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Radiation oncology phase B > Lung > Flashcards

Lung Flashcards

1
Q

lining epithelium of lung structures

A

upto lobular bronchiole: pseudo stratified ciliated columnar epithelium
terminal and respiratory bronchiole: low columnar or cuboidal with cilia
rest of the part: simple squamous cell epithelium

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2
Q

histological classification of lung cancer broadly

A 
**Epithelial tumors:**
--adenocarcinoma
--squamous cell carcinoma
--adeno squamous carcinoma
--neuro endocrine tumors
--large cell
--sarcomatoid
Mesenchymal tumors
Lymphohistiocytic tumors
Tumors of ectopic origin
Metastatic tumors
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3
Q

Classification of adenocarcinoma

A 
lepidic
acinar
papillary
micro papillary
solid
colloidal
fetal adenocarcinoma
enteric
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4
Q

squamous cell carcinoma classification

A

keratinizing
non keratinizing
basaloid
SCC in situ

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5
Q

types of sarcomatoid carcinoma in lung

A 
pleomorphic carcinoma
spindle cell carcinoma
giant cell carcinoma
carcinosarcoma
pulmonary blastoma
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6
Q

types of mesenchymal tumors

A 
pulmonary hamartoma
chondroma
pecomatous tumors
synovial sarcoma
pulmonary artery intimal sarcoma
pulmonary myxoid sarcoma
myoepithelial tumor
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7
Q

Lymph node zone of lung: N2

A 
1=low cervical, supraclavicular
2=upper paratracheal
3=pre vascular, retro tracheal
4=lower paratracheal
5=sub aortic
6=para aortic
7= sub carinal
8=para esophageal
9= pulmonary ligament
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8
Q

Lymph node zone of lung N1

A 
10=hilar nodes
11=inter lobar 
12=lobar
13=segmental
14=sub segmental
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9
Q

Endocrine PNS of lung cancer

A 
SIADH
cushing syndrome
carcinoid syndrome
hypercalcemia
hypercalcitonemia
hyperthyroidism
hypoglycemia
gynecomastia
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10
Q

Neurologic PNS

A 
Encephalopathy
sub acute cerebellar degeneration
progressive multifocal leukoencephalopathy
peripheral neuropathy
autonomic neuropathy
Lambert Eaton syndrome
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11
Q

SIADH diagnostic Criteria

A

serum osmolarity: < 275 mosm/kg
urine osmolarity >100 mosm/kg
clinical euvolemia
urine Na> 30 mmol/L with normal dietary salt and water
absence of adrenal, thyroid, pituitary or renal insuff
no recent use of diuretics

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12
Q

Chemotherapy causing SIADH

A 
cisplatin
cyclophosphamide
ifosfamide
vincristine
vinorelbine
vinblastine
MTX
imatinib
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13
Q

Pancoast tumor

A

it is the tumor that arises from apex of lung

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14
Q

Pancoasts syndrome

A

this is characterized by the pain in the shoulder or inner aspect of arm along the ulnar nerve distribution due to the involvement of lower part of brachial plexus. (C8, T1, T2)

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15
Q

Horners syndrome

A

it is a combination of S/S caused by disruption of cervical sympathetic nerve pathway as it passes through T1 root and characterized by ptosis, miosis, enopthalmus, ipsilateral anhydrosis.

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16
Q

Maker IHC for adenocarcinoma

A

TTF 1 +ve
Napsin a +ve
Ck 7+ve
Ck 20-ve

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17
Q

Sq cell carcinoma IHC

A

TTF1 -ve
p40 +ve
p63 +ve
ck 5/6 +ve

18
Q

Small cell lung cancer IHC

A 
NSE > 100 mcg/dl(+ve)
CD 56 +ve
chromogranin +ve
synoptophysin +ve
ki 67 (50-100%)
19
Q

Mesothelioma IHC

A

To confirm: WT1, calretinin, D2-40
To exclude: CEA, TTF1, Claudin-4
BAP-1 IHC specific marker to distinguish mesothelioma from reactive mesothelial proliferation

20
Q

Dose limitation for lung

A

mean <20 gy

combined volume of both normal lung v20<35%

21
Q

Heart dose limitation

A

V40<80%
v60 <30%
mean <35 gy

22
Q

Prognostic factors of lung cancer

A

patient age, sex, weight loss and performance stats
staging
tumor histology:sqcc better prognosis
LDH, Albumin, Hb

23
Q

five year survival of NSCLC

A

stage I: 68-92%
Stage II: 53-60%
stage III: 13-36%
stage IV: 0-10%

24
Q

Nodal disease estimation:
EBUS: Stations
EUS : stations

A

Ebus: 2r/l, 4R/L, 7, 10 R/L
EUS: 5,7,8,9
TTNA(anterior mediastinotomy): 5,6

25
Q

method of pathological mediastinal lymph node evaluation

A 
mediastinoscopy
mediastinotomy
EBUS
EUS
CT guided biopsy
26
Q

Stage IV a , C/L lung nodule: how to treat

A

treat as two primary lung tumors if both curable

27
Q

Follow up protocol: Stage I and II

A

H&P , contrast CT chest+-contrast 6 monthly 3 yrs

than H&P and low dose ct scan contrast annually

28
Q

follow up for stage I-II(if rx with RT)

stage III IV (definitive intent treatment)

A 
H&P, contrast CT +- 3-6 monthly 3 yr
than H&P , chest CT +-contrast 6 monthly 2 yr
than LDCT annually
smoking cessation
pet/CT & brain MRI 
cancer survivor ship
29
Q

Lung cancer prognostic factor

A

Female sex
Ps
Wt loss
Staging ( rakib sir favrt question)

30
Q

lung lymph node station: N1

A

10: hilar
11: interlobal
12: lobar
13. segmental
14. subsegmental

31
Q

lung lymph node station: N2

A

supraclavicular zone:
1. low cervical, supraclavicular
superior mediastinal:
2R,L: upper paratracheal
3a: prevascular
3p: Retrotracheal
4R: lower paratracheal
4L: lower paratracheal left
5: Sub aortic
6: para aortic
7. Sub carinal
8. paraesophageal
9. pulmonary ligament

32
Q

Squamous cell carcinoma lung : curative dose

A

Curative:
55gy in 20 fractions 2.75 gy in 4 weeks
64-66 gy in 32-33 daily fractions given in a six and a half weeks

33
Q

Nsclc sbrt dose

A

60 gy in 8 fractions on a alternate days
60 gy in 5 fractions weekly ( nazir sir)

34
Q

Curative small cell lung dose

A

40 gy in 15 fractions 2.67 gy bid 6 hours gap in 3 weeks
45 gy in 15 fraction 1.5 gy BID 6 hours apart over 3 weeks (nazir mollah favorite)

35
Q

PCI dose in ca lung

A

25 gy in 10 daily fractions of 2.5 gy given in 2 weeks

36
Q

PCI used in

A

Small cell lung carcinoma
Leukemia

37
Q

Difference between pleural effusion due to carcinoma or infective cause

A

The characteristics of pleural fluid can help differentiate between malignant and infective causes. In general, malignant pleural effusions tend to have higher protein and lactate dehydrogenase (LDH) levels than non-malignant effusions 2. Additionally, malignant effusions are more likely to be exudative, meaning that they contain high levels of cells and other substances 2. In contrast, transudative effusions are more commonly associated with non-malignant causes such as heart failure or liver disease 2

38
Q

Complication of RT in lung

A

COMPLICATIONS
… Acute
esophagitis, dermatitis, cough, fatigue.
… Subacute/late
radiation pneumonitis, pulmonary fibrosis, esophageal stricture or perforation, pericarditis, coronary artery disease, brachial plexopathy, rib fracture. 2nd malignancy

39
Q

How smoking cause lung cancer

A

Cigarette smoking is by far the leading cause of lung cancer, accounting for approximately 80% to 90% of cases. Combustion of tobacco produces multiple known carcinogens, with the most important including polycyclic aromatic hydrocarbons, tobac- co-specific nitrosamines, and nitrates

40
Q

Sensitivity and specificity of CT scan and PET CT for identifying lung lesion

A

CT scan
Sensitivity: 55%
Specificity: 81%
PET CT
Sensitivity 80%
Specificity 88%

41
Q

Common paraneoplastic syndrome of lung

A

Hypercalcemia
SIADH
Cushing syndrome
Lambert eaton myasthenic syndrome
Paraneoplastic encephalitits
Unexplained hematologic abnormalities
Hypercoagulability with venous thromboembolic disease
Hypertrophic pulmonary osteoarthropathy
Dermatomyositis and polymyositis

Radiation oncology phase B (33 decks)

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