Lung Cancer Flashcards
(119 cards)
1
Q
What are the risks for lung cancer?
A
Smoking
Secondhand smoke
Genetic predispostion
Asbestos, radon, arsenic, radiation, polycyclic aromatic hydrocarbons
2
Q
Do cancer cells do apoptosis
A
No they avoid it thats why they grow so much
3
Q
What is another name for a Solitary Pulmonary Nodule?
A
“Coin Lesion”
4
Q
What is a solitary pulmonary nodule (SPN)?
A
An isolated lung nodule that is less than 3cm and round
5
Q
Are most SPNs benign or malignant?
A
Benign
6
Q
What do benign SPNs look like?
A
Smooth, well-defined edges
Dense central calcification
7
Q
Most benign SPNs end up being________
A
Infectious granulomas
8
Q
If a lesion is spiculated, it is (good/bad)
A
Bad
9
Q
If a nodule is calcified, it is (good/bad)
A
Good
10
Q
What is the difference between a nodule and a mass?
A
A mass is greater than 3cm
11
Q
How does size of a lung mass relate to its chance for malignancy?
A
The bigger the mass, the more likely it’s malignant
12
Q
Other than infectious granulomas, what are other possible causes of benign SPNs?
A
Hamartoma (tumor of cells from somewhere else like hair cells)
Vascular
Inflammation
13
Q
Who is more likely to have a lung malignancy: males or females
A
Females
14
Q
How does age relate to likelihood of malignancy
A
Older = higher risk
15
Q
Most SPNs in Arizona are _____
A
Cocci (valley fever)
16
Q
Most SPNs in patient who have had cancer before are ______
A
Metastasis
17
Q
If an SPN is 5cm or bigger, what are the chances its cancerous
A
90%
18
Q
What is the 1st step in evaluating an SPN?
A
Review old films
Malignant nodules grow FAST
Minimal growth in 2 years suggests a benign lesion
19
Q
Smooth, well defined edges on an SPN indicate that it is most likely (benign/malignant)
A
Benign
20
Q
What kind of chest CT do you need to do to evaluate a suspicious SPN?
A
Without contrast
Low radiation
Thin 1mm slices
21
Q
What should you do if you find a solid nodule that is over 8mm?
A
You determine the probability of it being malignant and then go from there
Low probability <5%
Intermediate probability 5-65%
High probability >65%
22
Q
What should you do if you find a solid nodule that is over 8mm and has a LOW probability of being malignant?
A
Get a CT 3 months later
No growth= serial CTs at 9-12 months and 18-24 months
Growth= needs Pathologic evaluation
23
Q
What should you do if you find a solid nodule over 8mm and there is an intermediate probability of it being malignant?
A
Do an FDG PET/CT and/or biopsy
If “FDG avid”= biopsy/excision
If PET/CT unavailable, negative, or indeterminate= you can do individualized management based on suspicion (??)
CT scans at 3, 9-12, and 18-24 months is an acceptable alternative to biopsy
I hate this
24
Q
What does “FDG avid” mean?
A
It means the PET/CT showed that it was abnormal
FDG is fluorodeoxyglucose
25
What should you do if you find a solid nodule that is over 8mm and there is HIGH probability that it is malignant?
Biopsy/excision
26
What should you do if you find a solid nodule that is smaller than 8mm?
6-8mm= do a CT in 6-12 months
<6mm do not require follow up
27
What are the 3 types of NSCLC?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
28
What is another name for small cell lung cancer?
Oat cell carcinoma
29
Where does Small Cell LC show up
Central airways
*********
Was in red
30
What does small cell LC look like?
Large hilar mass with bulky mediastinal adenopathy
31
Is small cell lung cancer aggressive?
HIGHLY aggressive. THE MOST aggressive. 70% of patients have metastatic disease when they are first diagnosed.
6-18 WEEK survival without treatment
32
What are the 2 categories of Small Cell Lung Cancer?
Limited- one lung and nodes on same side
Extensive- both sides of chest
33
What should you be really worried about if you have a small cell lung cancer in the right side?
(Other than dying.... 😞)
SVC syndrome
34
What is the most common form of non small cell lung cancer
Adenocarcinoma
35
What kind of tissue gives rise to adenocarcinoma?
Mucous glands
Epithelial cells in or distal to terminal bronchioles
36
Where do adenocarcinomas metastasize to?
Distant organs
37
Where in the lung does adenocarcinoma show up?
Periphery
38
Where in the lung does squamous cell carcinoma show up?
Centrally or in main bronchus
**Intraluminal growth inside the bronchus)***
39
What kind of tissue gives rise to squamous cell carcinoma?
Bronchial epithelium
40
What kind of non small cell LC is most likely to cause hemoptysis?
Squamous cell carcinoma
| It’s often INSIDE the main bronchi
41
What is the most likely cause of hemoptysis?
BRONCHITIS*****
***********
She said this 7386 times
42
Where does squamous cell carcinoma metastasize to?
Nearby lymph nodes
43
Which kind of lung cancer did she say “cavitates?”
Squamous cell carcinoma
44
Where does large cell carcinoma appear?
Anywhere
| Central or peripheral
45
Where does Large cell carcinoma metastasize to?
Distant organs
46
What is the most aggressive non small cell lung cancer?
Large cell carcinoma
| Small cell is the most aggressive lung cacner though
47
Are most patients symptomatic at the time of lung cancer diagnosis?
Yes
48
What is the most common symptom of lung cancer?
Cough
| ***************
49
What are the symptoms that lung cancer patients may present with at diagnosis?
Cough
Weight loss
Dyspnea
Chest pain
Hemoptysis
Bone pain
Hoarseness**** DO NOT FORGET
50
Cough is the most common symptom of lung cancer, but what 2 types does it most frequently occur with?
Squamous cell
Small cell
51
If a patient has weight loss, what does it mean for their prognosis?
BAD NEWS
52
Does a CXR rule out lung cancer?>
No
| Idk this had an exclamation point
53
What causes hoarseness in lung cancer patients?
Left sided tumors compression the recurrent laryngeal nerve
**********SHE REALLY HARPED ON THIS
54
What is the most common cause of intrathoracic malignancy that causes SVC syndrome?
Small Cell Lung Cancer *********************
55
What are the symptoms of SVC syndrome?
Dyspnea #1
Facial swelling
Head fullness (worse when bending forward/supine)
Arm swelling
Cough
Chest pain
Dysphagia
56
What will you find on physical exam in a pt with SVC syndrome?
Facial edema
Dilated neck veins
Prominent venous pattern on chest
57
What is the GOLD STANDARD of diagnosing SVC syndrome?
Superior vena cavogram
| taking pictures inside the SVC
58
What kind of imaging can be done to diagnose SVC syndrome?
CXR
Duplex ultrasound
CT scan WITH contrast
Superior vena cavogram
59
What kind of imaging for SVC syndrome will allow you to see the level of blockage, map collateral pathways, and ID the underlying cause?
CT with contrast
| BUT superior vena cavogram is still the gold standard for diagnosing SVC syndrome
60
How do you treat SVC syndrome?
Emergency Radiation Therapy
Venous stents
Chemo
Removal of cardiac devices and anticoagulation (if caused by thrombosis)
61
Which patients with SVC syndrome require emergency radiation therapy?
Stridor from central airway obstruction
Laryngeal edema
Coma from cerebral edema
62
What causes Pancoast syndrome?
A tumor in the superior sulcus (apical chest) compressing the brachial plexus and cervical sympathetic nerves
63
What is Horner’s syndrome and what condition is it associated with?
Injury to the sympathetic nerves of the face
Associated with Pancoast syndrome
64
What kinds of Sx will a pt with Pancoast syndrome have?
Right shoulder pain A LOT
Forearm, scapula and finger pain
One pupil constricted
Not sweating on one side
Eyelid drooping on one side
Rib destruction
Atrophy of hand muscles
Pain in C8, T1, T2 nerve roots
(Signs are going to be on the same side as the tumor)
65
What kind of lung cancer is most likely to cause Pancoast syndrome?
Squamous cell
66
What are paraneoplastic syndromes?
Sx that occur as a result of organ/tissue damage at locations remote from the site of the primary tumor/metastases
Ex: hypercalcemia due to bone destruction and SIADH
67
What kinds of hematologic effects can occur due to paraneoplastic syndromes?
Hypercalcemia due to bone destruction
Anemia
Leukocytosis -poor prognosis
Thrombocytosis
Hypercoagulabilty
68
What are the 4 endocrine effects caused by paraneoplastic syndromes?
PTH-like substance causing bone erosion=hypercalcemia
Excess HCG production- gynecomastia, milky nipple discharge
SIADH- hyponatremia
Cushing’s syndrome- ectopic ACTH.
69
What kind of lung cancer causes a PTH-like substance to be secreted?
Squamous cell
70
What kind of lung cancer causes excess HCG production?
Large Cell
71
What kind of lung cancer causes SIADH and Cushing’s syndrome?
Small cell lung cacner
72
What causes patients with Small Cell LC to develop Cushing’s syndrome?
Tumor secretes ectopic ACTH leading to lots of cortisol
VERY BAD PROGNOSIS
73
What is Eaton-Lambert syndrome?
An immune mediated attack of antibodies at the NMJ causing:
Acetylcholine release
Muscle weakness
74
What kind of cancer causes Eaton Lambert syndrome?
Small cell lung cancer
75
What are the most common sites of distant metastases?
Liver
Bone
Adrenal glands
Brain (especially Small cell)
76
What kinds of symptoms will someone with liver metastasis have
Elevated LFTs
77
What kinds of symptoms will someone with bone metastases have
Back, chest, extremity pain
Elevated alkaline phosphate (from bone growth)
78
What kinds of symptoms will someon with metastasis to the adrenal glands have?
None
79
What is necessary to diagnose Lung cancer?
Tissue biopsy
| Sputum, bronchoscopy, thoracentesis, etc
80
How is Non small cell LC staged?
With the TNM staging system
T- Tumor
N- Nodal involvement
M-Metastasis
81
How is small cell LC staged?
Limited vs Extensive
82
What kind of tissue sample is best for central lesions?
Sputum culture
83
How is performance status graded?
| Don’t know if you have to know this?
0= no restriction
1= strenuous physical activity restricted
2= capable of all self care but unable to do work
3= capable of only limited self care, confined to bed or chair more than 50% of waking hrs
4= completely disabled, no self care, totally bed or chair confined
84
What is the strongest indicator of post-op complications?
FEV1 less than 60%
85
Which is better to detect metastasis:
| PET or CT
PET
86
What kind of radioactive isotope is used in PET scans?
fluorodeoxyglucose (FDG)
87
What kind of tissue may show as a false positive on a PET scan?
Infections
88
What tissue is NORMAL to light up in a PET scan?
Heart
Kidneys
Bladdder
89
What is the treatment of choice for non small cell LC?
Surgical resection (if the disease is localized)
90
Do we do surgery for Small Cell LC?
Not usually an option
| Only if its very small primary lesion with no spread
91
What is the treatment for Small Cell LC?
Chemotherapy
Radiation
Prophylactic cranial radiation
92
How do you treat malignant effusions?
Thoracentesis
Pleurodesis (fusing pleura to lung tissue)
Pleura Catheter
93
What are the side effects of chemotherapy?
Fatigue
Chemo brain
N/V
Anorexia, weight loss
Anemia
Neutropenia
Nephrotoxicity
Neurotoxicity
94
How do you treat stage 1 Non small cell LC
Surgical resection
95
How do you treat stage 2 non small cell LC
Surgical resection + chemo
96
How do you treat Stage 3 non small cell LC?
Uncertain:
Dont do surgery and do chemo+ radiation
Do surgery and do chemo and add radiation if you didn’t get clear margins from surgery
97
How do you treat stage 4 non small cell lung cancer
Palliative :(
Chemo, clinical trials
Resection of metastases
“Targeted therapy”
98
Every patient with suspected lung cancer needs this kind of imaging screening:
Low dose helical CT
| This was in orange idk
99
Who needs a low dose helical CT to screen for lung Cancer?
Every pt with suspected lung cancer
Age 55-74 with 30 pack year history
20 pack-year history with one additional risk factor (other than secondhand smoke)
100
What drugs can you prescribe to help your patients quit smoking?
Zyban aka Wellbutrin (Bupropion)
Chantix (Varenicline)
Nicotrol (Rx nicotine inhaler/nasal spray)
101
How should you instruct your patent to take Zyban/Wellbutrin/Bupropion to quit smoking?
Start taking it and keep smoking
Quit smoking after 5-7 days
102
What are the what does your patient need to avoid doing when taking Zyban/Wellbutrin/Bupropion?
Alcohol (to prevent seizures)
103
What is the black box warning for zyban/Wellbutrin/bupropion?
Suicidal risk in children, young adults, and adolescents
104
What are the adverse reactions of Zyban/Wellbutrin/bupropion?
Seizures***
Agitation
Weight loss
105
How should you instruct your patient to take Chantix (varenicline) to quit smoking?
Start taking med
Stop smoking after 7 days
Keep taking it for 12-24 weeks
106
What is the biggest thing you can do to help your patient quit smokiong?
Positive support! 🥳
107
Which paraneoplastic syndromes are associated with SMall Cell Lung Cancer
SIADH
Cushings
Eaton-Lambert
108
What parts of the lungs are usually affected by Small Cell lung cancer
Central lung
Hilar and mediastinal lymphadenopathy
109
Thrombophlebitis and clubbing are associated with this type of cancer:
Adenocarcinoma
110
What is the most common NSCLC
Adenocarcinoma
111
Adenocarcinoma usually arises (centrally/peripherally)
Peripherally
112
Which kind of LC is slower growing and metastasizes later?
Squamous cell
113
Squamous cell LC usually arises in what part of the lung
Central bronchi
114
Which kind of lung cancer is associated with excess PTH, which causes hypercalcemia?
Squamous cell
115
Which kind of LC may cause cavitations?
Squamous cell
116
Which kind of LC is associated with hemoptysis?
Squamous cell
117
Who should get CXR screening for lung cancer?
NO ONE.
We don’t screen with CXRs, only CT
118
True or false:
Every nodule requires a CT
True
119
What is the most common presenting symptom of lung cacner?
Cough
