22 - Lung Cancer

Question 1

What percentage of smokers will get lung cancer in their life time?

Answer 1

20-30%

Question 2

How does the risk of lung cancer decrease after smoking cessation?

Answer 2

80-90% reduction in risk after 15 years, but never back to the risk of a non-smoker

Question 3

Aside from smoking, what are the risk factors for lung cancer?

Answer 3

• second hand smoke
• radon
• ionizing radiation
• pollution
• asbestos
• pulmonary fibrosis
• COPD
• HIV
• nickel
• arsenic
• beryllium
• genetics (60% of patients have a p53 mutation)

Question 4

What are the 3 ways that someone will present with lung cancer?

Answer 4

• symptomatic
• nodule/mass discovered on screening
• nodule/mass incidental finding

Question 5

What are the symptoms of lung cancer? What does the presence of symptoms suggest?

Answer 5

• cough
• hemoptysis
• chest pain
• dyspnea

Suggests the disease is progressed past the point of being curable my surgery

Question 6

What type of lung cancer has a good prognosis?

Answer 6

Adenocarcinoma in-situ

Question 7

Adenocarcinoma is [slow/fast] growing.

Answer 7

slow

Question 8

Small cell lung cancer is [slow/fast] growing.

Answer 8

fast

Question 9

What types of lung cancer are associated with early metastases?

Answer 9

• adenocarcinoma

- large cell lung cancer

Question 10

Large cell lung cancer is [central/peripheral].

Answer 10

Peripheral

Question 11

Which type of lung cancer is most commonly associated with paraneoplastic syndromes?

Answer 11

Small cell lung cancer

Question 12

What are the common sites of metastases from lung cancer?

Answer 12

• bone
• brain
• liver
• lymph nodes
• adrenal glands

Question 13

What type of lung cancer causes SIADH?

Answer 13

small cell lung cancer

Question 14

What type of lung cancer causes ACTH?

Answer 14

small cell lung cancer

Question 15

What type of lung cancer causes Lambert-Eaton Syndrome?

Answer 15

small cell lung cancer

Question 16

What type of lung cancer causes neurologic syndromes?

Answer 16

small cell lung cancer

Question 17

What key radiographic features suggest malignancy?

Answer 17

• increased size (> 2.5 cm)
• ragged/speculated margins
• doubling time (< 2 years)
• absence of calcification

Question 18

In cancer staging, what does T indicate?

Answer 18

• size
• location
• invasion

Question 19

In cancer staging, what does N indicate?

Answer 19

level of lymph node involvement

Question 20

In cancer staging, what does M indicate?

Answer 20

if distant metastases

Question 21

What is the best treatment for non-small cell cancer?

Answer 21

lobectomy (but only possible in early stages)

Question 22

When is surgery indicated for lung cancer treatment?

Answer 22

• low stage

- cardiac and lung function are suitable to handle anesthesia

Question 23

Who should be screened for lung cancer? How is it done?

Answer 23

• ages 55-74
• > 30 pack years

Done with low dose CT

Question 24

A pancoast tumor is usually what type of cancer?

Answer 24

Non-small cell, usually squamous cell