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SALMAN HARRISON'S > 74 - Neoplasms of the Lung > Flashcards

74 - Neoplasms of the Lung Flashcards

1
Q

A smoker is ___ more likely to suffer from lung cancer compared to a non smoker

A

X10

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2
Q

A former smoker is ___ more likely to suffer from lung cancer compared to a non smoker

A

X9

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3
Q

If you quit smoking, and you are not yet in ___ there’s a ___ less chance to suffer from lung cancer

A

Middle age

90%

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4
Q

There’s not a lot of risk reduction in _____ the amount of cigarettes you smoke

A

reducing

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5
Q

First degree family genetic polymorphism of ____ have ___ more chance to suffer from lung cancer and other malignancies

A

P450 - CYP1A1

X2-3

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6
Q

What are the two main groups of lung cancer?

What does the latter include? (3)

A 
Small Cell Lung Cancer (SCLC)
Non Small Cell Lung Cancer (NSCLC)
Adenocarcinoma
Large Cell Carcinoma 
Squamous Cell Carcinoma
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7
Q

What is the histological origin of lung cancer? ___ (__, __, __)

A

Respiratory epithelium (Bronchi, Bronchiole, Alveoli)

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8
Q

Which type of lung cancer is most linked to smoking?

A

SCLC

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9
Q

What are the markers of SCLC? (4)

A

CD56
Neural Cell Adhesion Molecule (NCAM)
Synaptophysin
Chromogranin

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10
Q

What is the most common type of lung cancer in the US?

A

Adenocarcinoma

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11
Q

Adenocarcinoma is most common in ___ under the age of __ which are ___ ___

A

Women
60
Non-Smokers

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12
Q

What is the histological origin of adenocarcinoma?

A

Epithelia type II- Alveolar epithelium

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13
Q

In adenocarcinoma, lipid type has ____ prognosis, while ____, ____, and ____ have worse prognosis

A

Good
Acinar
Papillary
Solid

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14
Q

Most lung cancer patients are diagnosed in ___ stage of the disease

A

late

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15
Q

CXR is __ __ as a ___ test

A

Not recommended

Screening

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16
Q

Low Dose Spiral Chest CT (LDCT) has shown some efficiency for discovering ___ stage tumors in ___ and ____

A

Early
Smokers
>60

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17
Q

In LDCT there’s a high ____ rate leading to more invasive procedures and ___. Nevertheless, this examination leads to an ___ in survival and complication of lung cancer

A

False Positive
Complications
improvement

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18
Q

More than ___ of patients with lung cancer present with an advance stage or even ____ disease

A

50%

Metastatic

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19
Q

Patients with lung cancer are usually with the following characteristics: (4)

A

> 60
Former smoker
Coughing (+/- hemoptysis)
COPD

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20
Q

Central/endobronchial tumors will present with: (4)

A

Coughing (+/- hemoptysis)
Stridor/ Wheezing
Dyspnea
Post obstructive pneumonia

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21
Q

Peripheral tumors will present with: (3)

A

Localized pain (pleural involvement)
Restrictive dyspnea
Lung abscess

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22
Q

Regional spread of tumor in the thorax (by contiguous growth or by metastasis to regional lymph nodes) may cause: __ obstruction, esophageal __+__, recurrent __ paralysis with hoarseness, __ nerve palsy with dyspnea, sympathetic nerve paralysis with __ syndrome. Malignant pleural effusions can cause pain, dyspnea, cough.

A

1) Tracheal
2) compression + dysphagia
3) laryngeal
4) Phrenic
5) Horner’s syndrome (enophthalmos, ptosis, miosis, anhydrosis).

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23
Q

Pancoast syndrome (superior sulcus tumor) results from:___ extension of a tumor growing in the ___ of the lung, involving the __ cervical and __+__ thoracic nerves. It presents with ___ pain that radiates in the ___ distribution of the arm, often with the destruction of the first and second __

A
  • Local
  • apex
  • eighth
  • first+ second
  • Shoulder
  • Ulnar
  • ribs
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24
Q

Pancoast syndrome often coexist with ___ syndrome

A

Horner’s

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25
Q

SVC syndrome in lung cancer is caused by ___ obstruction and may lead to: __ and __ extension resulting in tamponade, arrhythmia, or cardiac failure

A

Vascular
Pericardial
cardiac

26
Q

Metastasis are found in ____ of patients with SCC, ___ of patients with adenocarcinoma, and ____ of patients with SCLC

27
Q

The most common sites for metastatic spread of lung cancer tumors are: (5)

A 
Brain
Bones
BM
Liver
Adrenal
28
Q

Paraneoplastic syndrome is especially common in patients with ____

29
Q

Paraneoplastic endocrine symptoms include: (3)

A

Hypercalcemia (PTHrP related)
Hyponatremia (SIADH related)
Ectopic secretion of ACTH

30
Q

What is the best type of biopsy for diagnosing LC

A

Core biopsy

31
Q

What are the two component of LC staging?

A

Anatomical

Physiological

32
Q

Anatomical staging of NSCLC is based on __ . We will look for nodules >__ mm

33
Q

FN in PET CT can be caused by: (3)

A

Diabetes
<8 mm nodules
Slow growing tumors

34
Q

Brain metastasis will require ____ imaging

35
Q

The main C/I for curative surgery are: ___ metastases, __ syndrome, __ and or __ paralysis, malignant pleural __, cardiac __, tumor within __ cm of the __, metastasis to the __ lung.

A
  1. Extrathoracic
  2. SVC syndrome
  3. Vocal cord and or phrenic nerve
  4. effusion
  5. tamponade
  6. 2 cm of the carina
  7. contralateral
36
Q

What is the best predictor in the evaluation of metastasis of NSCLC?

A

History and physical examination

37
Q

מבוטל

A

מבוטל

38
Q

How will you treat NSCLC in the occult/stage 0 phase? locate the ___ with ___ examination of the __ __ -> __ surgery ->___.

A 
tumor 
fiberoptic 
bronchiole tree
curative 
follow up
39
Q

Solitary pulmonary nodule is an __ density completely surrounded by normal __ lung with margins, of any shape, usually - cm in greatest diameter.

A

XR
aerated
circumscribed
1–6 cm

40
Q

What are the radiological predictors for a benign solitary pulmonary nodule? ___________, _______ (4)

A

Lack of growth over a period >2 years

patterns of calcification (dense central nidus, popcorn ball, bulls eye, multiple punctate foci)

41
Q

Which risk factors will suggest an additional histological examination of a nodule? (4): __ mass, lack of ___, __ symptoms, positive ___

A

Big
calcifications
Chest
PET CT

42
Q

What is the best treatment for patients with NSCLC stage 1/2?

A

Pulmonary resection

43
Q

For patients with NSCLC stage 1A the best curative surgery is:

A

Lobectomy. Better than wedge resection

44
Q

Patients with NSCLC stage 1/2 and a central tumor are best treated with:

A

Pneumonectomy. Make sure they have sufficient lung reserve

45
Q

Patients with NSCLC stage 1/2 who do not have sufficient lung reserve will be treated with

A

Wedge resection or segmentectomy

46
Q

Patients with NSCLC stage 1/2 who refuse/cannot go through surgery will be treated with:

A

Radiation but not chemotherapy

47
Q

What is the only case where chemotherapy is recommended for NSCLC patients in stage <3?

A

Stage 1B after removing a tissue > 4 cm.

Adjuvant therapy in 4 cycles with Cisplatin + Vinorelbine

48
Q

Pancoast tumors are a subtype of stage 3 NSCLC. Treatment without N2 will include ____. Patients with N2 involvement will include

A

Neoadjuvant chemotherapy or post surgery radiation

Radiation, chemotherapy, no surgery

49
Q

____ of NSCLC patients are presented with metastatic (stage 4) disease. They will have a life expectancy of ___ months in average

50
Q

SCLC is a more ____ disease with a dramatic response for ____

A

Aggressive

1st line of chemotherapy and radiation

51
Q

Generally speaking, SCLC patients will not benefit from ____, due to _____

A

Surgery

Occult micrometastases

52
Q

The main combination of chemotherapy in NCLC patients contains:

A

Irinotecan/Etoposide + Cisplatin/Carboplatin

53
Q

Paraneoplastic syndrome is very common in __ and can be the first sign of the disease/relapse

54
Q

Systemic signs for neoplastic syndrome include: (4)

A

anorexia
weight loss -> cachexia
fever
immune depression

55
Q

The common endocrine symptoms caused by neoplastic syndrome include: hyper___ due to __, hypo__ due to __, and ectopic secretion of __

A 
calcemia
PTHrP
natremia
SIADH
ACTH
56
Q

Hypercalcemia due to paraneoplastic syndrome may present itself with: 5

A 
nausea + vomiting
abdominal pain
constipation
polyuria + polydipsia
mental status changes
57
Q

How will you treat hyponatremia due to SIADH when restricting drinking is not sufficient?

A

demeclocycline

58
Q

What will be the common sign for ectopic secretion of ACTH?

A

hypokalemia

59
Q

What are the 3 skeletal signs in lung cancer?

A

clubbing
periostitis
hypertrophic primary osteoarthropathy

60
Q

Neurological symptoms are found in __% of patients with lung cancer. What are the common clinical signs? 3

A

1
Eaton Lambert
encephalomyelitis
peripheral neuropathy

61
Q

Eaton Lambert is a type of ___. It is an __ disease leading to ___ muscles weakness in the __ limbs, __ dysfunction, and decreased reflexes. Unlike MG strength returns when exercising. Treatment- ___

A 
MG
AI
proximal
lower
automimic
chemotherapy
62
Q

Coagulation/thrombosis disorders appear in -% of patients with lung cancer. Common problems include: 5

A 
1-8
Trousseau's syndrome (migratory thrombophlebitis)
DIC
anemia
bleeding
granulocytosis

SALMAN HARRISON'S (163 decks)

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