Lecture 10: Cancers of the Respiratory System Flashcards
Based on what concept why must the entire area be investigated when a malignancy is identified in the head or neck area?
“Field cancerization” - entire upper aerodigestive tract is exposed to carcinogens so multiple malignancies are common
What is trismus and why must this be investigated?
Inability to open the jaw from compression of the trigeminal n. or muscle invasion by a tumor
When does ear pain need further evaluation?
If not responding to conventional tx
Which patient complain related to the upper GI tract needs prompt investigation?
ANY complaint of difficulty swallowing or intermittent choking
What are the 3 tx’s commonly used for head and neck cancers that are locally or regionally advanced disease which make it multimodal?
- Radiotherapy + Systemic therapy (chemotherapy)
- Surgery
What are 2 options for patients who have undergone a laryngectomy so that that they are able to speak?
- Electrolarynx –> placed in submandibular region; vibrates at constant pitch
- “Talking” tracheostomy –> provide a set of synthetic“vocal cords” to allow partial speech
HPV-related tumors of the head/neck typically present with what as the first sign?
Neck lymphadenopathy
Which imaging modalities are utilized to identify the extent of head/neck cancers; which modality is used to identify or exclude distant metastases?
- CT of the head and neck to identify extent of the disease
- PET scan can help identify or exlude distant metastases
What is the definitive stage procedure for head/neck malignancies?
Endoscopic examination under anesthesia (i.e., laryngoscopy, esophagoscopy, and bronchoscopy); obtaining multiple biopsy samples
Head and neck cancers are classified with what system?
TNM system
In patients with lymph node involvement and no visible primary tumor of the head and neck, how should diagnosis be made?
Lymph node excision
If results of a LN biopsy indicate SCC, what should be performed?
Panendoscopy, with biopsy of all suspicious-appearing areas and directed biopsies of common primary sites, such as nasopharynx, tonsil, tongue base, and pyriform sinus
What is the preferred tx for laryngeal cancer as to preserve voice function?
Radiation therapy
What is the preferred tx for small lesions/malignancies in the oral cavity?
Surgery, as to avoid long-term complications of radiation, such as xerostomia and dental-decay
Most recurrences of head and neck cancer happen in what time frame and are often what?
Within the first 2 years following diagnosis and are usually local
Pts with recurrent or metastatic disease are typically treated how?
With palliative intent; typically with chemotherapy for transient symptomatic benefit
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?
Cetuximab (EGFR-directed therapy)
About 50% of patients who undergo tx for head/neck cancer develop decreased function of what organ?
HYPOthyroidism; thus, thyroid function should be monitored
Distention of superficial veins and edema of the head and neck is characteristic of what paraneoplastic process of lung cancer?
SVC syndrome
What is a good starting point for imaging of lung cancer?
CXR
Following a CXR what is the most commonly performed test to further evaluate findings suspicious for bronchogenic carcinoma of the lung?
CT scan
Which imaging modality when fused with CT gives higher predicatbility for cancer vs. benign disease?
PET scan
Which imaging modality allows for visualization of the upper airway as well as mainstem, segmental, and some subsegmental bronchi?
Bronchoscopy
Which diagnostic procedure is required for any patient in whom curative resection of lung cancer is considered?
Bronchoscopy
What is the procedure of choice for peripheral lung lesions and has an accuracy of about 90%?
Fine needle aspiration (FNA) done w/ either plain radiographic or CT guidance
What is a complication which may arise with fine needle aspiration?
Pneumothorax
What is the recommended screening test for pt with high-risk of lung cancer?
Low-dose spiral CT
Which patients should be considered for low-dose CT screening for lung cancer?
- 55-80 y/o who have a ≥30-pack-year smoking hx either as current smoker
or
- Former smokers who have quit within the past 15 years
Hypercalcemia as a paraneoplastic process is most common with which lung cancers?
Adenocarcinoma or Squamous cell carcinoma
Hypertrophic pulmonary osteoarthropathy is most common with what lung cancer?
Adenocarcinoma
What is the best approach for histological confirmation in a pt with a lung mass in the setting of weight loss and unilateral supraclavicular LN enlargement?
Peripheral node biopsy; allows for diagnosis and staging
Which diagnostic method for lung cancer is reserved for pt’s with poor pulmonary function who cannot tolerate invasive procedures?
Sputum cytology
Which imaging modality may be indicated if pt has bone pain or an elevated serum Ca2+ or AlkPhos?
Bone scan
What are 2 features which define benign pulmonary nodules?
1) No growth in 2 years
AND
2) Calcification in a diffuse, central, or laminar pattern
What is the size, morphology, and location characteristic of malignant pulmonary nodules?
>2 cm w/ spiculated edges and located in the upper lobes
What is the best strategy in patients with incidentally discovered pulmonary nodules?
Obtain prior CXR’s or imaging scans to determine stability over time
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?
No follow-up recommended
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?
Nodules >4cm
What is the recommendation for pt’s with solid pulmonary nodules ≥1.5 - 2 cm who are considered high-risk or low-risk?
Immediate biopsy; close interval CT scanning is option in low-risk pt’s
What is the mainstay of tx for pt’s with stage I or II non-small cell lung cancer?
Surgery; adjuvant chemotherapy for pt’s with more advanced disesase
What is the superior tx for pt’s with unresectable non-small cell lung cancer?
Chemo-radiation
What is the tx of choice for small-cell lung cancer?
- Combination chemotherapy w/ platinum based agent (i.e., cisplatin) and etoposide is mainstay
- Radiation is given concurrently or sequentially
Which tx should be used for airway obstruction or SVC syndrome?
Thoracic radiation
What drug can be given to pt’s with brain metastases to decrease intracranial edema?
Glucocorticoids
