Lecture 26 - Lung Cancer: Clinical

Question 1

What is the reason mortality is so high for lung cancer vs other cancers?

Answer 1

It is not typically discovered until it has already metastasized.

Question 2

In general, fast growing cancers have a doubling time of approximately ____ days, while slow growing cancers have a doubling time of approximately ____ days.

Answer 2

30days

300days

Growth far outside of this range suggests the growth is not cancerous.

Question 3

When there are multiple, well circumscribed nodules detected in the lung, it is more likely to be _____ (primary or metastases?).

Answer 3

Metastases

Question 4

Another reason lung cancer is often not detected before it metastasizes is that up to ____% of patients don’t have symptoms.

Answer 4

25%

Question 5

If a lung tumor invades the ____/____ nerve, patients can develop Horner’s syndrome. They may present with Miosis (constricted pupil), ______, and Anhydrosis.

Answer 5

Cervical/Thoracic nerve

Ptosis

Question 6

Obstruction of lymphatic draining in the lung from regional metastases from lung cancer can result in _____ ______.

Answer 6

Pulmonary Embolism

Question 7

Small Cell Lung Cancer (SCLC) RARELY arises in ___-______ (what group of people?). It is often ______ located, and it is typically more responsive to ______ than NSCLC. However, SCLC is very _____ (rapidly or slow?) growing.

Common paraneoplastic syndromes associated with SCLC include _______ from inappropriate secretion of ADH, Ectopic _____ secretion (leading to Cushing’s syndrome), and many neurologic/myopathic syndromes.

Answer 7

Non-smokers

Centrally located

Chemo

Rapidly

Hypokalemia

ACTH secretion

Question 8

How is SCLC staged?

What is significant about the Supraclavicular lymph node in SCLC vs NSCLC?

Answer 8

If it is limited to one hemithorax and its associated lymph nodes –> limited

If it is beyond one hemithorax and its associated lymph nodes –> extensive

Limited SCLC CAN include invasion of Supraclavicular lymph node. NSCLC is considered advanced and NOT surgically treatable if it reaches that lymph node.

Question 9

Common metastatic sites for lung cancer include:

The lung itself, ____, ____, ____, and ____. (LBLAB - “Lung Biopsy LAB”).

Answer 9

LBLAB –> Lung, Bone, Liver, Adrenals, Brain.

Question 10

________ is the only lung cancer type in which there is a decent proportion of patients who are non-smokers.

Answer 10

Adenocarcinoma

Question 11

Which of the three NSCLC is the slowest growing and which is the fastest?

Answer 11

Adenocarcinoma –> slowest

LCLC –> fastest

Question 12

Adenocarcinoma tends to be more ______ located in the lungs, while Squamous Cell Carcinoma (SCC) tends to me more _______ located. LCLC can appear anywhere in the lung.

Answer 12

Centrally located

Peripherally located

Question 13

The most common paraneoplastic syndrome associated with NSCLC (usually SCC) is _______.

Answer 13

Hypercalcemia (from Parathyoid hormone-related peptide)

Question 14

TNM are the three letters used for staging of NSCLC. What do they denote?

Answer 14

T –> Size/location of the lesion

N –> Nodes (which lymph nodes have been invaded)

M –> metastases

Question 15

NSCLC stages ___ and ___ are treated with surgery, while ___ and ___ are treated with chemo and/or radiation. Remember that ALL SCLCs are treated with Chem and/or Radiation.

Answer 15

1 and 2 –> Surgery

3 and 4 –> Chemo and/or radiation

Question 16

Adenocarcinoma patients with _____ mutations and who are NON-smokers are candidates for treatment with Erlotinib and/or Gefitinib.

Answer 16

EGFR

Question 17

Adenocarcinoma patients with _____ _____ _____ translocation and who are NON- or LIGHT smokers are candidates for treatment with Crizotinib and/or Ceritinib.

Answer 17

Anaplastic Lymphoma Kinase translocations