___

A

lung cancer

–> subset of smokers exhibit accelerated loss of FEV1

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7
Q

if your parents or 1st degree relative, do you have incr risk of lung cancer

A

yes!! family history

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8
Q

SEQUENCE OF lung cancer development

A

1) normal epithelium
2) hyperplasia
3) dysplasia
4) CIS
5) invasive carcinoma

INcidence based on initials putum

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9
Q

Precision medicine

Methylation of tumor suppressors –> tumor formation

A

Look at # of genes methylated

good at diagnosis within 18 months

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10
Q

Types of lung cancer

and subtypes

A

NSCLC (87%)

  • adenocarcinoma
  • adenocarcinoma in situ
  • squamous cell
  • large cell

Small cell lung cancer (13%

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11
Q

small cell lung cancer histology

findings

A

1) high N:C ratio
2) large cytoplasm
3) neuroendocrine marker (NCAM) = diagnostic
4) TTF-1 = positive in lung cancer

high rate of paraneoplastic = may lead to endocrinopathies and weakness

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12
Q

History/Physical of lung cancer

symptoms of lung cancer

A

1) weight loss
2) cough
3) hemoptysis
4) neuro symptoms
5) lymphadenopathy

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13
Q

lab studies indicative of lung cancer

A

suggest metastases

high alk phos
Ca2+
anemia
cytopenias

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14
Q

CT/pet scans

why use?

A

CT/PET scans

N2 nodes/upper abdomen

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15
Q

why use fiberoptic or needle biopsy

A

fiberoptic bronchoscopy or needle biopsy to establish histology (SCLC vs NSCLC)
proximety to carina, mediastinal staging

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16
Q

purpose of mediastinal biopsy

A

mediastinal biopsy = confirm status of mediastinal nodes

biopsy of lymph nodes

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17
Q

T classification for T1a, T1b, T2a, T2b

A

tumor 2, 7 cm and invades pareital pleura, mediastinum, pericardium, diaphragm

T4 = invade mediastinum and heart and apical tumors

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18
Q

why use thoracentesis

A

Pleural effusions
thoracentesis = to stage and make diagnosis

3 samples

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19
Q

symptoms of upper lobe tumor (apical)

A

upper lobe tumor = apical = involve brachial plexus and upper extremity

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20
Q

N classification

A 
N0 = no regional nodes
N1 = ipsilateral intrapumonary/peribronchial/hilar
N2 = contralateral (less surgical and more radiation/chemo)
N3 = node in neck
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21
Q

M classification

A

M1a= malignant pleural effusion
malignant pericardial effusion
contralateral pulm nodes

M1b = more distant mets= liver, adrenals, bone, brain

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22
Q

NSCLC

EGFR (ERB-1)
% of NSCLC vs. SCLC

drugs to use?

23
Q

Her-2/neu (ERB-2)

drugs to use?

24
Q

EGFR leads to…

Study These Flashcards
A

1) prolif
2) invasion
3) inhib of metastasiss

25
vEGF in lung cancer what drug?
overexpressed bevacizumab (Avastin)
26
Ras mutations found in what cancers? mutations assoc with resistance to?
2-30% NSCLC, adenocarcinoma | mutations assoc with resistance to TKIs and EGFRi
27
Precision medicine of NSCLC 50% adenocarcinoma 30% squamous cell
Using specific drugs to target types of cancer
28
Paradigm for precision medicine in lung cancer
Initial presentation Genetic testing Platinum doublet +/- Bevacizumab or target therapy if recur then go on to pemetrexed, docetaxel erlotinib or 2nd line targeted 3rd line chemotherapy or 3rd line
29
Squamous cell cancer compared to adenocarcinoma for therapies
compared to lung adenocarcinoma = no proven genomically targeted therapy for lung squamous cell
30
Immunotherapy for targeting lung cancer why use them?
Tumors make PD-L1 in periphery that kill the immune response so harness inhibitors for PD-L1 or CTLA-4 because allows body's own immune system
31
Solitary Pulm nodules | define
1) less than 3cm in diameter 2) Surrounded by normal, aerated lung tissue 3) Has round, smooth contours 4) Lacks satellite lesions 5) Has no associated atelectasis, pnuemonitis, or regional adenopathy
32
SPN usually _____ and common on CXR Goals of SPN evaluation
SPN usually asymptomatic and common on CXR (10-20% = bronchogenic carcinomas or pulm masses) 1) expedite resection potentially curable lung cancer 2) minimize resection of benign nodules 3) morbidity of nodule evaluation = 5-10%
33
Not all large nodules are ___
cancer (only 1/3 malignant) follow up with biopsy
34
what makes pleura calcified? define rounded atelectasis
asbestos pleural calcifications twist with tail and invaginate part of lung and gets trapped in lung
35
What should we do for solitary pulm nodules
1) look at all previous CXRs 2) stable for >2 years = no eval 3) benign, central calcification = no eval (granulomas = near river valley) 4) spiral chest CT with contrast 5) if nodule > 8 mm estimate a pretest probability 6) SPN in marginal candidates (poor lung fxn and CT) --> , PET, if negative repeat CT in 3 months 7) If growth on serial imaging, proceed to non-surgical biopsy and resection 8) all resections include lymph node dissection 9) lobectomy is preferred over wedge or segmentectomy
36
what do you do to treat benign, central calcification
no eval (granulomas = near river valley)
37
what do you do for nodule > 8 mm
estimate a pretest probability for cancer
38
what do you do for SPN in marginal candidates (poor lung fxn
PET if negative CT repeat in 3 months
39
if you have growth on serial imaging
proceed to non-surgical biopsy and resection
40
all resections should include ___
lymph node dissection
41
___ is preferred over wedge or segmentectomy
lobectomy
42
if nodule size 8 mm
follow up optional if no risk factors follow up at 12 mo if risk factors follow up at 12 mo follow up at 6-12 month; then at 18-24 mo follow up at 6-12 then 18-24 mo follow up at 3-6, 9-12, 24 do PET or biopsy regardless Low risk = minimal or absent history high risk = history of smoking nown risk = hx of lung cancer in 1st degree and exposure to asbestos, radon or uranium
43
GGN (ground glass nodule) are typically what type of cancer
adenocarcinoma
44
things to note on imaging: Size= as SPN gets larger, more likely ___ if stable for > 2 years, it is likely ___ central clacification types enhance with contract more common in ___ incr PET activity is more likely __
1) malignant 2) benign 3) o Bull’s eye lamination (granulomas) o Popcorn or chondroid (hamartomas) o Dense central core of calcification 4) malignancies due to incr blood supply more common in malignancies
45
Methods of lung ancer screen
1) CXR 2) sputum cytology 3) spiral CT 4) autofluorescence bronchoscopy
46
Mayo Lung project | males > 45 and smoking 1 ppd in last year
No difference in two groups if received CXR every 4 or 12 month sputum cytology = no reduction in lung cancer mortality CXR = no reduction in lung cancer mortality reduction in lung cancer fatality
47
Results? NLST = prospective comparing low-dose helical CT compared to CXR 55-74 y/o 30 PPD Former smoker quit within 15 years received 3 annual screeens and followed for 5 years
Those who received spiral CT scan = more lung cancer, 20% decr rate of lung cancer Number to screen for 1 death = 219 292 lung cancers diagnosed in CT group and 190 in CXR difference accounted for by higher incidence of stage 1A no difference in # of IIB through IV so CT IS GREAT FOR LOOKING AT EARLIER STAGE LUNG CANCERS more adenocarcinoma in0situ and adenocarcinoma
48
Final medicare decision Medicare B now covers which patients Must include? Risks of low dose CT?
Meidcare B = convers lung cancer screen with low dose CT onceper year (55-77) current or former smoker who quit in last 15 years at least 30 PP year must include visit for counseling and shared-decision making Risk of overdiagnosis bias, radiation exposure, false positive scans Smoking cessation discussions
49
PET scans 1) evaluate for? 2) look for? 3) in patients with peripheral stage T1 A tumors a PET scan may ___
1) evaluate for mediastinal and extrathoracic metastases in all patients with NSCLC being treated with curative 2) look for ground glass opacities
50
effect of beta carotene (because smokers probably eat low fruits and vegetables) so give them beta carotene
got more lung cancer than those that didn't get beta carotene
51
Chemoprevention | current agents to reverse, suppress or prevent carcinogenesis
Iloprost- benefit for former smokers = improvement in areas of damage in airway Selenium- no benefit in prevention of patinets with resected NSCLC COX-2- PGI2= decr in # of tumors in mice future = EGFR inhibitors Rosigliatzone VEGFR/EGFR antagonists Angiogenesis modulators
52
Staged chemoprevention
Stage 1 = stop smoking Stage 2 = identify highest risk groups (gene expression pattern in buccal or nasal mucosa, blood, sputum atypia, FHx, tobacco exposure) Stage 3 = presence of pre-malignant lesions with specific alterations
53
strategy for early stage cancer
personalized tertiary chemoprevention/Stage 1A therapy such as apsirin use for colorectal cancer

Spr2015_Week7 (10 decks)

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