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AA - Thoracic surgery > Cancer > Flashcards

Cancer Flashcards

1
Q

Incidence of Small cell lung cancer (SCLC)

A

15-25% of lung cancers

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2
Q

SCLC

A

chemo is primary treatment (Cisplatin, etoposide); surgery can rarely impact survival. Partial response to chemo may be amenable to surgery. Radiation is reserved for localized lesions without evidence of metastasis.

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3
Q

Radiation induced osteosarcoma. Radiologic and pathologic findings

A

Radiology: “sunburst”, periosteal reaction
Biopsy: malignant spindle cells, mitosis, and excess osteoid. Rib and sternum account for 5% of osteogenic sarcomas

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4
Q

Radiation induced osteosarcoma rx

A

Neoadjuvant protocols. Complete wide local excision. Radiation is reserved for palliation.

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5
Q

Fleischner recommendations for < 4mm (Low risk and High risk pts)

A

Low risk: no follow up needed

High risk: F/u in 12 months. If unchanged, no further f/u

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6
Q

Fleischner recommendations for 4-6 mm (Low risk and High risk pts)

A

Low risk: F/u in 12 months, if unchanged, no further f/u

High risk: f/u in 6-12 mon, then 18-2 mo if no change

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7
Q

Fleischner recommendations for <6-8 mm (Low risk and High risk pts)

A

Low risk: f/u in 6-12 mo, then 18-24 mo if no change

High risk: CT at 3-6 mo, then 9-12 mo, and 24 months if no change

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8
Q

Fleischner recommendations for >8 mm (Low risk and High risk pts)

A

Low risk: f/u CT at 3, 9, 24, dynamic contrast enhanced CT, PET, and/or biopsy
High risk: f/u CT at 3, 9, 24, dynamic contrast enhanced CT, PET, and/or biopsy

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9
Q

What size nodule is a PET scan considered sensitive and specific

A

Purely solid lesion > 7 mm

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10
Q

S/p pneumonectomy, c/o cough with serosanguineous sputum/hemoptysis, fever, CXR with air fluid level. Dx? Next step?

A

Post-pneumonectomy bronchopleural fistula with empyema. Next step is thoracentesis with culture –> chest tube placement –> bronchoscopy. Avoid bronchoscopy until pt is drained to minimize infection of the contralateral lung

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11
Q

S/p RU Lobectomy, fever + tachycardia 4 days later. CXR shows atelectactic middle lobe. Dx? Next Step?

A

Torsion of the lung. Next Step is flex bronch (will appear “fish mouth” on bronch) –> surgical emergency

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12
Q

Risk factors for lobar torsion (4)

A

division of inferior pulm ligament
failure to reexpand lung prior to closure
residual pneumothorax and pleural effusion
a remaining complete fissure

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13
Q

How to avoid lobar torsion after lobectomy

A

Ensure remaining lobes are inflated in neutral and anatomic position
anchoring lung tissue at 2 points (the hilum and somewhere else (e.g. suturing or stapling middle lobe to the lower lobe)

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14
Q

According to National Lung Screening Trial (NLST), what patient factors must be present to justify use of CT screening for lung cancer

A

age 55-74
> 30 pack year smoking
active smoker or quit < 15 years ago

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15
Q

Pt with SCC of RUL. Right hilar and level 4 lymph node with FDG avidity on PET, SUV (standardized uptake values) of 7 and 4, respectively. Next step?

A

EBUS with lymph node biopsy

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16
Q

What value of SUV (standardized uptake values) is associated with high probability of malignancy

A

2.5

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17
Q

What factor affect the accuracy of SUB

A 
weight
blood glucose
leng of uptake period
partial volume effect
recovery coefficient
type of region of interest
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18
Q

50 obese F with HTN and hirsutism, presented with hypokalemia, elevate urine/plasma cortisol and serum ACTH. MRI shows normal pituitary gland. CT shows LLL nodule. Whats the syndrome? Ddx? Next step?

A
  • Cushing syndrome
  • Ddx: bronchial carcinoid, islet cell cancer, small cell lung CA, medullary thyroid ca, neuroendocrine tumor, thymic carcinoid, pheochromocytoma, (of note, pituitary adenoma causing cushing syndrome is known as cushing disease)
  • next step: Somatostatin receptor scintigraphy with octreotide to identify hypersecreting tumors or FDG-PET
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19
Q

Patient with resected stage III non-small cell lung cancer. Next step?

A

According to the LACE (lung adjuvant cisplatin evaluation) meta-analysis, adjuvant cisplatin-based chemotherapy had survival benefit over observation

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20
Q

Staging: any metastasis

A

At least stage IV-A

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21
Q

T classification for tumor size < 1 cm

A

T1a

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22
Q

T classification for tumor size 1-2 cm

A

T1b

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23
Q

T classification for tumor size 2-3 cm

A

T1c

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24
Q

T classification for tumor size 3-4 cm

A

T2a

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25
Q

T classification for tumor size 4-5 cm

A

T2b

26
Q

T classification for tumor size 5-7 cm

A

T3

27
Q

T classification for tumor size >7 cm

A

T4

28
Q

N1 nodes

A

ipsilateral, bronchopulmonary/hilar nodes (double digit, 10-15)

29
Q

N2 noes

A

1-9 mediastinal nodes, subcarinal or ipsilateral internal mammary nodes

30
Q

N0

A

No lymph node mets

31
Q

N3

A

Contralateral mediastinal, internal mammary or hilar nodes or any subclavicular or scalene lymph nodes

32
Q

Staging: N1 involvement

A

At the very least is a stage II B

33
Q

Staging: T4, N0

A

Stage IIIA

34
Q

Staging: T3, N1

A

Stage IIIA

35
Q

Staging T2b, N0

A

Stage IIA (this is the only permutation of stage IIA)

36
Q

Staging: T2a, N0

A

Stage I B (This is the only permutation of stage 1B)

37
Q

Staging: T1, N0

A

Stage I A (subcategory of 1,2,3, based on tumor size)

38
Q

Staging: T3, N2

A

Stage IIIB

39
Q

Staging: T4, N2

A

Stage IIIB

40
Q

Staging: T1, N3

A

Stage IIIB

41
Q

Staging: T3, N3

A

Stage IIIC

42
Q

Staging T1, N1

A

Stage IIB

43
Q

Staging T1, N2

A

Stage IIIA

44
Q

Staging: any N2 involvement

A

At least a stage IIIA

45
Q

Staging: any N3 involvement

A

At least a stage IIIB

46
Q

Findings of LACE meta analysis

A

Survival benefit for adjuvant cisplatin based chemo over observation in patients with resected stage II and III NSCLS.

47
Q

Intergroup trial INT0139 findings

A

Patients with Stage IIIA (N2) disease had no significant difference in overall survival to chemorad with or without surgical resection. However, in an exploratory analysis, post-induction lobectomy had superior survival.

48
Q

Management of pancoast tumor

A

According to the intergroup trial (INT 0160), treat with induction chemoradiation therapy, followed by complete resection including en-bloc chest wall resection, (may include subclavian vessels if involved)

49
Q

Eligibility criteria for INT 0160

A

T3 or T4 superior sulcus tumors with either N0 or N1 disease, no distant metastasis

50
Q

When is a sublobar resection oncologically sound?

A

Tumors <2cm in maximal diameter

51
Q

T classification if tumor involves main bronchus (not carina), invades visceral pleura, or associated with atelectasis or obstructive pneumonitis that extends to the hilar region

A

T2a

52
Q

T classification if tumor invades the parietal pleura and superior sulcus tumors, phrenic nerve, or parietal pericardium

A

T3

53
Q

T classification if tumor is associated with a separate tumor nodule in a DIFFERENT ipsilateral lobe

A

T4

54
Q

T classification if tumor is associated with a separate tumor nodule in the SAME ipsilateral lobe

A

T3

55
Q

T classification if tumor involves with CARINA, diaphragm, mediastinum, heart, great vessels, trachia, recurrent largyneal nerve, esophagus, vertebra

A

T4

56
Q

Patients with lung cancer with primary tumors > 4 cm or pos lymph nodes can be treated with?

A

adjuvant platinum-based chemo. This shows improved survival in a meta analysis of a large prospective randomized studies

57
Q

Definition of R0 resection

A

Microscopically margin-negative resection

58
Q

Definition of R1 resection

A

Indicates removal of all macroscopic disease, but microscopic margins are positive for tumor.

59
Q

65F w/ T2N2 adenoCA and neoadj chemorads s/p RULobectomy. Post op, developed SOB, hypoxemia on PEEP 8. CXR with b/l fluffy infiltrate. Dx? Next step?

A

Post-resection pulmonary edema. Usually occurs after pneumonectomy, but may happen after lobectomy or sublobar resections.

Tx: supportive. Ventilation with management analogous to tx of ARDS, i.e. high PEEP. If refractory, consider ECMO.

60
Q

Risk factors for post op ARDS / post resection pulm edema. (10)

A 
Older age
Male
Chronic suppurative lung disease
reduced DLCO
Low predicted post-op lung perfusion
Prior irradiation or chemo
Concurrent cardiac disease
High blood loss/blood transfusion
Excessive periop IVF
Reoperation
61
Q

Definition of persistent air leak per STS

A

Air leak that last for 5 days.

62
Q

Risk factors for persistent air leak

A

COPD

Low preop lung function

AA - Thoracic surgery (6 decks)

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