Lung neoplasms and malignancy

Question 1

what are the major risk factors for lung cancer?

Answer 1

smoking 
occupational 
ionizing radiation 
p450 polymorphisms - CYP1A1 
chromosome fragility

Question 2

what % of newly diagnosed lung cancer occur in those who never smoked?

Answer 2

60%

Question 3

what are the major presenting signs and symptoms of lung cancer?

Answer 3

weight loss 
chest pain 
bone pain 
fever 
SVCO 
wheezing and stridor

Question 4

what tests are ordered for a likely cancer diagnosis?

Answer 4

PET
biopsy
resection

Question 5

what are the most common cancers that metastasize to the lung?

Answer 5

breast 
colorectal 
prostate 
cervical 
endometrial 
renal 
head / neck

Question 6

what are the non small cell lung cancers?

Answer 6

squamous cell CA
adenocarcinoma
large cell CA

Question 7

lung cancer arises from what tissue?

Answer 7

respiratory epithelium (alveoli, bronchioles, bronchi)

Question 8

which NSCLC cancer type has a classic association with smoking?

Answer 8

squamous cell

Question 9

what are the features of squamous cell CA?

Answer 9

centrally located mass
nests of cells, often have keratin pearls
can cavitate

Question 10

what is the current #1 lung cancer in non-smokers?

Answer 10

adenocarcinoma

Question 11

what are the features of adenocarcinoma?

Answer 11

bronchoalveolar
peripherally located
multiple subtypes / variants
wide metastases

Question 12

what are the features of large cell CA?

Answer 12

usually peripheral
sheets of cells, often with necrosis
poor differentiation

Question 13

what are some lung cancer-associated syndromes?

Answer 13

horner syndrome
pancoast’s syndrome
SVC syndrome

Question 14

all types of paraneoplastic syndromes can cause what condition?

Answer 14

dermatomyositis

Question 15

what is/are the paraneoplastic syndromes associated with squamous cell CA?

Answer 15

hypercalcemia - PTHrP

Question 16

what is/are the paraneoplastic syndromes associated with small cell CA? why?

Answer 16

cushing’s syndrome - ACTH, cortisol
SIADH - ADH
eaton-lambert syndrome - calcium channel antibody

it is a neuroendocrine tumor

Question 17

what is/are the paraneoplastic syndromes associated with adenocarcinoma?

Answer 17

DIC
thrombophlebitis
microangiopathic hemolytic anemia

Question 18

what is/are the paraneoplastic syndromes associated with large cell CA?

Answer 18

gynecomastia

Question 19

what are the most likely metastasis sites for lung cancer (where does it go)?

Answer 19

liver
brain
bone
adrenal

Question 20

what is the definitive diagnostic test for lung cancer?

Answer 20

biopsy

Question 21

what are the indications for low dose CT?

Answer 21

age 55-74
over 30 pack year smoking history
current smoker or have quit within the last 15 years
in relatively good health

Question 22

treatment: NSCLC stages I and II

Answer 22

resection possible

chemo / radiation

Question 23

treatment: NSCLC stage III

Answer 23

chemo

Question 24

treatment: NSCLC stage IV

Answer 24

chemo

palliative

Question 25

treatment: SCLC - solitary nodule, no regional nodes, no distant mets

Answer 25

surgery (rare)

Question 26

treatment: SCLC - advanced

Answer 26

chemo

radiation

Question 27

what are the biologic agents for lung cancer? what is the MOA?

Answer 27

nivolumab
pembrolizumab

monoclonal IgG4 Ab

Question 28

half of benign lung neoplasms are what type of growth?

Answer 28

hamartoma