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Flashcards in Malignancies Deck (85):
1

What percent of lung cancers are found to be metastatic at the time of diagnosis?

56%

2

Who is typically affected with Lung CA?

70 yo men who smoke

3

What ethnicity is most affected with lung CA?

Males -blacks
Females- whites

4

What is the average age of death of lung cancer?

72

5

Which ethnicity is least affected by lung cancer?

Hispanics

6

How many genetic mutations are there with every 15 cigarettes smoked?

1

7

What are the genetic predispositions to developing lung cancer?

Chromosome fragility
CYP1A1

8

What element increases the risk for lung cancer?

Radon

9

What type of lung disease increases the risk for lung cancer?

Pulmonary fibrosis

10

What is the major prevention technique for lung cancer?

Smoking cessation and prevention

11

What percent of people who get diagnosed with lung cancer never smoked or in those who quit for at least a year?

60%

12

Which gender is more affected with lung cancer unrelated to smoking?

Women

13

What is the increase in lung cancer incidence with environmental smoke?

20-30%

14

True or false: CXRs are not reliable for diagnosing lung malignancies

True

15

What are the typical ssx of lung cancer, beside B symptoms?

-Chest pain
-Bone pain
-Wheezing and stridor

16

SVC obstruction is usually pathognomonic for what?

Lung CA

17

If you find something on a CXR that is suspicious for a mass, what should you look for?

Old films

18

What is the size of nodules that are benign?

Less than 2 cm in size

19

What is the morphology of nodules that are most likely benign?

Central, concentric popcorn calcifications

20

Over what age should raise your suspicious of lung cancer if you find a mass in the lungs?

35

21

If a lung nodule is calcified, is this most likely benign or malignant?

Benign

22

What is the most common causes of nodules in CXR in Iowa?

Histoplasmosis

23

What is the most common cause of lung cancer?

Cannonball lesions (secondary metastases)

24

What percent of malignant solitary tumors of the lungs are metastatic lesions?

10%

25

What are the cancers that like to metastasize to the lung?

-Breast
-Colorectal
-Prostate
-Cervical
-Endometrial

26

Multiple masses in the lungs suggests what source of cancer?

Metastatic (secondary tumors)

27

What are the three major NSCLCs?

-Squamous cell CA
-Adenocarcinoma
-Large cell carcinoma

28

What are NSCLCs?

Lung cancers that arise from the respiratory epithelium

29

What is SCLC?

usually a centrally located neuroendocrine tumor that is associated with tobacco smoking

30

What are the histological characteristics of SCLC? (3)

Rosettes
Trabeculae
Palisades

31

What are the hormones that are often secreted with SCLC?

AVP
ACTH
GRP

32

What is the prognosis with SCLC?

Really Bad--early metastasizes

33

True or false: SCLC usually comes back after treatment

True

34

What is squamous cell lung CA?

Centrally located mass associated with smoking

35

What are the histological characteristics of squamous cell lung CA?

Keratin pearls

36

What are the characteristics of the lesions with squamous cell lung CA?

Cavitary

37

Where does squamous cell CA usually met to?

Hilar lymph nodes

38

What is the #1 lung cancer in non-smokers?

Adenocarcinoma

39

What is adenocarcinoma of the lung?

Typically a peripherally located mass

40

What are the histological characteristics of adenocarcinomas of the lung?

Signet rings
Mucinous

41

What is the prognosis of adenocarcinoma?

Wide mets

42

What are the radiologic findings with adenocarcinoma of the lung?

Fluffiness and ground glass appearance

43

What is large cell lung CA?

Peripherally located mass with poor differentiation

44

What are the histological characteristics of large cell CA?

Sheets of cells, often with necrosis

45

What are the gross findings of large cell carcinoma?

Cavitating mass

46

What is the prognosis with large cell CA?

Late distant mets

47

What are the classic ssx of a pancoast tumor?

Horner's syndrome + brachial plexus involvement

48

What are the ssx of SVC syndrome?

-Head swelling
-CNS sx
-Increased BP in UE

49

What are the ssx of horner's syndrome?

miosis
ptosis
anhidrosis

50

All types of paraneoplastic syndrome can cause what?

Dermatomyositis

51

What are the metabolic findings with paraneoplastic syndrome from squamous cell carcinoma? Why? Why lab will be lower with this?

Hypercalcemia
Tumor produces PTHrP (parathyroid related hormone)

Low PTH since there is feedback

52

What happens with paraneoplastic syndrome d/t SCLC? (3)

-Cushing syndrome
-SIADH
-Eaton-Lambert syndrome

53

What is Eaton Lambert syndrome?

AB against Ca channel in presynaptic channel, causing MG

54

What happens with paraneoplastic syndrome with adenocarcinoma? (3)

-DIC
-Thrombophlebitis
-Hemolytic anemia

55

How do you differentiate Eaton-Lambert syndrome from MG?

MG will get progressively weaker

Eaton-Lambert syndrome will get progressively stronger

56

What happens with paraneoplastic syndrome with large cell CA?

Gynecomastia

57

Hematocrit levels below what value is suspicious for metastatic disease?

Less than 40% in women
Less than 35% in men

58

What are the lab values that are suspicious of metastases? (LFTs x3, metabolic)

Elevated alk phos
GGT
SGOT
Ca

59

What are the four most likely sites of metastases for lung cancer?

Liver
Brain
Bone
Adrenals

60

How do you diagnose lung cancer?

*Biopsy*

61

What is endobronchial ultrasound guided biopsy?

US guided biopsy

62

What are the indications for annual low dose CT scans for lung CA? (age range, smoking history, current health)

-Age 55-74
-More than 30 pack year
-Current smoker or quit in the last 15 years
-In good health

63

What are the components of the TMN staging of lung cancer?

Tumor
Node
Metastasis

64

What is a T4 tumor?

So big that it invades other organs, or in a really bad spot

65

What is the general trend of tumor staging?

Higher number = bigger

66

What is M1a?

Mets to the lung or a malignant pleural effusion

67

What is M1b?

Distant metastases

68

True or false: any metastatic lesion means the cancer is stage 3

False- stage 4

69

What is the treatment for stage I or II NSCLC?

Resection
Chemo/radiation

70

What is the treatment for stage III NSCLC?

Chemoradiation

71

What is the treatment for stage IV NSCLC?

Palliative
Chemo

72

True or false: surgery is rarely indicated for small cell lung cancer. Why or why not?

True-- so fast mets

73

What is the treatment for advanced SCLC?

Chemo
Radiation

74

What is the MOA of nivolumab? What is it used for?

Monoclonal ab against programmed cell death receptor to decreased NSCLC (non-squamous)

75

What is the MOA of Pembrolizumab? What is it used for?

IgG3 Ab against PD-L1 ligand for programmed cell death receptor

Metastatic NCLC

76

Does cutting back on smoking have any effect on lung cancer incidence?

Nah

77

What is the effect of smoking on chemo?

Worsens side effects

78

How long does it take to develop mesothelioma?

30+ years

79

What is the risk of getting lung cancer with mesothelioma if you smoke as well?

x2

80

What causes the pleuritic chest pain with mesothelioma?

Pleural thickening causes rubbing and effusion

81

What is the most common benign pulmonary lung nodules?

hamartomas--usually composed of normal tissue

82

Which gender is more often affected with benign pulmonary neoplasms?

Males

83

If you get a histology sample of a lung mass back with a lot of necrotic tissue, what should you suspect?

SCLC

84

What is the M staging if you cross the midline?

M3

85

True or false: ANY metastasis with lung cancer indicates stage 4 cancer

True