28. Lung Cancer

Question 1

true or false: lung cancer is the most common cause of cancer mortality

Answer 1

true

Question 2

what are some risk factors for lung cancer

Answer 2

• smoking!!!!!!
• personal hx of lung cancer
• family history of lung cancer
• asbestos
• age (> 40)
• second hand smoke
• radiation exposure

Question 3

true or false: women are more susceptible to tobacco effects

Answer 3

true

Question 4

what are the early symptoms of lung cancer

Answer 4

• cough
• dyspnea
• hemoptysis
• recurrent infections
• chest pain

Question 5

what are the most common sites of metastases in lung cancer (+ their symptoms)

Answer 5

brain (seizures, confusion, personality changes, h/a, n/v), bones (pain), liver (weight loss, weakness) and adrenals (asymptomatic)

Question 6

what % of lung cancers are small cell carcinomas

Answer 6

15%

Question 7

what % of lung cancers are non-small cell carcinomas

Answer 7

85%

Question 8

this type of lung cancer has the most aggressive clinical course of all lung tumors if left untreated

Answer 8

small cell lung cancer

Question 9

true or false: small cell lung cancers are related to smoking

Answer 9

true

Question 10

true or false: small cell lung cancers are located centrally

Answer 10

true

Question 11

what are the 3 types of non-small cell lung cancer

Answer 11

1. adenocarcinoma (45-50%)
2. squamous cell carcinoma (25-30%)
3. large cell carcinoma (5-10%)

Question 12

this type of non-small cell lung cancer usually arises from the mucus-producing cells in the lung

Answer 12

adenocarcinoma

Question 13

true or false: adenocarcinomas are mainly centrally located

Answer 13

false - 2/3 in outer part of lung, 1/3 develop in central part of lung

Question 14

true or false: adenocarcinomas are related to smoking

Answer 14

false

Question 15

true or false: adenocarcinomas are more common in women

Answer 15

true

Question 16

this non-small cell carcinoma is slower growing and often causes bronchial obstruction

Answer 16

squamous cell carcinoma

Question 17

true or false: squamous cell carcinoma is related to smoking

Answer 17

true

Question 18

true or false: squamous cell carcinomas are located centrally

Answer 18

true

Question 19

true or false: squamous cell carcinomas are more common in women

Answer 19

false

Question 20

this non-small cell carcinoma tends to spread/metastasize early

Answer 20

large cell carcinoma

Question 21

true or false: large cell carcinomas are related to smoking

Answer 21

false

Question 22

true or false: large cell carcinomas are located centrally

Answer 22

false

Question 23

what are some negative prognostic factors for lung cancer

Answer 23

• weight loss
• poor performance status
• mediastinal lymph node involvement
• male gender
• elevated LDH
• bone or liver metastasis
• adeno and large cell

Question 24

know the stages of small cell lung cancer

Answer 24

limited - one side of the chest
extensive - both sides of the chest

Question 25

know the stages of non-small cell lung cancer

Answer 25

stage 1 - small tumor that has not spread to lymph nodes or any other structures in the chest stage 2 - tumor is bigger than stage 1 or it has spread to nearby lymph nodes or it has spread into the large bronchial tubes stage 3a - tumor has spread to the lymph nodes or other structures in the middle of the chest stage 3b - tumor has spread to the other side of the chest or mediastinal lymph nodes stage 4 - BBLA involvement

Question 26

what is the treatment for NSCLC stage Ia

Answer 26

surgery (+ rads if surgical resection markers are positive)

Question 27

what is the treatment for NSCLC stage Ib

Answer 27

surgery + adjuvant chemo (+ rads if surgical resection markers are positive)

Question 28

what is the treatment for NSCLC stage II

Answer 28

surgery + adjuvant chemo +/- immunotherapy (+ rads if surgical rescetion markers are positive)

Question 29

what is the treatment for NSCLC stage IIIa

Answer 29

surgery + adjuvant chemo +/- immunotherapy (+ rads if surgical rescetion markers are positive)

Question 30

what is the treatment for NSCLC stage IIIb

Answer 30

combined chemo/rads + maintenance Durvalumab x 12 months

Question 31

what is the treatment for NSCLC stage IV

Answer 31

chemo or TT or immunotherapy or rads

Question 32

how many cycles of chemo is used in all stages of NSCLC

Answer 32

4-6 cycles

Question 33

what treatment is given if your patient has stage 4 NSCLC, PD-L1 > 50%, and the disease is not rapidly progressive/very extensive

Answer 33

Pembrolizumab

Question 34

what treatment is given if your patient has stage 4 NSCLC, PD-L1 < 50%, and they have squamous histology

Answer 34

Pembrolizumab, Carboplatin & Paclitaxel

Question 35

what treatment is given if your patient has stage 4 NSCLC, PD-L1 < 50% and they have adenocarcinoma histology

Answer 35

Pembrolizumab, Carboplatin & Pemotrexed

Question 36

this mutation accounts for about 15% of NLCSC

Answer 36

EGFR

Question 37

what is the most common EGFR inhibitor used

Answer 37

Osimertinib

Question 38

this mutation accounts for about 5-7% of NSCLC

Answer 38

ALK

Question 39

what are examples of ALK inhibitors

Answer 39

crizotinib, alectinib and lorlatinib

Question 40

true or false: if a patient fails one ALK inibitor, they can try another one

Answer 40

true

Question 41

how is the limited stage of small cell lung cancer treated

Answer 41

radiation + chemo (4-6 cycles of chemo)

Question 42

how it the extensive stage of small cell lung cancer treated

Answer 42

4 cycles of chemotherapy with durvalumab then durvalumab monotherapy