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Flashcards in lung cancer Deck (65):
1

more pts die of lung ca than..

colorectal, breast, prostate ca combined

2

this causes 85-90% lung ca

smoking

3

over past 30 years: mortality dec or inc in MEN? why?

dec, change in tobacco use
(Females: started falling in 2003)

4

median age of dx

70

5

worldwide, this % of M/F lung ca pts are nonsmokers
why?

15% men, 50% women
biomass cooking

6

other risk factors

radon gas
asbestos
metals (arseninc, chromium, Ni, iron oxide)
industrial carcinogens
familial predis.
preexisting disease: pulm. fibrosis, COPD (4x inc.), sarcoidosis

7

lung ca breakdown:
30-40%
22%
13-20%
16%
2%

adenocarcinoma
SqCC
SmCC
non-small cell
large cell

8

SqCC

From the bronchial epithelium, centrally located, can be intraluminal sessile or polyps
More likely to present with hemoptysis; can cavitate
Highly associated with smoking history
Tend to spread locally and may be associated with hilar adenopathy

9

adenocarcinoma

From mucous glands or epithelial cells in terminal bronchioles
Never smokers, higher rate of metastatic disease
Peripheral nodules/masses
Adenocarcinoma in Situ (previously Bronchoalveolar cell carcinoma)
Spreads along preexisting alveolar structures without evidence of invasion

10

large cell carcinoma

Relatively undifferentiated cancers that do not fit into other categories but share large cells
Aggressive clinical course with rapid doubling times
Central OR peripheral masses

11

non-small cell carcinoma

Can’t be better differentiated on pathological review

12

SmCC

Bronchial origin typicall centrally located
Highly associated with smoking
Infiltrates submucosa causing narrowing or obstruction of the bronchus without discrete luminal mass
Often involves lymph nodes

13

for staging, divided into

SmCC vs non-SmCC (included other 4)

14

what type is more prone for hematogenous spread and rarely approp. for surg. resection
more or less aggressive course?
median survival?

SmCC
MORE aggressive
only 6-18 wk survival

15

s/s lung ca

anorexia, wl, asthenia
new/change in cough
hemoptysis
pain (bony, nonsp. chest)
postobstr. pneumonia
pleural effusion (12-33%)
change in voice (rec. lary. n)
SVC syndrome
Horner's
invol. inf cervical ganglion, paravert. symp. chain

16

brain metastasis more common in these lung ca
and cause ???

adenocarcinoma, SmCC
cause ha, nausea, seizures, dizziness, AMS

17

paraneoplastic syndrome caused by
occurs in what %

immune-med. or secretory effects of neoplasms
in 10-20% lung ca pts

18

PNP syndrome comps

SIADH (10-15% SmCC)
hypercalcemia (10% SqCC)
inc. ACTH, anemia, hypercoag, peripheral neuropathy, labert eaton myasthenic syndrome

19

lung ca dx

sputum cytology
thoracentesis
thoracoscopy
fine needle aspiration
fiberoptic bronchoscopy
mediastinoscopy
video assisted thorascopic surgery (VATS)
open thoracotomy

20

sputum cytology: sp or sn?
more like to be positive if ??? lesion

highly specific, v. insensitive
central lesion

21

thoracentesis used for..
sens. of ??
do this to inc. yield

malignant pleural effusion
sn 50-60%
repeat 3x

22

thorascoscopy for..
preferred over ??

malignant pleural effusion
pref. over blind pleural biopsy

23

what is fine needle aspirated?

supraclavicular LNs

24

fiberoptic bronchoscopy allows visualization of ??
accompanies...

major airways
w/ BAL of lung segs + cytology/biopsy

25

can also FNA ??
blindly or with ??

mediastinal LNs
endobronchial US guidance (EBUS)

26

this helps properly biopsy peripheral nodules

electromagnetic navigational bronchoscopy

27

this is a high risk for pts (peripheral nodules) esp. with ??

*pneumothorax!*
underlying emphysema

28

this can be used then less invasive techniques fail

mediastinoscopy, VATS, open thoracotomy
-wedge biopsy-imm. analysis on simult. tx/lobectomy
(wait on management as frozen sects. can be inaccurate?)

29

if multiple nodules on imaging, be more suspicious for ??? than ???

metastatic disease
primary lung ca

30

TNM staging used for..

tx guidance, prognosis, to standardize trials

31

TNM...

T: tumor (primary) size/location (where, how big?)
N: nodal metastasis presence/location (+/-, where?)
M: metastasis (distant) presence/absence (+/-)

32

TNM stages grouped into prognostic categories

stages I-IV

33

need to ?? in order to stage

evaluate LNs

34

if no LNs on imaging larger than 1 cm...

resection of primary tumor and sample mediastinum at thoracotomy

35

if suspect metastatic disease, LNs > 1-2 cm

CT guided FNA, mediastinoscopy, EBUS, EUS, limited thoracotomy to eval. LNs (prior to decision about thoracotomy?)

36

PET scanning uses ??? to identify ???
specificity depends on ??

18F fluoro-2-deoxyglucose (FDG) to ID metastatic foci
size of mediastinal LN

37

freq. obtain this to eval. for metastatic disease and determine surgical candidates
limited resolution if ???
false positive if ???

whole body fusion PET-CT imaging
if nodule

38

with PET, need separate ??? to r/o brain metastasis in pts with at least Stage ??? disease

MRI of brain
Stage II

39

periop. assessment for tumor resection is necessary b/c most pts have ???
most pts req ??? to evaluated how tolerate post-resection ???

other chronic lung diseases
spirometry
pulmonary insufficiency

40

if pre-op. FEV1 is ??? have low risk of compl. from lobectomy/pneumonectomy

>2L

41

if FEV1 ??? need to calculate an est. ???
if ??? have low incident peri-op complications

800mL

42

if borderline spirometry, can do ??? to determine if resection is an option
??? is desired

cardiopulmonary exercise testing
high max. O2 uptake

43

national lung screening trial done on..

former heavy smokers

44

USPSTF recommends annula screening for lung ca w/ ???
for ages ??? who have ??? smoking hx or ???

low-dose CT (LDCT)
55-80 yo
30 pk-yr hx and currently smoke or have quit w/in past 15 years

45

screening should discontinue once person has not smoked in ??? OR develops ???

15 years
health problem that subst. limits life expectancy or willingness to have curative lung surgery

46

ddx for solitary pulmonary nodule

non-sp. healed granuloma
hamartoma
lymphoma
fibroma
lunc abscess
round atelectasis
AVM (art-ven malform.)
hematoma
granulomatosis w/ polyangiitis

47

radiological prob. of ca increases if...

inc. diameter
spiculation
upper lobe location

48

if ??? zero likelihood of ca

calcified completely

49

non-SmCC (NSCLC) tx:
first ID if ??? is feasible and if pt can tolerate it

complete surgical resection

50

these prevent surgery

Extrathoracic metastases, malignant pleural effusion, tumor involving heart, pericardium, great vessels, esophagus, trachea, contralateral mediastinal LNs

51

NSCLC Stage I and II

surgical resection (when possible)

52

NSCLC IB and II

adjuvant chemotherapy

53

NSCLC Stage IIIA

resection and chemo and/or radiotherapy

54

NSCLC Stage IV

chemotherapy and palliation

55

??? for early stage primary NSCLC -non-surg. candidate

stereotactic body radiotherapy (Cyberknife)

56

??? gives antineoplastic drugs in advance of sx or radiation
used in stages ???

neoadjuvent chemotherapy (NSCLC)
Stage IIIA/B (no impact I/II)

57

??? admin antineoplastic drugs FOLLOWING sx, radiation
??? regimens for stages ???

adjuvent chemotherapy (NSCLC)
Cisplatin, Stage II or IB

58

chemo in Stages IIIB and IV (NSCLC): curative?
improves survival from ?? to ??
also improves ??

not curative
5 mos-->7-11 mos
improved quality of life and symptom control

59

chemo drugs for NSCLC Stage IIIB, IV

cisplatin or carboplatin combined with pemetrexed, gemcitabine, taxane or vinorelbine

60

NSCLC advanced molecular profiling: target tx for these mutations

EGFR, EML4-ALK, more

61

SCLC tx: response to ??? are excellent (80-90%) in ??? and 60-80% partial response in ???

cisplatin and etoposide
limited stage disease
extensive disease

62

SCLC tx: remission is ?? and if recurred med. survival is ??

short-lived
3-4 mos

63

overall 2 yr survival ??? in limited stage and ?? in extensive stage

20-40%
5%

64

pallliative tx relieves ??? and also ???

endobronchial obstruction
improves dyspnea, contols hemoptysis

65

this improves quality of life if no evidence of other metastatic disease

resection for solitary brain metastasis