Clinical aspects of lung cancer Flashcards by she ign

features of cancer cells

abnormal nuclei
lack of differentiation
mutated chromosomes
gene amplification
do NOT undergo apoptosis

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T/F: cancer may be present even though we can’t see it radiographically

true

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smallest detectable cancer radiographically is –

1 cm^3 or 10^9 cells

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diagnosis cancer thru

biopsy (tissue sample) or blood (circulating tumor cells)

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lymph node sarcoma is always stage –

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excluding –, chemotherapy can’t cure cancer

leukemia, lymphoma, testicular cancer

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monitor cancer thru –

surveillance imaging or serial blood sampling

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how can cancer be cured?

detect early –> surgery/radiation

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what do we do about cancer?

identify, diagnose, stage, treat, monitor

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is lung cancer hereditary?

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lung cancer is the – most commonly diagnosed caner

2nd

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lung cancer is the – cause of cancer death

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common symptoms of lung cancer

fatigue, weight loss, anorexia, low-grade fever

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hemoptysis; pleural effusion; chest pain is a – symptom of lung cancer that usually goes to bone

less common

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lung cancer –> protein bodies –>

paraneoplastic syndrome (rare)

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risk factors for lung cancer

smoking, age, prior radiation, family history, asbestos

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median age at lung cancer diagnosis

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what is pack years?

(# cigarettes a day/20) x # years smoked

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what is a greater risk factor in regards to smoking?

duration is greater risk than number of cigarettes

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it takes – to decrease risk of dying from lung cancer by half

10 years of quitting smoking

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T/F: after quitting smoking the risk of dying from lung cancer goes back to that of a non-smoker

false

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T/F: most smokers do not develop lung cancer

true

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yearly lung screening is recommended for –

55-80 y/o with 30 years history of smoking and active in last 15 years and can undergo curative surgery

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yearly lung screening test is –

low dose CT (better than CXR)

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biopsy types in increasing accuracy (small to big)

FNA < core needle < excisional

biopsy sites

lung peripheral or perihilar (preferred over metastasis sites)

interventional radiology is usually -- guided

interventional pulmonology via --

bronchoscopy

thoracic surgery

excisional

risks of biopsies

hemoptysis, pneumothorax, bleeding

which is more prevalent small cell or non-small cell lung cancer?

non-small cell lung cancer

prevalence of non-small cell lung cancer in increasing order

large cell < squamous cell < adenocarcinoma

small cell lung cancer is usually seen near -- and is almost always caused by smoking

bronchi

this type of cancer can begin almost any part of lung and often grows and spreads quickly

large cell carcinoma

squamous cell carcinoma tumors appear in -- usually near bronchi

flat cells that line airways

squamous cell carcinoma is usually caused by smoking and is more common in --

men

squamous cell carcinoma grows --

slowly

adenocarcinoma usually arises in --

cells lining alveoli

adenocarcinoma is a common form of lung cancer in --

non-smokers

T?F: adenocarcinoma is seen in smokers

true

preferred treatment for NSCLC

stages 1 and 2: surgery + systemic therapy stage 3: cheomradiotherapy or surgery + systemic therapy stage 4: systemic therapy

preferred treatment for SCLC

limited-stage (I-3): surgery or radiation therapy + systemic therapy extensive stage (4): systemic therapy

which stage is incurable?

stage IV

only true cure for NSCLC

chemoradiatio or surgery

T/F: high risk of relapse or secondary cancer

true

which type of lung cancer is more aggressive?

SCLC

RT: conventional radiation therapy delivers --

small dose of tumor directed radiation over a long time in highly fractioned manner

SBRT/SRS (stereotactic): delivers --

higher doses of tumor directed radiation in fewer fractions

which tumor directed radiation therapy is more focused and therefore preserves more tissue

SBRT/SRS

whole brain radiation can also be given to treat -- (but lowers cognition)

SCLC

Drugs that inhibit cell division, but are not specific for cancer cells

chemotherapy

Drugs that inhibit new blood vessel growth and eventual death of cancer cell

angiogenesis inhibitors

Drugs that target unique characteristics of cancer (oncogenic driver mutations)

targeted therapy

Drugs that harness a patient’s immune system to fight diseases such as cancer

immunotherapy

systemic therapy types

chemotherapy, angiogenesis inhibitors, targeted therapy, immunotherapy

which systemic therapy type has a lot of side effects

chemotherapy

what is the standard systemic therapy after surgical resection of NSCLC

chemotherapy (adjuvant or concurrent)

Stage IV NSCLC: -- is a marker of the immune system and indicates if a patient will respond to immunotherapies

PD-L1

Stage IV NSCLC: molecular testing for targetable --

driver mutations

mutation that causes cancer cells to grow uninhibited

EGFR

what can target EGFR mutations?

TKI = tyrosine kinase inhibitors

ALK or anapestic lymphoma kinase gene rearrangement is common in --

non-smoking Asian women

treat ALK with --

oral therapies

-- gene rearrangement is commonly found in smokers

ROS1

BRAF mutation is seen in --

NSCLC smokers and melanoma

PDL1 (dark brown) is a marker used in normal body with -- to tell T cell not to kill it

viral infection

T/F: tumor cells have evolved to express PD-L1 to prevent being killed by T cell

true

if a patient has -- PD-L1 staining we use pembrolizumab immunotherapy (anti-PDL1 therapy)

more than 50%