Cancer

Question 1

Two classes of lung cancer

Answer 1

Non-Small Cell (78-85%, squamous cell, adenocarcinoma, large cell)
Small Cell (15-18%)-linked to cigarette smoking

Question 2

Most common type of lung cancer

Answer 2

adenocarcinoma

Question 3

major risk factors for developing cancer

Answer 3

• smoking
• asbestos/radon exposure
• HIV
• interstitial lung disease

Question 4

squamous cell carcinoma traits

Answer 4

• more common in males
• makes up 30-35 % of all lung cancers
• occurs centrally in large airway bronchial mucosa
• keratin deposits

Question 5

adenocarcinoma traits

Answer 5

• most common type of lung cancer
• common in the periphery of the lung which leads to minimal symptoms, therefore highly metastatic
• mostly in smokers, but also women non smokers typically of SE asian descent

Question 6

bronchiolalveolar carcinoma

Answer 6

• develops from alveolar lining
• not related to smoking
• presents like pneumonia that doesn’t resolve
• copious clear sputum

Question 7

small cell carcinoma

Answer 7

• common in male smokers
• arises from Kulchitzky cells (ectopic production of ACTH and ADH)
• extrremely aggressive, highly metastatic

Question 8

paraneoplastic syndromes

Answer 8

-cushing syndrome (ACTH) sclc
-SIADH sclc
eaton-lambert syndrome sclc
hypercalcemia-squamous (PTH like)
gynecomastia-large cell (gonadotropin)

Question 9

non-small cell lung cancer staging

Answer 9

I-<5 cm and in only one area, sx recommended
II-larger, may involve lymph nodes, sx recommended
III->7 cm, involves lymph nodes or other parts of chest/lung, IIIA spread to lymph nodes in the chest on the same side where cancer began chemo followed by radiation or sx recommended, IIIB spread to lymph nodes on opposite side of chest combo chemo/radiation recommended
IV-spread to both lungs, other parts of bod, chemo/palliative recommended

Question 10

small cell lung cancer staging

Answer 10

limited-within one lung field, treat w/radiation and chemo
extensive-outside one lung field, treat w/chemo
prophylactic brain radiation recommended, no sx bc it has likely spread all over the body already

Question 11

How to dx lung cancer?

Answer 11

CXR then biopsy

Question 12

under what conditions would you remove the lung?

Answer 12

If FEV1<1 liter, tumor can be removed but pt will be stuck on ventilator
If FEV1 1.5 liters then sx can be done

Question 13

How to treat EGFR mutations in adenocarcinomas?

Answer 13

tyrosine kinase tablet, no chemo required

Question 14

a yearly CT is recommended for…

Answer 14

smokers aged 55-80 or former smokers

Question 15

coin lesion vs

mass

Answer 15

<3 cm nodule

>3 cm-often malignant

Question 16

differential diagnosis of lung nodules

Answer 16

• if pt is a smoker
• fh of lung cancer
• if CT shows change in a growth at 6 month intervals