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CPR Exam 2 > Cancer of the Respiratory System > Flashcards

Cancer of the Respiratory System Flashcards

1
Q

Where do epithelial carcinomas of the head and neck arise from and what is their origin?

A

Mucosal surfaces

Squamous cell

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2
Q

What are the most significant risk factors for head and neck cancer?

When both are abused, what affect do they have?

A
  • Alcohol and tobacco
  • Synergistic
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3
Q

_______ is an etiologic agent for oral cancer.

A

Smokeless tobacco

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4
Q

Some head and neck cancers can be caused by viruses.

Nasopharyngeal cancer can be caused by _______

Oropharyngeal tumors can be caused by _______.

A
  • EBV, esp in Meditarrenan and Far East
    • Smoked fish
    • Indoor pollutants
  • _HPV (16** and 18),_ in younger patients.
    • more often in Men
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5
Q

What are other causes of head and neck cancers?

Salivary gland tumors?

A
  • Dietary factors
  • No specific risk factors or environmental carcinogens are assx with salivary gland tumors
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6
Q

Squamous cell head and neck cancers can be divided into ___________.

Which has the worst prognosis?

A
  1. Well differentiated
  2. Moderately well-differentiated
  3. Poorly differentiated ***
    • ​WORSE PROGNOSIS
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7
Q

What part of the pharynx is at risk for the development of premalignant or malignant lesions?

why.

A
  • Entire mucosal surface, because they are exposed to alcohol and tobacco.
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8
Q

How common are premalignant lesions in head and neck cancer?

A

MOST do not have premalignant lesions

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9
Q

Typically, what age to the following cancers present at

  • Tobacco-related head and neck cancers
  • EBV-related nasopharyngeal cancer
  • HPV-related cancers
A
  • Older than 60YO
  • All ages, even teens
  • 40-50s
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10
Q

What procedure should be performed in patients with nonspecific signs and symptoms of the head & neck?

A
  • Otolarygolic exam, if sx last longer than 2-4 weeks.
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11
Q

How do nasopharyngeal cancers present?

A
    • No early symptoms
    • Unilatereral serous otitis media d/t obstruction of eustachian tube.
    • Unilateral/bilateral nasal obstruction
    • Epistaxis
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12
Q

How do oral cavity carcinomas present?

A
  • Nonhealing ulcers,
  • changes in how dentures fit,
  • painful lesions.
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13
Q

What is the first sign of HPV-related tumors?

A

Neck lymphadenopathy

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14
Q

What is the earliest symptom if laryngeal cancer and how should we treat first?

A
  • Hoarsness
  • ABX
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15
Q

If a patient has enlarged LN in the upper neck and the tumor cells are squamous cells, where did the malignancy probably arise from?

A

Mucosal surface of head and neck

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16
Q

If a patient has enlarged supraclavicular LN, where did the malignancy probably arise from?

A

Chest or abdomen

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17
Q

PE of head and neck should include what?

A
  1. Inspect ALL visible mucosal surfaces
  2. Palpate floor of mouth, tongue and neck.
  3. Check for pre-malignant lesions: leukoplakia (white mucosal patch) and erythroplakia (red mucosal patch), which can represent hyperplasia, dysplasia, CIS and need biopsy.
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18
Q

Which imaging modalities are utilized to identify the extent of head/neck cancers; which modality is used to identify or exclude distant metastases?

A
  • CT of the head and neck to identify extent of the disease
  • PET scan can help identify or exlude distant metastases
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19
Q

What imaging modalities should patients with LN involment have to screen for distant metases?

Heavy smokers, to rule out a second lung primary tumor?

A
  • CT of chest and upper abdomen
  • CT of chest
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20
Q

What is the definitive staging procedure for head/neck malignancies?

A

Endoscopic examination under anesthesia (i.e., laryngoscopy, esophagoscopy, and bronchoscopy); obtaining multiple biopsy samples to establish primary diagnosis, extent and ID premalignant lesions

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21
Q

Head and neck cancers are classified with what system?

A

TNM system

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22
Q

Primary head and neck cancers are classified as ________ as size increases.

If another structure is invaded, it is classified as ____.

A
  • T1-3
  • T4
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23
Q

In patients with lymph node involvement and no visible primary tumor of the head and neck, how should diagnosis be made?

A

Lymph node excision

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24
Q

If results of a LN biopsy indicate squamous cell carcinoma, what should be performed?

A

Panendoscopy, with biopsy of all suspicious-appearing areas and biopsies of common primary sites, such as nasopharynx, tonsil, tongue base, and pyriform sinus

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25
Q

How are patients with head and neck categorized into treatment groups?

A
    1. Localized disease
    1. Locally or regionally advanced disease (LN +)
    1. Recurrent and/or metastic disease
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26
Q

How are patients with localized disease and no LN involvement (____) treated?

A
  • T1 and T2
  • Curative intent by surgery or radiation, depending on location and insitution education.
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27
Q

What is the preferred tx for laryngeal cancer as to preserve voice function?

A

Radiation therapy

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28
Q

What is the preferred tx for small lesions/malignancies in the oral cavity?

A

Surgery, to avoid long-term complications of radiation, such as xerostomia and dental-decay

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29
Q

Most recurrences of T1 and T2 head and neck cancer happen in what time frame and are often what?

A

First 2 years after diagnosis and are usually local

30
Q

How are patients with locally or regionally advanced disease (primary tumor + LN involvement) treated?

A

Curative intent: combined modality therapy (surgery, radiation, chemo). Chemo can be given as

    1. Inductive chemo (before surgery or radiation)
    1. Concomitant (same time as radiation), which is most commonly used!
31
Q

Pts with recurrent or metastatic head and neck tumors are typically treated how?

A

With palliative intent; typically with chemotherapy for transient symptomatic benefit because they will die in 8-10 onths.

32
Q

The addition of which drug to standard combination chemotherapy with [cisplatin or carboplatin and 5-FU] has shown to result in significant increase in median survival in patients with recurrent/metastic head and neck cancer?

A

Cetuximab (EGFR-directed therapy)

33
Q

About 50% of patients who undergo tx for head/neck cancer develop decreased function of what organ?

A

HYPOthyroidism; thus, thyroid function should be monitored

34
Q

What is the leading cause of cancer-related deaths in both M and W, but is less common than breast, prostate and colon combined?

A

Lung cancer

35
Q

85% of lung cancers are due to ______.

A

Smoking

36
Q

Majority of lung cancer is __________ (85%).

The other 15% is ____________.

A
  • Non-small cell lung cancer (85%)
  • Small cell lung cancer (15%)
37
Q

How does small cell lung cancer differ from non-small cell lung cancer?

A
  • Almost exclusively in smokers
  • More aggressive and during intial presentation, already metasized.
38
Q

best way to prevent lung cancer

A

stop smoking

39
Q

Which patients should be considered for low-dose CT screening (LDCT) for lung cancer?

A
    • Current and former smokers (if quit within past 15 years) 55-80 y/o who have a ≥30-pack-year smoking hx
40
Q

What is a good starting point for imaging of lung cancer?

A

CXR; easy and cheap

41
Q

How do we diagnose lung cancer in smokers and former smokers?

A
  • Evaluate for new pulmonary or chest complaints
    • hemoptysis, pulmonary infections, dyspnea, cough, chest pain
42
Q

Patients with small cell lung cancer often present with what?

A
  • Metastasis
  • Paraneoplastic syndrome
43
Q

Hypercalcemia as a paraneoplastic process is most common with which lung cancers?

A

Adenocarcinoma or Squamous cell carcinoma

44
Q

Hypertrophic pulmonary osteoarthropathy is most common with what lung cancer?

A

Adenocarcinoma

45
Q

Distention of superficial veins and edema in the head and neck is characteristic of what paraneoplastic process of lung cancer?

A

SVC syndrome

46
Q

What are 3 paraneoplastic syndromes commonly assx with small cell lung cancer?

A

1. Acromegaly

2. Cushings

3. Lambert-Eaton myasthenic syndrome

47
Q

If a patient comes in with new or persistant lung symtpoms come in, what is examined?

A
    1. Primary tumor
    1. Intrathoracic thread (hoarse voice, Horner, chest wall tenderness)
    1. Extrathoracic spread (wasting, lymphenopathy, neuro findings, bone tenderness)
    1. Paraneoplastic syndrome
    1. CXR
    1. If small cell lung cancer, CT.
48
Q

What is NECESSARY for diagnosis of cancer?

A

Histology by a way that furthers staging.

49
Q

What is the best approach for histological confirmation in a pt with a lung mass that is losing weight and unilateral supraclavicular LN enlargement?

A

Peripheral node biopsy; allows for diagnosis and staging

50
Q

Which diagnostic method for lung cancer is reserved for pt’s with poor pulmonary function who cannot tolerate invasive procedures?

A

Sputum cytology

51
Q

When staging non-small cell lung cancer, what is the task?

A
  • Find out if it metasized. If so, surgery is NOT an option.
  • Do so by conducing: CT of chest and abdomen, a combined PET-CT, which assess for malignant mediastinal lemphadenoopathy.
52
Q

What diagnosing method is performed to ID advanced disease and can prevent unneccesary thoracotomy?

A
  • PET CT
53
Q

Which imaging modality may be indicated if pt has bone pain or an elevated serum Ca2+ or AlkPhos?

A

Bone scan

54
Q

When diagnosed, small cell lung cancer is viewed how?

How does it respond to radiation and chemo?

A

- Systemic disease, because most patients have WIDESPREAD organ involvement.

- SENSITIVE

55
Q

How is small-cell carcinoma staged?

A

By whether or not the tumor is in a field where radiation can be performed.

    • Limited stage stage: tumor is in one port site
    • Extensive-stage disease: tumor has metasized to liver, bone, bone marrow,
56
Q

What tests are performed to evaluate a metastatic disease?

A
  1. CT of chest and abdomen
  2. PET-CT
  3. MRI of bone
  4. Bone scan
  5. Serum electrolytes, aminotranferase, lactate DH.
57
Q

What are 2 features which define benign pulmonary nodules?

A

1) No growth in 2 years

AND

2) Calcification in a diffuse, central, or laminar pattern

58
Q

What is the size, morphology, and location characteristic of malignant pulmonary nodules?

A

>2 cm w/ spiculated edges and located in the upper lobes

59
Q

What is the best strategy in patients with incidentally discovered pulmonary nodules?

A

Obtain prior CXR’s or imaging scans to determine stability over time

60
Q

What is the recommendation for incidentally discovered pulmonary nodules < 4cm in pt who have never smoked and who have no other known risk factors for malignancy?

A

No follow-up recommended

61
Q

Which size pulmonary nodule requires follow-up at an interval determined by whether the patient is considered to be at high or low risk for malignany?

A

Nodules >4cm

62
Q

What is the recommendation for pt’s with solid pulmonary nodules ≥1.5 - 2 cm who are considered high-risk or low-risk?

A

Immediate biopsy; close interval CT scanning is option in low-risk pt’s

63
Q

In non-small cell lung cancer, what determines the best options for treatment?

A
  • Staging from I-IV; examine size of tumor (T), regional node status (N) and prescence or absence of metastatic disease (M)
64
Q

Stage 1 non-small cell lung cancer:

Description and treatment

A
  • Cancer is small (1A is less than 3cm; 1B is less than 5cm) and has not spread to LN.
  • Tx: Surgery; if 1B, adjuvant chemo can help
65
Q

Stage 2 Non-small cell lung cancer:

Description and treatment

A
  • Tumor is in between 5- 7cm and may have spread to LN.
  • Tx: Surgery and adjuvent chemo
66
Q

Stage 3 Non-small cell lung cancer:

Description and treatment

A
  • Cancer has grown, spread into surrounding tissue and most have same-side mediatinal lymphanopathy, which dictate survival rate.
  • Tx:
    • Potentially resectable cancer with minimal mediatinal lymphenopathy:
      • Neoadjuvent chemotherapy is done to shrink tumor B4 surgery
    • Unresectable cancer:
      • Chemoradiation + surgery
67
Q

Stage 4 Non-small cell lung cancer:

Description and treatment

A

Cancer has spread and formed new tumors in bone, brain, liver and adrenal glands.

Tx: Inoperable; Combination therapy (radiation of symptomatic mass and palliative chemotherapy)

68
Q

What is the superior tx for pt’s with unresectable non-small cell lung cancer?

A

Chemo-radiation

69
Q

What is the tx of choice for small-cell lung cancer?

Does this work well?

A
  • Combination chemotherapy w/ platinum based agent (i.e., cisplatin) + etoposide
  • Radiation is given concurrently or sequentially
  • Most patients relapse and die of disease, even though responding well at first.
70
Q

A patient being treated for head and neck cancer presents with substantial weight loss (>10% of body weight), would benefit from what?

A

Placement of a feeding tube.

CPR Exam 2 (29 decks)

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