L62

Question 1

What enzyme system with genetic polymorphism is an inherited predisposition to lung cancer?

Answer 1

P450

Question 2

Which 2 lung cancers are more commonly associated with smoking?

Answer 2

Small cell

Squamous cell carcinoma

Question 3

Which 2 oncogenes are closely tied to lung cancer?

Answer 3

EGFR
ALK
These both have targeted therapies against them

Question 4

Describe the lesion on CT for small cell carcinoma

Answer 4

Central mass - endobronchial growth

Might see LN involvement

Question 5

Where in the lung do squamous cell carcinoma occur? What is the classic histo pattern?

Answer 5

Central
Infiltrating nest of tumor cells w/ central necrosis -> cavitation
Keratin

Question 6

What are 2 important variants of squamous cell carcinoma?

Answer 6

Papillary pattern

Basaloid variant

Question 7

What is the difference between adenocarcinoma in situ and minimally invasive adenocarcinoma?

Answer 7

Pre-invasive lesions:

• AAH
• Adenocarcinoma in situ (lesions 3 cm lesion and more than 5mm invasion

Question 8

Adenocarcinoma characteristics on histo

Answer 8

Gland like structures

Might see type 2 pneumocytes

Question 9

Adeno on CT scan

Answer 9

Ground glass opacities on periphery

If see solid components = invasive

Question 10

What is pancoast syndrome?

Answer 10

Lung cancer that is destructive into thoracic inlet - brachial plexus or cervical sympa nerve involvement

• Severe shoulder pain
• Atrophy of hand/arm muscles
• Horner’s!!!

Question 11

Do lung cancer pts usually present with clinical symptoms?

Answer 11

If they do - means late stage 
By time you have symptoms you're stage 3/4
Cough
Weight loss
Dyspnea 
Chest pain
Hemoptysis

Question 12

If you have this clinical symptom, how/where has your lung cancer met to 
Dysphagia
Hoarseness
Horner's
Pancoast
Pleural effusion 
SVC syndrome 
Effusion or tamponade

Answer 12

Dysphagia - tumor compression esophagus
Hoarseness - laryngeal nerve paralysis
Horner’s - symptomatic nerve paralysis
Pancoast - cervical/thoracic nerve invasion
Pleural effusion - lymphatic obstruction
SVC syndrome - vascular obstruction (see co-laterals draining, worried about cerebral edema)
Effusion or tamponade - pericardial/cardiac extension

Question 13

What does a beaded interstitial pattern on CT mean?

Answer 13

Look for lines in the periphery = septal lines

Means lymphatic spread of cancer

Question 14

What are the paraneoplastic syndromes that might occur due to a lung tumor?

Answer 14

1. Hypertrophic pulmonary osteoarthropathy
2. SI-ADH (seem hyponatremic but really hypervolemic)
3. Hypercalcemia due to increased PTH like compound
4. Cushing syndrome - increased ACTH
5. Lambert Easton Syndrome - opposite of MG, strength improves w/ activity
6. Clubbing

Question 15

What is hypertrophic pulmonary osteoarthropathy

Answer 15

Tumor causes angiogensis and osteogenesis
New periosteal thickening of long bones
Association with clubbing

Question 16

What is the most likely site of mets for lung cancer?

Answer 16

Adrenals

Question 17

Why don’t you do PET scan on a CT that shows ground glass opacities?

Answer 17

Ground glass - probably carcinoid or adenocarcinoma

These won’t pick up glucose well - not good for PET

Question 18

What are the 3 ways you can biopsy the lung?

Answer 18

1. Transbronch/endobronch biopsy (bronchoscopy)
2. Endobronch US guided biopsy
3. CT transthoracic biopsy

Question 19

How stage small cell lung cancer?

Answer 19

Limited = confined to hemi-thorax
Extensive = anything outside that area

Question 20

Treat small cell lung cancer:
Chemo
Radiation
Surg
Combos

Answer 20

Chemo + radiation

Question 21

How stage non-small cell lung cancer?

Answer 21

T0-4 = tumor size
0/1 more peripheral
4 = hugging more important things
N0-3 = LN invovlement
N2: mediastinal LN
N3: crosses to other lung LN
M0-1 = yes or no distant mets

Question 22

What system do you use to evaluate pts lifestyle before starting their cancer treatment?

Answer 22

ECOG

Question 23

What is the treatment for non-SC lung cancer stage:
1 = lung only
2 = local LN
3 = mediastinal LN
4 = distant mets

Answer 23

1 = surg
*Catch early b/c surg is often curative 
- If not a surg candidate, might try radiation 
2 = surg + local chemo
3 = regional chemo + radiation 
4 = disseminated chemo

Question 24

What are the 3 types of chemo you might use for lung cancer?

Answer 24

1. Platinum based - cisplatin, carboplatin
2. Non-platinum
3. Targeted:
   EGFR inhibitors - cetuximab
   ALK inhibitors

Question 25

How do you screen for lung cancer in high risk populations?

Answer 25

Low dose CT