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Flashcards in PULM PART 3 Deck (10)
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1
Q

Cystic Fibrosis
Patho
Most common cause of severe chronic lung disease in young adults and the most common fatal hereditary disorder of whites in the US
• __________ disorder affecting 1 in 3200 whites; 1 in 25 is a carrier
• Caused by abnormalities in membrane ______ channel (cystic fibrosis transmembrane conductance regulator or ____ protein resulting in altered chloride transport and water flux across the apical surface of epithelial cells
• ½ of nearly 20,000 DF patients in the US are adults
• Increased risk of malignancies of GI tract, osteopenia and arthropathies

S/S
Chronic or recurrent productive _____, dyspnea, and wheezing
• Recurrent airway infections or chronic colonization of the airways with _______, _______, S aureus or Burkholderia cepacian. ________ and scarring on chest radiographs
• Almost all exocrine glands produce an abnormal ______that obstructs glands and ducts leading to tissue damage
• Respiratory tract: inadequate _____ of the tracheobronchial epithelium impairs mucociliary function
• High concentration of extracellular DNA in airway secretions increases sputum _______
Clinical Findings:
• Suspected in young adult with hx of chronic lung disease (esp bronchiectasis), pancreatitis or infertility
• Cough
• Sputum production
• Decreased exercise tolerance
• Recurrent hemoptysis
• Chronic rhinosinusitis
• _______
• ________
• ________l pain
Also possible
• Malnourished with low body mass index
• Digital clubbing
• Lungs
o Increased _______ diameter
o ________ to percussion
o Apical crackles
• Sinus tenderness
• Purulent nasal secretion
• Nasal polyps
• Biliary cirrhosis and gallstones are possible
• Men: congenital bilateral absence of the vas deferens with _______

Diagnostics
Sweat chloride concentration greater than __ mEq/L on two occasions or gene mutations known to cause cystic fibrosis
• Arterial blood gas studies reveal hypoxemia and in advanced disease a chronic compensated respiratory acidosis
• PFTs show mixed obstructive/restrictive pattern
o Reduction in ___, airflow rates and TLC
o Air trapping (high ratio of __ to TLC)
o Reduction in pulmonary diffusing capacity
Imaging
• ______ in early disease
• Peribronchial cuffing, mucus plugging, bronchiectasis, increased interstitial markings, small rounded peripheral opacities and focal atelectasis are common
• Pneumothorax can also be seen
• __ can confirm bronchiectasis
Diagnosis
• Quantitative pilocarpine iontophoresis sweat test
o Elevated sodium and chloride levels (greater than 60mEq/L
o Two tests on different days performed in experienced labs
o Normal sweat chloride test does not exclude the diagnosis
o Pursue genotyping or other alternative diagnostic studies
o Nasal membrane potential difference, semen analysis or assessment of pancreatic function

Prevention
Treatment
Early recognition and comprehensive multidisciplinary therapy improve symptoms control and the chance of survival
• Referral to regional treatment center
• Conventional tx programs focus on
o Clearance and reduction of lower airway secretions
o Reversal of bronchoconstriction
o Treatment of respiratory tract infections a
o Pancreatic enzyme replacement a
o Nutritional and psychosocial support
• Clearance of lower airway secretions
• ________
• Chest percussion or vibration techniques
• Positive expiratory pressure or flutter valve breathing devise
• Directed cough and other breathing techniques
• Inhaled recombinant human _____
o Cleaves extracellular DNA in sputum
o Decreases sputum _____
o Long term at daily nebulized dose of 2.5 mg
 Improves FEV1 and reduces the risk of DF related respiratory exacerbation and need for IV ABX
• Inhalation of hypertonic saline twice daily
o Small improvements in pulmonary function and fewer exacerbations

Short term ABX
• Treat _____ airway infections based on C and S of sputum
• S aureus including ____, mucoid variant of ______ are common
• H Flu and others are occasionally isolated
Long term ABX
• Helpful in slowing the disease progression and reducing exacerbations in patient with positive P aeruginosa cultures
• Include _______ (500mg three times a week; has immunomodulatory properties )
• Also ______ ABX two to three time a day.
• Incidence of atypical mycobacterial colonization is higher in CF patient
• Directed ABX recommended for frequent exacerbations, progressive decline in lung function or failure to thrive
• Yearly screening with sputum acid-fast bacilli cultures is advised
Inhaled bronchodilators
• ____2 puffs every 4 hours as needed
• Considered in patients who demonstrate an increase of at least 12% in FEV1 after inhaled bronchodilator
• Inhaled corticosteroid should be added to the tx regimen for patient with persistent asthma or allergic bronchopulmonary mycosis
______
• Oral medication available for the 5% of CF patients with G551D mutation
• Potentiator of the CFTR channel
• Works by increasing the time the channel remains open
• Found to improve lung function by 10% within 2 weeks of treatment
• Decreases pulmonary exacerbations by 55% and decrease sweat chloride into the indeterminate range
__________
• Only definitive treatment or advanced CF
• Double lung or heart-lung is required
• Afew transplant centers offer living lobar lung transplantation to selected patients
• 3 year survival rate is about 55%
Vaccination
• Pneumococcal infection and annual influenza vaccination
• Screening
• Family members and genetic counseling are suggested

A
autosomal recessive
chloride
CFTR
cough
H flu
P aeruginosa
bronchiectasis
mucus
hydration
viscosity
steatorrhea
diarrhea
abdominal
ap chest
hyperresonance
azoospermia
60
FVC, TLC
RV
hyperinflation
CT
postural drainage
DNA
viscosity
active
MRSA
P aeuginosa
azithromycin
inhaled
Albuterol
ivacaftor
lung transplantation
2
Q

Bronchiectasis
Patho
Congenital or acquired disorder of the large bronchi
• Characterized by permanent, abnormal _____ and _______ of bronchial walls
• May be caused by recurrent inflammation or _____ of the airways and may be localized or diffuse
• Most patients have pan hypergammaglobulinemia possibly reflecting an immune system response to chronic airway infection.
• ___ causes about ½ of all cases
• Other causes:
o Lung infection (__, fungal infections, lung abscess, pneumonia
o Abnormal lung defense mechanisms
o Deficiency with cigarette smoking
o Mucociliary clearance disorders
o Immunodeficiency states
o Localized airway obstruction

S/S • Chronic cough with production of copious amounts of _______ sputum
• _______
• Pleuritic chest pain
• ______ and wheezing in 75% of patients
• Weight loss, anemia and other systemic manifestations are common
• Physical findings are nonspecific
• Persistent crackles at lung bases are common
• Clubbing is infrequent in mild cases but common in severe cases
o Exact cause unknown; vasodilation/growth factors
• Copious, ________, purulent sputum is characteristic
• Obstructive pulmonary dysfunction with hypoxemia is seen in moderate or severe disease

Diagnostics
Radiographs
• Dilated and thickened bronchi that may appear as “_________” or as ______ like markings
• Scattered irregular _______, atelectasis and focal consolidation may be present
• High resolution ___ is the diagnostic study of choice

Microbiology
• _____ is the most common organism recovered from non CF patients
• ________ , S pneumonia and S Aureus are commonly identified
• Accelerated course with P Aeruginosa
o More frequent exacerbations and rapid decline in lung function
Prevention

Treatment
ABX
o Guided by sputum smears and cultures
o Screen for nontuberculous mycobacteria (may underlie lack of treatment response)
o Empiric oral antibiotic therapy for 10-14 days
o Amoxicillin or _________ ; ______ or tetracycline; ______ ; Cipro
• Chest physiotherapy with _________ and chest percussion
o Hand held flutter valve devices may be as effective as chest physiotherapy in clearing secretions
• Inhaled bronchodilators
• Preventive or suppressive treatment is sometimes given to stable outpatients with copious purulent sputum
o Prolonged macrolide therapy for 6-12 months decreases the frequency of exacerbations
o High dose Amoxicillin
o alternating cycles of _______ /______ for 2-4 weeks
• Underlying CF
o Inhaled aerosolized ________ reduce colonization by Pseudomonas species, improve FEV1 and reduce hospitalizations
• Surgical resection
o Reserved for the few patients with localized bronchiectasis and adequate pulmonary function in whom conservative treatment fails.
Misc.

A
dilation, destruction
infection
CF
TB
purulent
hemoptysis
dyspnea
foul smelling
tram tracks
ring
opacities
CT
H flu
P areuginosa
amoxicillin c lavulanate
ampicillin
TMP/SMX (bactrim)
macrolide/amoxicillin
aminoglycosides
3
Q

Mallamparti scoring
• To perform a Mallampati evaluation, with the patient seated, have the patient extend his neck, open his mouth fully, protrude his tongue, and say “ah.”
• Visualize the airway, looking for the tongue, soft and hard palate, uvula, and tonsillar pillars.
• In patients with a Mallampati score of _, the entire posterior pharynx is easily visualized; with a _, no posterior structures can be seen

A

1, 4

4
Q
Obstructive Sleep Apnea
Patho	
•	Intermittent cessation of airflow at the \_\_\_ and \_\_\_\_ during sleep
•	Sleep apnea syndrome – clinical disorder that arises from recurrent apneas during sleep
•	Apneas must be at least \_\_ seconds
Influencing factors:
Sleep 
•	Airway dilator and abductor muscle (loss of \_\_\_\_)
•	Protective airway reflex responses
•	\_\_\_\_\_ 
•	Anatomic disturbances–“pharyngeal crowding”
o	\_\_\_\_\_ hypertrophy 
o	\_\_\_\_\_\_\_\_  is a type of malocclusion which refers to a maxilla or mandible which is further posterior than would be expected. A retrognathic mandible is commonly referred to as an "\_\_\_\_\_ "
•	Obesity
o	MEN OF NORMAL WEIGHT: 11% INCIDENCE
o	OVERWEIGHT: 21%
o	\_\_\_\_\_ : 63%
•	Hormones
•	Macroglossia
•	Pregnancy
•	Smoking
S/S	PE findings:
•	Neck Circumference
o	>\_\_ inches in men; > \_\_ inches in women
o	Not applicable to children
•	Mallampati Score
History of:
•	Snoring
•	\_\_\_\_\_ sleepiness
•	Nocturnal choking/gasping
•	Witnessed apneas during sleep
•	Moderate obesity
•	Large neck circumference (>17 males;>16 women)
•	Mild-mod \_\_\_\_
Complications:
•	Cognitive & Behavioral disturbances
o	Loss of \_\_\_\_\_  sleep
•	Daytime sleepiness
o	Initially during passive conditions
o	Later active: 2-7x increased Motor vehicle accidents
•	Memory loss
•	Personality disturbances (\_\_\_\_\_\_\_)
•	Cardiorespiratory (increased ventricular afterload)
o	\_\_\_\_/\_\_\_\_\_arrhythmias
o	HTN (systemic/pulmonary)

Epidemiology •
Any age
• Men > Women
• Age 30-60; can occur ANY AGE
Diagnostics
_________
• Detailed overnight sleep study
• Electrographic variables (EEG, EOG)
• Ventilatory variables (central/obstructive)
• O2 sats
• HR, rhythm
• +/- PCO2
EEG
• The EEG (electroencephalogram) monitors ______ and can be used to determine the level of sleep or _______
• It is helpful for determining if an event (respiratory or limb movement) disrupts the level of sleep
EOG
• An EOG (electro-oculogram) measures ____ movements using sticker electrodes placed next to each eye.
• This measurement can help determine the duration of REM sleep.
EMG
• An EMG (electromyogram) measures _____ movements.
• Frequently, an additional monitor is placed on the chin to measure muscle relaxation (tone).
• During stage 1-4 sleep there is a baseline muscle tone; however, during REM sleep all muscles relax.
• The EMG also helps to determine the duration of REM sleep.
• An EMG of the legs can be used to detect “restless leg syndrome” or periodic leg movements during sleep
More tests:
• ______. is used to measure the decreases in oxygen in the blood during apneas and hypopneas
• The video monitor is most helpful for detecting movement disorders, parasomnias, or seizures during sleep
• Often a patient will not remember sleepwalking, sleep talking, or other parasomnias, so a video is helpful to review the events with the patient.)
Severity levels:
• SLEEP APNEA: AN AHI GREATER THAN _ EVENTS PER HOUR WITH AT LEAST ___ SYMPTOM OF DISTURBED SLEEP
• Obstructive sleep apnea can be categorized as mild, moderate, or severe
• This stratification helps to determine the direction of treatment

Treatment
• In people with nasal airway obstruction causing obstructive sleep apnea, nasal steroid sprays have been shown to be effective
• Topical nasal _______ , like oxymetalizone and ________, also can temporarily improve nasal swelling.
• ______ where appropriate!
• Avoid alcohol and other hypnotic medications.
Dental appliances:
• A dental appliance holds the jaw and tongue forward and holds the palate up thus preventing closure of the airway
• This small increase in airway size often is enough to control the apneas
• excellent treatment for ____. to _____ obstructive sleep apnea
____
• probably the best, non-surgical treatment for any level of obstructive sleep apnea
• In finding a treatment for obstructive sleep apnea, the primary goal is to hold the airway open so it does not collapse during sleep
• The dental appliances and surgeries focus on moving the tissues of the airway
• CPAP uses air pressure to hold the tissues open during sleep
Surgeries:
• UPPP: In simple terms, the _____ are removed, the _____ is removed, and the palate is trimmed higher
• A UPPP is successful 50-60% of the time in preventing or decreasing obstructive sleep apnea

Misc.

A
nose, mouth
10
tone
tone
ETOH
adenotonsillar
retrognathia
overbite
OBESE
17, 16
daytime
hypertension
slow-wave
depression
tachy/brady
polysomnography
brainwaves
wakefulness
eye
muscle
oximetry
5
one
decongestants
neosynephrine
weight loss
mild to moderate
CPAP
tonsils, uvula
5
Q

Central sleep apnea
Patho
• Abolition of Central drive to the ______ muscles
• Occurs because your ____ doesn’t send proper signals to the muscles that control your breathing

Conditions causing CSA
• _____ and degenerative changes in the cervical spine or the base of the skull
• Bulbar poliomyelitis
• Complications of cervical spine surgery
• _____ affecting the brainstem
• Neurodegenerative illnesses such as Parkinson’s disease
• Obesity
• Radiation of the cervical spine
• ____ affecting the brainstem
• Primary hypoventilation syndrome
• Use of certain medications such as narcotic-containing painkillers

S/S Defects
• Metabolic respiratory _____ defect
• Respiratory neuromuscular apparatus defect
• Chronic ________ during wakefulness
• ____ high alt or due to cardiopulm dz)
• RECURRENT APNEAS ARE NOT ACCOMPANIED BY RESPIRATORY EFFORT

A
ventilatory
brain
arthritis
encephalitis
stroke
control
hyperventilation
hypoxia
6
Q
Pickwickian syndrome
Patho	
Also called \_\_\_\_\_\_\_\_\_  syndrome
S/S	•	Awake hypoventilation (PaCO2 > \_\_ mmHg) in an obese person (BMI> 30)
•	Coexisting \_\_\_\_\_\_\_ with desaturation
Epidemiology	
Diagnostics	
Prevention	
Treatment	
	Treatment: \_\_\_ and lifestyle modification for weight loss
•	Other tmts: \_\_\_\_\_\_ for sleep disordered breathing or \_\_\_\_\_\_\_.  surgery
Misc.
A
hypoventilation
45
OSA
45
PAP
tracheostomy
bariatric
7
Q

. Staging and treatment of small cell lung cancer
• Traditionally divided into two categories
• _____ disease (30%) – tumor is limited to the unilateral hemithorax
• _______ disease (70%) – tumor extends beyond the hemithorax
• It is also recommended to stage according to the TNM guidelines
• Staging in NSCLC:
o T – describes the ____ and location of the primary ____
o N – describes the presence and location of _____ metastess
o M – refers to the presence or absence of _____metastases
o The TNM stages are grouped into summary stages I-IV
• Generalized staging guidelines:
o Thorough history and physical examination
o Identify performance status
o ____ scan can identify mediastinal spread and distant metastases
o _____I brain to evaluate for metastatic disease
o When PET not available, ____ abdomen/pelvis and bone scan are used

A
limited
extensive
size, tumor
nodal
distal 
PET
MRI
CT
8
Q

Pulmonary metastasis
Patho
• Results from spread of an _______ malignancy to the lung parenchyma through vascular or lymphatic channels or by direct extension
• Typically present as _____ nodules or masses on imaging
• Most common primary cancers are ____ , ____t, colon and rectum, cervix, and malignant melanoma
• Also seen in head and neck cancers and soft tissue sarcoma
• Metastatic cancer can also present as a malignant _________
• Lymphangitic carcinomatosis is diffuse involvement of the pulmonary lymphatic network

S/S
Epidemiology
Diagnostics
• Investigate for primary location using imaging and tumor markers
• ____ is useful for diagnosis and staging, _________ staining is used to identify primary
Prevention
Treatment
• Treat _____ malignancy
• Treat any pulmonary complications
• ________of solitary pulmonary nodule is possible, only if primary cancer is otherwise under control
• Stereotactic radiosurgery may be an option
• Unfavorable prognosis for large number of pulmonary nodules and short disease-free interval

Misc.

A
extrapulmonary
multiple
kidney, breast
pleural effusion
biopsy
immunohistochemical
primary
surgical resection
9
Q

Small cell Lung Cancer
Patho
Small cell (oat cell):
• About 10-15% of lung cancers
• Typically ______ located
• SCLC is more ______ and fast growing
• Usually responds more _____ to treatment
• Limited treatment options
S/S
• ______ and weight loss are common
• ___ cough or change in chronic cough
• ________
• Pain – nonspecific chest pain or pain due to bone metastases
• SOB – due to bronchial obstruction or pleural effusion
• ______
• Change in voice – due to compression of recurrent ______ nerve
• Superior vena cava syndrome
• ______ syndrome – ipsilateral ptosis, miosis, and anhidrosis
• ______ metastasis – weight loss and abdominal pain
• _____ metastasis – headache, N/V, seizure, dizziness, altered mental status
• Paraneoplastic syndromes – most common are ______, __________, hypercoagulability, and anemia
Biopsy methods:
• ____ guided lung biopsy
• _______ – allows for biopsy and brushing and lavage
• EBUS – endobronchial US with bronchoscopy can increase yield
• Navigational bronchoscopy allows biopsy of small peripheral nodules
• Risk of pneumothorax and bleeding varies
• Mediastinoscopy usually used for staging
• VATS and thoracotomy may be necessary
Epidemiology

Diagnostics
• Diagnosis is dependent on histology
• ________ gives best yield
• Sputum cytology is specific but not sensitive
• Fluid cytology also less sensitive
• Tumor markers are not sensitive or specific enough
• Diagnose and stage with single biopsy if possible
Prevention
Treatment General tx guidelines:
• Depends on type, stage, and molecular characteristics of the tumor
• SCLC – ________ and possibly _______
Surgical candidates:
• Preoperative assessment
o Labs
o Cardiac clearance
• Pulmonary function testing
o Many patients have chronic lung disease that increases risk of perioperative complications as well as long-term pulmonary insufficiency
o FEV1 determines risk for resection
SCLC tx:
• Response rate to _______ and _______ is 80-90% in limited-stage disease and 60-80% in extensive stage disease
• Remission tends to be ____ lived, median 6-8 months
• Median survival is 15-20 months in limited stage and 8-13 months in extensive stage
• Overall 2-year survival is 20-40% in limited stage and 5% in extensive stage
• Radiation therapy can improve survival in limited stage disease
• Consolidative RT may be indicated
• High rate of brain metastases, prophylactic whole brain RT is recommended
• Rarely, very early stage SCLC is found and patients are able to have surgery followed by adjuvant chemotherapy (due to high risk for micrometastases)
• _______ therapy:
o Can use radiation on central tumors to relieve obstruction or stop bleeding
o Radiation also used to palliate pain due to bone metastases
o Resection of a solitary brain metastasis improves quality of life and survival
o Pain syndromes are common in advanced disease and pain control is necessary
o Consult a Palliative Care team to help with symptom management
Misc. Risk factors:
• Cigarette smoking causes 80% of cases of lung cancer
o Risk increases with both quantity and duration of smoking
o Cigar and pipe smoking also increase risk
• Other environmental risk factors include radon gas, secondhand smoke exposure, asbestos, metals, industrial carcinogens
• Familial susceptibility plays a role in some cases
• Certain diseases increase risk: pulmonary fibrosis, COPD, sarcoidosis

A
centrally
aggressive
quickly
anorexia
new
hemoptysis
clubbing
laryngeal
horner
liver
brain
SIADH, hypercalcemia
CT. guided
bronchoscopy
tissue biopsy
chemotherapy, radiation
cisplatin, etoposide
short
palliative
10
Q
Non-small cell Lung Cancer
Patho	
Non-small cell:
•	NSCLC is the most \_\_\_\_\_type of lung cancer
•	Approximately 85% of lung cancers
•	\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_ cell carcinoma subtypes are most common
o	Adenocarcinoma: 
	Arises from \_\_\_\_\_ glands
	Most common (40% of cancers)
	Most common type in woman, non-smokers and younger patients
	Usually peripheral nodules
	\_\_\_\_ and \_\_\_\_\_ positive
o	Squamous cell carcinoma:
	Arise from \_\_\_\_\_ epithelium
	Linked with \_\_\_\_\_\_\_
	Can be intraluminal mass or centrally located
	More likely to cause hemoptysis
	\_\_\_ and \_\_\_ positive
  • Large cell carcinoma is more undifferentiated
  • Sarcomatoid is another subtype – has features of both carcinoma and sarcoma
  • Spreads more slowly
  • May be cured by resection in early stage
  • Systemic therapy is specific to histology and molecular mutations

S/S
• Anorexia and weight loss are common
• New cough or change in chronic cough
• Hemoptysis
• Pain – nonspecific chest pain or pain due to bone metastases
• SOB – due to bronchial obstruction or pleural effusion
• Clubbing
• Change in voice – due to compression of recurrent laryngeal nerve
• Superior vena cava syndrome
• Horner syndrome – ipsilateral ptosis, miosis, and anhidrosis
• Liver metastasis – weight loss and abdominal pain
• Brain metastasis – headache, N/V, seizure, dizziness, altered mental status
• Paraneoplastic syndromes – most common are SIADH, hypercalcemia, hypercoagulability, and anemia
Biopsy methods:
• CT guided lung biopsy
• Bronchoscopy – allows for biopsy and brushing and lavage
• EBUS – endobronchial US with bronchoscopy can increase yield
• Navigational bronchoscopy allows biopsy of small peripheral nodules
• Risk of pneumothorax and bleeding varies
• Mediastinoscopy usually used for staging
• VATS and thoracotomy may be necessary
Epidemiology
Diagnostics
• Diagnosis is dependent on histology
• Tissue biopsy gives best yield
• Sputum cytology is specific but not sensitive
• Fluid cytology also less sensitive
• Tumor markers are not sensitive or specific enough
• Diagnose and stage with single biopsy if possible
Prevention
Treatment General tx guidelines:
• Depends on type, stage, and molecular characteristics of the tumor
• Early stage NSCLC – ______ is treatment of choice, with or without ______ or radiation
• Late stage NSCLC – _______, targeted therapy, and/or immunotherapy, possibly radiation

Surgical candidates: 
•	Preoperative assessment
o	Labs
o	Cardiac clearance
•	Pulmonary function testing
o	Many patients have chronic lung disease that increases risk of perioperative complications as well as long-term pulmonary insufficiency
o	FEV1 determines risk for resection

NSCLC tx:
• Cure unlikely without resection
• Initial questions:
o Is surgical resection technically feasible?
o Is the patient able to tolerate the surgery?
• Surgery not possible in many instances
• Stage I and Stage II – ______
• Stage IIIA – undergo multimodality treatment that includes _____ when possible, and _____ or radiation, or both
• Stage IIIB – concurrent _______ and radiation
• Stage IV – _______ and/or symptom-based _______therapy
• Surgical resection:
o Wedge resection
o Sublobar resection
o Lobectomy
o Partial pneumonectomy
o Pneumonectomy
o VATS is a reasonable alternative to thoracotomy

• STEREOTACTIC RADIATION THERAPY
o Stage I patients who are not candidates for ______may have SBRT
o Large dose of radiation to a small, well defined target
o Usually given over 1-5 doses
o Takes 30-60 minutes each treatment
o Three-year local control exceeds 90%
• NEOADJUVANT CHEMOTHERAPY
o Giving ______ drugs in _____ of surgery or radiation therapy
o More widely used in Stage ___or Stage ___ disease to make patient a surgical candidate or make surgery more successful
• CONCURRENT CHEMOTHERAPY/RADIATION
o Chemotherapy and radiation are given together on a specific schedule
o Chemotherapy given on schedule depending on regimen
o Radiation given daily over 6-7 weeks
o More difficult to tolerate due to increased side effects
• ADJUVANT CHEMOTHERAPY
o Giving antineoplastic drugs ______ surgery or radiation
o Increases overall survival
o For patients with poor performance status, chemotherapy risks can outweigh the benefit
• CHEMOTHERAPY
o In Stage ___ or Stage ___ disease, chemotherapy is not curative, but provides an increase in survival when compared to supportive care alone
o Palliative chemotherapy can lead to increased symptom control and quality of life
o The choice of treatment is tailored to histologic type and NCCN guidelines
o Maintenance chemotherapy may be continued after the initial 4-6 induction cycles
• Immunotherapy
o Stimulates bodys own immune system to target and kill cancer cells
o Checkpoint inhibitors work by blocking a signaling protein that allows cancer cells to hide from the immune system
o Examples are: Opdivo (nivolumab), Keytruda (pembrolizumab), Tecentriq (atezolizumab), Imfinzi(durvalumab)
o Many can now be used first-line in combination with chemotherapy

A
common
adenocarcinoma
squamous cell
mucous
TTF-1, napsin-A positive
bronchiol
smoking
P63, P40
surgery, chemotherapy
chemotherapy
resection
surgery
chemo
chemo
chemo
palliatiive
surgery
antineoplastic
advance
IIIA, IIIB
following
IIIB, IV