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FM2 > Lung Cancer (Respiratory Block) > Flashcards

Lung Cancer (Respiratory Block) Flashcards

1
Q

Lung cancer is the second most common cancer diagnosis but the ________ most common cause of cancer mortality

A

First/ number one

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2
Q

Smoking is estimated to cause _____% of lung cancer causes

A

85-90%

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3
Q

Currently about ___% of Americans still smoke

A

20%

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4
Q

Average smokers are defined as _____ pack-years and have a 10x increased risk of lung cancer whereas heavy smokers are defined as ___ pack- years and have a 20x increased risk of cancer

A

10; 20

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5
Q

Why is smoking cessation beneficial even after a lung cancer diagnosis?

A

Symptomatic relief from other problems
Anti-cancer therapies are more effective and have reduced side effects in non-smokers (oxidative damage from chemo is worse in smokers)

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6
Q

What is the relationship between second hand smoke and lung cancer

A

50% increased relative risk compared to non-smokers

3-5% of all lung cancers caused by second hand smoke

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7
Q

Asbestos is associated with a ___x increased risk of lung cancer, and strongly associated with risk of _________

A

5x increased risk of lung cancer

mesothelioma

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8
Q

______ is the second leading cause of lung cancer behind smoking and increases lifetime risk by 0.3%

A

Radon 222

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9
Q

Describe the relative percentages of different types of lung cancers

A 
Small cell lung cancer (SCLC) ~15% of all lung ca
Non small cell lung cancer (NSCLC) ~80%
- Squamous cell 25-40% but decreasing
- Adenocarcinoma 25-40% but increasing
- Large cell carcinoma ~10%
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10
Q

Describe features of squamous cell carcinoma

A
  • centrally located
  • associated with smoking
  • associated paraneoplastic syndrome= PTH-RP secretion, hypercalcemia
  • precursor lesion: metaplasia–> dysplasia–> carcinoma in situ–> carcinoma
  • keratinization and intracellular bridges
  • can have central necrotic cavidation
  • associated with p53 mutation
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11
Q

Describe features of large cell carcinoma

A
  • large cells with pleomorphic nuclei, no glandular differentiation
  • peripherally located
  • common giant cells or clear cells
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12
Q

Describe features of adenocarcinoma

A
  • common in women, non-smokers (75% occur in smokers)
  • peripherally located, pleural puckering
  • AAH is precursor lesion
  • acinar appearance, clusters of glands with intracellular mucin
  • TTF-1 positive
  • associated with KRAS and EGFR mutations
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13
Q

Describe features of carcinoid tumors

A
  • slow growing/ low grade neuroendocrine tumors derived from Kulchitsky cells; positive for chromogranin and synaptophysin
  • nests or cords of uniform, bland cells
  • post-obstructive pneumonia
  • typical vs atypical
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14
Q

Describe features of small cell carcinoma

A
  • small, blue staining cells with scant cytoplasm, fast growing soft masses with necrosis and metastasis to nodes
  • blue tightly packed nuclei–> nuclear modeling, azzopardi phenomenon (encrusted DNA) and crushed cell appearance
  • can quickly outgrow blood supply and show central necrosis
  • associated with Eaton-Lambert paraneoplastic syndrome- antibody against voltage gated Ca channel, proximal symmetric muscle weakness
  • associated with ectopic ACTH production and SIADH (hyponatremia)
  • associated with p53 and RB1 mutations, positive neuroendocrine markers
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15
Q

List mutations associated with adenocarcinoma

A
  • KRAS

- EGFR

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16
Q

What screening technique has been shown to lower lung cancer mortality in heavy smoking populations?

A

Serial CT, low dose

17
Q

List presentation/ features of Pancoast tumors

A
  • tumor of superior sulcus extending into chest wall/ pleura
  • horner’s syndrome: ptosis, myosis, anhydrosis
  • shoulder/ upper arm pain and wasting of intrinsic muscles of hand
18
Q

List presentation for a patient with SVC syndrome

A
  • large central mediastinal mass causes obstruction of SVC

- swollen purple face, headache, dyspnea, vascular distension and formation of collateral blood vessels

19
Q

Describe hypercalcemia as a paraneoplastic syndrome

A

bony invasion or secretion of PTH-RP (squamous cell carcinoma)

20
Q

Describe endocrine abnormalities associated with paraneoplastic syndromes

A

Ectopic ACTH production- Cushing’s
SIADH (hyponatremia)
Associated with small cell lung cancer

21
Q

Describe bronchoscopy and its limitations

A

Inserting fiber optic bronchoscope to detect intrabronchial pathology
Limitation if lesion is peripheral or if upper lobe

22
Q

Describe percutaneous image guided biopsy and its limitations

A

Using imaging to guide needle insertion to get biopsy

Limitation if central lesion

23
Q

List common sites of metastasis for lung cancer

A

** adrenal glands

liver, bone, brain

24
Q

True or false: CT is the best imaging modality to assess for CNS metastasis

A

FALSE, need brain MRI with contrast

25
Q

Describe treatment for non-small cell lung cancer

A
  • surgery if tumor is resectable and patient can tolerate (performance status matters)
  • post- op chemo for larger primary tumors or those with positive ipsilateral nodal involvement
  • Stage III disease- commonly chemo + radiation but no surgery- distant relapse before local so costs of surgery outweigh benefits
  • metastatic disease treated primarily with chemotherapy with possible supportive tx with radiation/ surgery at metastatic sites to improve symptoms (CNS, bone)
26
Q

What is the rough median survival time for lung cancers

A

about 12 months

27
Q

What targeted agents are appropriate for patients with EGFR mutation positive primary tumors?

A

EGFR mutation common in non-smokers, women, Asians
Erlotinib, gefitinib (no longer FDA approved), afatinib
Dramatic improvement in progression free survival

28
Q

Erlotinib targets tumors with what mutation?

A

EGFR exon 19 mutation

29
Q

Why is the T790 mutation concerning?

A

EGFR mutation, confers resistance to erlotinib

30
Q

What is the targeted agent for primary tumors with ALK rearrangements?

A

Crizotinib

31
Q

Describe how small cell lung cancer is staged

A

limited- confined to one hemithorax

extensive: not confined to one hemithorax

32
Q

Describe how small cell lung cancer is treated

A

limited: aggressive chemo + radiation- good overall response rate but high rates of distant relapse. Some evidence for prophylactic cranial irradiation but limited role for surgery
extensive: chemotherapy, possibly radiation (if few metastatic lesions), no role for surgery. Relapse is certainty.

33
Q

Describe prognosis for small cell lung cancer

A

Limited: 14-20 months
Extensive: 8-13 months

5 year survival improving for limited stage disease with prophylactic cranial irradiation but near zero for extensive disease

34
Q

Describe double effect and its role in palliative care decisions

A

Ethical principle, advocates for evaluating the permissibility of acting when one’s otherwise legitimate act (for example, relieving a terminally ill patient’s pain) may also cause an effect one would normally be obliged to avoid (sedation and a slightly shortened life).

35
Q

Describe features of bronchioloalveolar carcinoma

A

BAC: subtype of adenocarcinoma

  • cells grow along alveolar septa in lepidic pattern with no invasion or destruction of surrounding tissue
  • low grade, well differentiated- good prognosis
  • pneumonia like consolidation pattern
  • derived from AAH and may be precursor to adenocarcinoma (AAH–> BAC–>ADCA)
36
Q

Describe features of atypical adenomatous hyperplasia

A

AAH: precursor lesion for BAC and ultimately ADCA

- Mild nuclear atypica, no nuclear crowding, few mitosis

FM2 (11 decks)

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