Lung Cancer

Question 1

round to fusiform shape with scant cytoplasma and finely granular nuclear chromatitine and absent or incospicious nucleoli

Answer 1

Small cell lung cancer - neuroendocrine cancer

makes up about 15% of all lung cancers and biggest risk factor is tobacco abuse

Question 2

Treatment of SCLC

Answer 2

based on stage.

on limited stage SCLC - means one radiation field - ipsilateral hemithorax and regional lymph nodes

early on- very small we use surgery to cut area and/or plantinum based chemotherapy.

Question 3

what is considered metastatic SCLC?

Answer 3

when there’s dx that cannot be limited to one radiation field (mets to brain, adrenals, bone, and liver)

Question 4

Treatment of limited stage SCLC?

Answer 4

platinum based chemotherapy + radiation therapy; aim for curative intent.

molecular testing is not routinely done.

Question 5

Treatment of extensive stage SCLC?

Answer 5

Offer platinum based chemotherapy plus immunotherapy with radiation. Those who respond to chemotherapy often receive subsequent chest and or prophylactic cranial irradiation. used palliative for symptomatic metastatic dx such as bone or brain mets.

Question 6

who gets small cell lung cancer?

Answer 6

heavy smokers and most cases involve the central airway (hilar mass) and manifest with cough, dyspnea hemoptysis and weight loss and fatigue

Question 7

Extensive stage small cell lung cancer

Answer 7

involvement of contralateral lymph nodes, malignant pericardial or pleural effusion or distant metastasis

Question 8

For small cell lung cancer first choice of treatment is:

Answer 8

etoposide plus cisplatin chemotherapy first. Then can get radiation or prophylactic head radiation

Question 9

non small cell lung cancer treatment is often based on:

Answer 9

molecular profiling in order to determine 1st line treatment (endothelial growth factor receptor tyrosine kinase inhibitos)

Question 10

early stage non small cell lung cancer:

Answer 10

lobectomy is 1st line if early NSCLC but that’s only if there’s no mediastinal lesions or contraindications to surgery.

Question 11

advanced non small cell lung cancer is treated with:

Answer 11

tumor molecular markers

tx is based on age, functional status, and comorbodities

non elderly pts with good performance status get treated with cytotoxic agents (platinum compounds) or targeted agents EGFR inhibitors, ALK fusion inhibitors, monoclonal antibodies.

elderly pts with good performance status may be treated.

elderly with poor performance status need palliative care.

Question 12

what is associated with squamous cell carcinoma

Answer 12

super vena cava syndrome

Question 13

treatment for squamous cell carcinoma stage I and II

Answer 13

surgical resection

Question 14

stage III squamous cell carcinoma treatment

Answer 14

chemoradiation

Question 15

squamous cell carcinoma of the lung is likely to cause this paraneoplastic syndrome

Answer 15

hypercalcemia

Question 16

which cancer causes hyponatremia

Answer 16

small cell lung cancer causes small sodium

Question 17

Kulchitsky cells located in the central airways

Answer 17

think small cell carcioma

Question 18

histology shows small highly basophilic cells that are poorly differentiated

Answer 18

small cell lung cancer

Question 19

Associated paraneoplastic syndromes with small cell lung cancer

Answer 19

SIADH
hyponatremia
hypokalemia
hypochloremia

Lambert Eaten - muscle weakness from antibodies against pre synaptic calcium channels

Cushings syndrome with ectopic ACTH production

central weight gain

Question 20

adenocarcinomas are located on the

Answer 20

periphery of lung parenchyma

Question 21

large cell carcinoma are located with

Answer 21

highly malignant with early metastasis; undifferentiated anaplastic with large nuclei in histology

poorly responsive to chemotherapy and treated surgically

generally poor prognosis

Question 22

psammona bodies seen on histology

Answer 22

mesothelioma which is found on adjacent to pleura and unrelated to smoking.
can cause pleural effusions with hemorrhages

Question 23

bronchial carcinoid tumors of the lung

Answer 23

low grade malignant neuroendocrine tumor that rarely metastasizes and see carcinoid syndrome with wheezing, flushing diarrhea and hypotension.

Question 24

prior to surgery for resectable Stage 1 and 2 NON small cell cancer need to do:

Answer 24

get rigorous functional evaluation to predict anticipated pulmonary reserve after surgery

look at FEV1 and DLCO

If mild to moderate impairment then need to get exercise testing

Question 25

how do you TREAT pts who are NON SURGICAL candidates and have Stage 1 and 2 NON small cell cancer

Answer 25

stereotactic body radiation and other ablative treatments that can be used to treat the primary tumor - works for small tumors. Larger tumors need conventional chemotherapy

Question 26

If you have stage I or II NON small cell lung cancer when do you get radiation therapy?

Answer 26

pts who have been treated surgically who have positive margins they get post op radiation those who are non surgical candidates

Question 27

When do you give chemotherapy in pts who have stage I or II NON small cell lung cancer?

Answer 27

give to people who have gotten surgery for resection. Get cisplastin based adjuvant chemotherapy get four cycles cisplatin + EITHER vinorelbine, pemetrexed, gemcitabine and docetaxel.

Question 28

what improves survival in stage II and stage III non small cell cancer?

Answer 28

cisplatin based chemotherapy as adjuvant therapy get four cycles cisplatin + EITHER vinorelbine, pemetrexed, gemcitabine and docetaxel.

Question 29

follow up surveillance for resected and treated non small cell lung cancer:

Answer 29

CT scan q6 months for 1st two years and annually stop smoking.

Question 30

locally advanced non small cell lung cancer is defined as:

Answer 30

presence of clinically detectable LAD in mediastinum or by a primary tumor that invades into local structures (mediastinum, heart, trachea, esophagus, or great vessels) Tx is with better surgery all get neoadjuvant or adjuvant platinum based chemotherapy or radiation those with dx and bulky adenopathy should get combo platinum based chemoradiation.

Question 31

metastatic NON small cell lung cancer

Answer 31

- get palliative care early on - get palliative performance status - test for mutations for possible treatment (EGFR, ALK and ROS1) - give platinum based chemotherapy doublet + bevacizumab

Question 32

side effects of bevacizumab

Answer 32

stroke, MI, thrombosis and hemoptysis

Question 33

Immunotherapy is

Answer 33

agents that act upon cells via the programmed cell death ligand PDL1 to kill non small cell lung cancer cells. Used in metastatic situations

Question 34

when do we use pembrolizumab?

Answer 34

in pts who have NSCLC and have >50% PDL1 expression allows for greater progression free survival and overal survival compared to standard therapy.

Question 35

Treatment of Small cell lung cancer

Answer 35

if small tumor = surgical resection get treated adjuvant chemotherapy No radiation if surgerical margins were negative

Question 36

Treatment of limited disease small cell lung cancer

Answer 36

combined cisplatin plus etoposide and radiation chemotherapy is continued after radiation for up to six cycles

Question 37

after new diagnosis of Small cell lung cancer need to get

Answer 37

CT C/A/P and MRI brain for staging and whole bone scintigraphy

Question 38

if pt has limited disease small cell lung cancer and responsive to treat and no signs of brain metastasis what to do?

Answer 38

need to under prophylactic whole brain radiation