Lung Cancer Flashcards
(85 cards)
1
Q
What is the most common cause of death world wide
A
Lung cancer
2
Q
What is the most common cancer in men and women
A
Prostate in men, breast in women
Lung is the most common cause of cancer deaths in both
3
Q
What percentage of lung cancer is caused by smoking and what from passive smoke exposure
A
80-90% from smoke directly
Up to 25% for passive (mostly 2.5-5%)
4
Q
What is the breakdown of histologic classes of lung cancer and percentages
A
Adenocarcinoma = 32%
Squamous cell = 29%
Small cell = 18%
Large cell = 9%
5
Q
5 key features of squamous cell lung cancer
A
- 95% are smokers
- Usually centrally located
- May cavitate
- Associated with Hypertrophic Pulmonary Osteoarthropathy
- Associated with hypercalcemia
6
Q
4 key features of adenocarcinoma lung cancer
A
- Most common subtype
- Increased incidence in never smokers
- Peripherally located
- Metastatic at presentation usually
7
Q
4 key features of small cell lung cancer
A
- Considered metastatic at presentation
- Almost all smokers
- Central location
- Highly associated with paraneoplastic syndromes (except hypercalcemia)
8
Q
7 Key features of Bronchoalveolar Cell carcinoma of the lung
A
- ALso called adenocarcinoma in situ
- Subtype of adenocarcinoma (about 5%)
- Often in smokers and females
- Presents as either a
- Solitary nodule
- Lobar consolidation (pneumonia that won’t go away)
- Multiple nodules
- Classic symptoms of hyperproduction of mucous and “salty tasting” sputum
- Extremely slow growing
- Less likely to be PET positive
9
Q
What percent of lung cancers will have paraneoplastic syndrome?
A
5%
10
Q
% of lung cancers that are asymptomatic
A
5-15%
11
Q
4 Key facts from the National Lung Screening Trial
A
- Randomized 50,000 persons to LDCT or CXR
- 20% reduction of lung cancer specific mortality in CT arm
- 7% reduction in overall mortality
- 25% of the CT screens showed an abnormality
12
Q
Criteria for lung cancer screening
A
- Age 55-74 (77 for Medicare)
- Smoking history of at least 30 pack years unless quit 15 years ago or more
3.
13
Q
Minimum size for a nodule to be classified as a mass
A
3 cm
14
Q
3 patient characteristics that increase risk of solitary nodule being malignant
A
- Increased age
- Smoking history
- History of extrathoracic malignancy
15
Q
3 nodule characterstics for a solitary nodule that increase the risk of malignancy
A
- Larger size
- Spiculation
- Upper lobe location (2/3 of mets are upper lobe)
16
Q
Which solitary nodule risk formula should you use for incidental nodules and which for screening detected
A
- Screening detected = Brock
- Incidental = Mayo
17
Q
% chance of malignancy based off size of nodule
A
- 2-5 mm = 1%
- 6-10 mm = 24%
- 11-20 mm = 33%
- 21-45 mm = 80%
18
Q
Likelihood ratio for malignancy based off nodule border type
A
- Smooth = 0.2
- Lobulated = 0.5
- Spiculated = 5.0
- Corona radiata = 14
19
Q
A
- Benign
- A = Central
- B = Laminate
- C = Diffuse
- D = Popcorn
- Indeterminante
- E = Stippled
- F = Eccentric (“scar carcinoma”)
20
Q
Low, Intermediate, and High risk pulmonary nodule % and treatment
A
- Low = < 5%
- Serial CTs
- Intermediate = 5 - 60%
- PET, TTNA, Bronch
- High = > 60%
- Excisional biopsy with frozen section
21
Q
A non-diagnostic biopsy is how much more favorable of benign disease
A
5x
22
Q
Probability of pneumothorax with CT guided biopsy and how many of those need chest tube
A
15% median probability with 6% needing chest tube
23
Q
2 causes of false negative and 1 cause of false positive PET scan
A
- False Negative
- Small nodules (< 8-10 mm)
- Well-differentiated adenocarcinoma (BAC) and carcinoid
- False positive
- Granulomas/infection
24
Q
3 steps to diagnosis of malignant pleural effusion
A
- Tap fluid and send (only 50% chance of getting malignancy)
- Tap fluid again if negative
- If still negative, send for VATS or pleuroscopy
25
T staging of a Nodule \< 1 cm
T1a
26
T staging of a 1-2 cm lesion
T1b
27
T staging of a 2-3 cm lesion
T1c
28
T staging of a 3-4 cm lesion
T2a
29
T staging of a 4-5 cm lesion
T2b
30
T staging of a 5-7 cm lesion
T3
31
T staging of a lesion \> 7 cm
T4
32
T staging of a central (mainstem bronchus) tumor regardless of distance from carina or atelectasis
T2
33
Does invasion of the mediastinal pleura count for T staging?
No, previously was T4
34
N1, N2, and N3 nodes location
35
Node Location Anatomy
36
M staging with pleural/pericardial mets, malignant pleural or pericardial effusion, or a 2nd cancer nodule in the contralateral lung
M1a
37
M staging with a single distant metastasis
M1b
38
M staging for multiple distant metastases
M1c
39
Limited stage small cell definition
Tumore confined to 1 hemithorax, mediastinum, or supraclavicular nodes
40
Extensive stage small cell lung cancer definition
Clinically detectable distant metastasis or any involvement of the pleura or pericardium
41
4 most common sites of involvement for small cell lung cancer mets
Bone, liver, CNS, adrenals
42
FEV1 threshold on PFT for pneumonectomy and lobectomy
* Pneumonectomy = 2L
* Lobectomy = 1.5L
43
FEV1 % predicted threshold that increases risk for respiratory complications
\< 60%
44
Pre-op DLCO threshold that predicts respiratory complications and mortality
\< 60%
45
Post OP FEV1 threshold linked to 50% chance mortality
\< 40%
46
Test needed before pneumonectomy to predict post op FEV1
VQ scan
47
Algorithm for major anatomic resection
48
Follow up for low risk solid nodule \< 6 mm
None
49
Follow up low risk nodule 6-8 mm
CT at 6-12 months,
then consider at 18-24 months
50
Follow up low or high risk solid nodule \> 8 mm
Consider CT, PET, or tissue sampling at 3 months
51
Follow up high risk solid nodule \< 6 mm
Optional CT at 12 months
52
Follow up high risk solid nodule 6-8 mm
CT at 6-12 months
Repeat at 18-24 months
53
Follow up low risk multiple nodules \< 6 mm
None
54
Follow up low risk multiple nodules 6-8 mm
CT 3-6 months
Consider repeat at 18-24 months
55
Follow up low risk multiple nodules \> 8 mm
CT 3-6 months
Consder repeat at 18-24 months
56
Follow up high risk mulitiple nodules \< 6 mm
Optional CT at 12 months
57
Follow up high risk multiple nodules 6-8 mm
CT at 3-6 months
Repeat at 18 - 24 months
58
Follow up high risk multiple nodules \> 8 mm
CT at 3-6 months
Repeat at 18-24 months
59
Follow up ground glass nodule \< 6 mm
None
60
Follow up ground glass nodule \> 6 mm
CT 6-12 months to confirm persistence
Then every 2 years until 5 years
61
Follow up parly solid nodule \< 6mm
None
62
Follow up partly solid nodule \> 6 mm
CT at 3-6 months to confirm persistence
If unchange AND solid component \< 6 mm, annual CT for 5 years
63
Follow up multiple subsolid nodules \< 6 mm
CT 3-6 months
If stable, consider at years 2 and 4
64
Follow up multiple subsolid nodules \> 6 mm
CT 3-6 months
Use most suspicious nodule to guide decision from there
65
Treatment of Stage 1 NSCLC
Lobectomy with mediastinal node dissection
66
5 patients with stage 1 NSCLC for whom sublobar resection is acceptable
1. Poor cardiopulmonary reserve
2. Elderly
3. Second primary tumor
4. Very small tumor
5. Those with BAC
67
Patients for whom a mediastinal staging is not required
T1A with PET/CT negative nodes
68
NSCLC follow post treatment
CT every 6 months for 2 years, then annually till year 5
69
Radiation treatment for non-surgical NSCLC patients
Stereotactic Body Radiotherapy (SBRT)
AKA
Stereotactic Ablative Radiotherapy (SABR)
70
Treatment for NSCLC Stage 2
Surgery with adjuvant chemotherapy
71
Treatment for NSCLC stage IIIA
Chemotherapy with adjuvant immunotherapy
72
Treatment for NSCLC stage IIIB
Chemo and radiation if good functional status
Radiation only if poor functional status
73
Treatment NSCLC Stage 4
Platinum based chemotherapy doublet
Targeted therapy
Immunotherapy
Supportive care
74
4 platinum based chemotherapy regimens for NSCLC
Cisplatin/Paclitaxel
Carboplatin/Paclitaxel
Cisplatin/Docetaxel
Cisplatin/Gemcitabine
(NO benefit one over the other)
75
4 approved drugs for EGFR mutation NSCLC
1. erlotinib
2. gefitinib
3. afatinib
4. osimertinib
76
4 approved drugs for ALK fusion NSCLC
1. Crizotinib
2. Alectinib
3. Ceritinib
4. Brigatinib
77
Single drug approved for ROS1 fusion NSCLC
Crizotinib
78
2 drugs approved for BRAF V600E mutation NSCLC
1. Dabrafenib
2. Trametinib
79
4 patients that are likely to be EGFR positive in NSCLC
1. Adenocarcinoma
2. Never smokers
3. Females
4. East asian heritage
80
Duration of treatment for chemotherapy responsive NSCLC
* 4-6 cycles, then observe
* Non-squamous cell can be maintained on pemetrexed
* Some reports of maintenance erlotinib
81
Mutation associated with resistance to EGFR drugs
EGFR T790M
82
Timing of pneumonitis after immunotherapy for NSCLC
Median time around 2.5 weeks
83
Standard regimen for small cell lung cancer extensive stage
Cisplatin and VP-16 (etoposide)
Carboplatin and VP-16 may be less toxic
Cisplatin and irinotecan is an option
84
Treatment duration for small cell lung cancer extensive stage
2-4 cycles
No benefit after 6 cycles
85
Treatment regimen for limited stage small cell lung cancer
Cisplatin and etoposide for 2-4 cycles
Adds XRT
Also gets prophylactic cranial radiation
