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Pulm > Lec 23 Lung Cancer > Flashcards

Lec 23 Lung Cancer Flashcards

1
Q

What is epidemiology of lung cancer?

A

leading cause of cancer death in US and the world

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2
Q

What is risk of cancer smokers vs non-smokers?

A

smokers 20x increase risk

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3
Q

What are some smoking related carcinogens?

A
  • polycyclic aromatic hydrocarbons

- tobacco specific nitrosamines

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4
Q

What percent of lung cancers occur in non-smoking females vs males?

A

9-13% of lung cancer in females is non-smokers

2-6% of lung cancer in males is non-smokers

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5
Q

What are some other risk factors for cancer besides active cigarette smoking?

A
  • environmental/passive tobacco smoke
  • radiation/radon gas exposure
  • air pollution
  • cooking oil fumes and indoor coal/biomass burning
  • prior lung disease [COPD]
  • family history
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6
Q

What are some occupational exposures associated with lung cancer?

A
  • asbestos
  • silica
  • arsenic
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7
Q

What are genetic determinants of lung cancer susceptibility?

A
  • locus at 15q24-25
  • gene codes for nicotinic ACh receptor subunits
  • confers 30% increased risk of lung cancer
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8
Q

What is most common presentation of lung cancer?

A

pulmonary nodules

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9
Q

What should you think if pulm nodule in smoker?

A

cancer until proven otherwise

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10
Q

Are majority of pulm nodules cancer or benign?

A

mostly benign

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11
Q

What are some possible causes of small pulm nodules?

A
  • lung cancer
  • bronchial carcinoid tumor
  • hamartoma
  • metastasis
  • granuloma
  • abscess
  • inflammatory nodule
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12
Q

How can you tell benign from cancerous nodule?

A
  • stability vs growth over time
  • calcification pattern if present
  • appearance of lesion
  • metabolic characteristics
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13
Q

What does calcification of a nodule tell you?

A

tells you the nodule is old/has been around for a while

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14
Q

What does a perfectly round nodule suggest?

A

suggests benign

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15
Q

What does a popcorn calcification pattern suggest?

A

hamartoma

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16
Q

What does dense central calcification suggest?

A

granuloma

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17
Q

What does a spiculated border of small pulm nodule suggest?

A

suggets lung cancer

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18
Q

What does a cavitated pulm nodule tell you?

A

can be benign or malignant

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19
Q

How do you diagnose primary lung cancer?

A

-cytology on sputum, bronchoscopy, transthoracic needle aspiration

biopsy

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20
Q

What are two main histologic types of cancer?

A

small cell = 15%

non-small cell = 85%

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21
Q

What are 3 types of non small cell lung cancer?

A
  • squamous cell carcinoma
  • adenocarcinoma
  • large cell carcinoma
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22
Q

What type of non small cell lung cancer is most common?

A

adenocarcinoma

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23
Q

What are features of squamous cell carcinoma?

A
  • central location – mainstem or lobar bronchi
  • may be cavitary
  • strong association with smoking
  • often bulky; fast doubling time
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24
Q

What are features of adenocarcinoma?

A
  • peripheral location
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25
Q

What is most common type of lung cancer in non-smokers?

A

adenocarcinoma

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26
Q

What is new name for bronchioalveolar carcinoma?

A

lepidic adenocarcinoma

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27
Q

What are features of lepidic adenocarcinoma?

A
  • non-mucinous adenocarcinoma
  • lines alveolar spaces
  • slow progression
  • looks like pneumonia
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28
Q

What should you think if non-resolving pneumonia?

A

might be lepidic adenocarcinoma

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29
Q

What are features of large cell lung cancer?

A
  • may present as bulky tumors

- aggressive w/ poor prognosis

30
Q

What are features of carcinoid tumors?

A
  • well differentiated
  • neuroendocrine tumor
  • arise in central airways
31
Q

What are features of small cell carcinoma?

A
  • poorly differentiated
  • neuroendocrine tumor
  • central
  • perihilar masses; mediastinal lymphadenopathy
  • paraneoplastic syndromes
32
Q

How do carcinoid tumors present?

A

wheezing, cough, obstructive pneumonia

33
Q

What is prognosis carcinoid vs other tumors?

A

carcinoid = better survival than small cell or non small cell

34
Q

Which lung cancer has the highest association with smoking?

A

small cell carcinoma

35
Q

What type of cells does small cell carcinoma arise from?

A

pulmonary neuroendocrine cells

36
Q

What is survival for small cell carcinoma?

A

poor –> 5 year survival rate 6.2%

37
Q

How do lung cancers usually present?

A
  • often present at advanced stage

- early lung cancers often asymptomatic

38
Q

What are airway symptoms of lung cancer? Most common w/ what type?

A

most common with squamous cell

  • cough
  • hemoptysis
  • dyspnea
39
Q

What are symptoms of mediastinal spread of cancer?

A
  • hoarseness [recurrent laryngeal nerve involvement]
  • diaphragm paralysis [phrenic nerve]
  • SVC syndrome
40
Q

What are symptoms of distant spread of lung cancer?

A
  • headache
  • localized weakness
  • seizure
  • bone pain
  • abdominal pain
41
Q

What is a pancoast tumor? signs?

A

lung cancer originating in apex of lung

signs = arm pain/weakness due to brachial involvement; horner’s

42
Q

What cancer should you think if have hypercalcemia?

A

squamous cell carcinoma

hyper-Ca from ectopic PTH

43
Q

What cancer should you think if have clubbing?

A

non small cell lung cancer

44
Q

What cancer should you think if have cushing’s syndrome?

A

due to cortisol production by small cell carcinoma

45
Q

What cancer should you think if have SIADH?

A

due to ADH production by small cell carcinoma

46
Q

What cancer should you think if have Eaton-lambert syndrome?

A

SCC due to autoantibodies to voltage sensitive Ca channels

47
Q

What does sputum cytology tell you about lung cancer?

A

tells you cellular diagnosis

48
Q

What does bronchoscopy tell you about lung cancer? best for what kind of tumor?

A

tells you tissue diagnosis and extent/location of tumor

best for central tumors

49
Q

CT guided biopsy is best for what type of lung tumors?

A

peripheral lesions

50
Q

What are the 3 TNM stages of non small cell lung cancer?

A

T = site, size, local invasion of primary tumor

N = whether spread to local or regional lymph nodes

M = whether or not spread of lung cancer to distant metastatic sites

51
Q

How do you stage small cell lung cancer?

A

limited stage = confined to single hemothorax

extensive stage = spread beyond hemithorax

52
Q

How do you stage cancer non-invasively?

A

CT = assess size, location of tumor and sites of metastasis

PET = metabolic activity that could represent sites of metastatic disease

53
Q

Is positive or negative PET most helpful?

A

negative most helpful = tells you probably not cancer;

positive is less specific

54
Q

What is stage 1 NSCLC?

A
  • no nodes
  • no metastases
  • no local invasion
55
Q

What is prognosis of stage 1 NSCLC post resection?

A

60-70% 5 year survival post resection

56
Q

What is stage 2 NSCLC cancer?

A

ipsilateral peribronchial or hilar nodes

or limited local invasion w/ no nodal involvement

57
Q

What is 5 year survival stage 2 NSCLC?

A

30-50%

58
Q

What is stage 3 NSCLC?

A

positive ipsilateral mediastinal nodes; greater local invasion

59
Q

What is 5 year survival stage 3 NSCLC?

A

10-20%

60
Q

What is stage 4 NSCLC?

A

distant metastases or metastasis to any lung lobe other than lobe w/ primary tumor

61
Q

What is 5 year survival stage 4 NSCLC?

A

< 10%

62
Q

What is treatment of NSCLC?

A

surgery is only cure

chemo is life extending by months

63
Q

What is treatment of small cell lung cancer?

A

chemo +/- radiation

dramatic initial response then often recurs

64
Q

What is treatment stage 1/2 NSCLC?

A

resection of area or entire lobe

65
Q

What is treatment stage 3a NSCLC?

A

surgery and adjuvant chemo + radiation

66
Q

What is treatment stage 3b NSCLC?

A

chemo +/- radiation

67
Q

What is treatment stage 4 NSCLC?

A

chemo or palliative care

68
Q

What is treatment limited vs extensive small cell lung cancer?

A 
limited = chemo + radiation
extensive = chemo
69
Q

Who gets EGFR mutation? What does it predict?

A

more common in non smokers

predicts response to EGFR tyroskine kinase inhibitor [gefitinib, erlotinib]

70
Q

Who gets KRas mutation? What does it predict?

A

more common in smokers

predicts poor response to TKI/chemo and poor prognosis

71
Q

EML4-ALK mutation predicts what?

A

predicts response to ALK inhibitors

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