Lung Ca

Question 1

types of NSCLC

Answer 1

adenocarcinoma
squamous cell carcinoma
large cell carcinoma

Question 2

the 3 S’s and C of SCLC

Answer 2

Small
Sensitive to chemo
Smoking
Central

Question 3

RF for lung cancer

Answer 3

• smoking
• chronic lung diseases: COPD, fibrosis, radon
• exposure: asbestos, lead
• genetics/fhx

Question 4

patho for smoking and lung cancer

Answer 4

1. smoking has a field effect on the lung parenchyma ➔ gain a baseline sort of mutation
2. easier to gain a second mutation that results in the development of a cancer (can take 15-20Y, even if the pt stops smoking, the damage is done)

Question 5

define SCLC

Answer 5

small cell lung cancer, it’s a neuroendocrine tumour and is found centrally

releases a lot of hormones

Question 6

what paraneoplastic syndromes are associated with SCLC?

Answer 6

S - SIADH
C - Cushing
L - Lambert Eaton

Question 7

what paraneoplastic syndromes are assoiacted with NSCLC?

Answer 7

• hypertrophic osteoarthropathy (big clubbed fingers)
• hypercalcemia (increase PTHrP)
• dermatomyositis or myositis

Question 8

what s/s might a lung cancer pt present with?

Answer 8

1. coughing, wheezing, SOB, hemoptysis, pleuritic chest pain
2. mass effect of the tumor ➔ SVC syndrome ➔ pemberton’s sign
3. paraneoplastic syndromes
4. s/s of mets
5. brachial plexus compression ➔ arm weakness
6. pancoast tumour ➔ Horner syndrome: ptosis, miosis, and facial anhidonia
7. pleural effusions

Question 9

most common sites of mets for lung ca?

Answer 9

LN, liver, adrenals, brain, bone

Question 10

which has better prognosis? NSCLC or SCLC?

Answer 10

NSCLC has better prog; slower growing although, is not chemo sensitive

SCLC has poor prognosis; fast growth but it chemo sensitive

Question 11

what ix to order to dx lung cancer?

Answer 11

1. probs did imaging upon first presentation
2. imaging w/ multiple nodules and with malignant signs, we would consider going for biopsy
3. send biopsy for pathology and genetics to look for variants of signficance

Question 12

how to tx NSCLC?

Answer 12

early stage - resection +/- chemo (alkylating agent + MT inhibitor)

late stage - chemo + palliative

for both, consider EGFR inhibitors (tyrosine kinase inhibitors)

Question 13

how to tx SCLC?

Answer 13

limited - resection +/- chemo (alkylating agent + MT inhibitor) and radiation

extensive stage -chemo + radiation + immunotherapy (immune checkpoint inhibitors) + palliative care

Question 14

what pt education would you provide for lung ca?

Answer 14

smoking cessation
- tools: nicotine replacement therapy (patches, and gum), antidepressants, and nicotine receptor partial agonist

Question 15

what does lung cancer screening look like?

Answer 15

high risk Referral inclusion criteria: 1) 55-74Y AND 2) smoked cigs every day for at least 20 years total

annual low dose CT

can self refer or be referred by a PCP