Lung cancer

Question 1

two types of lung cancer

Answer 1

small cell (SCLC)
non small cell (NSCLC)

Question 2

makes up 80% of all lung cancer

Answer 2

NSCLC

Question 3

LS vs ES-SCLC prognosis

Answer 3

• LS– 14-20 months
• ES— 8-13 months; worse

Question 4

which type of cancer essentially has no long term survivors

Answer 4

extensive stage SCLC

Question 5

NSCLC prognosis

Answer 5

15 month median Os

Question 6

4 major signs and sx of lung cancer

Answer 6

• dyspnea
• hemoptysis
• cough
• chest pain

Question 7

describe bronchoscopy

Answer 7

• insert optic bronchoscope to detect intrabronchial pathology

Question 8

3 limitations of bronchoscopy

Answer 8

• peripheral lesions
• upper lobe
• minimal endobronchial component

Question 9

main limitation of percutaneous image guided biopsy

Answer 9

central lesion

Question 10

describe PET (3)

inject radioactive glucose

Answer 10

• heat map
• active in bone
• bad at anatomic differentiation

Question 11

Brain MRI w/ staging (3)

Answer 11

• needs IV contrast
• better for soft tissue
• chemo cant get up thru BBB

Question 12

review TNM staging (1-4)

Answer 12

1. small & localized
2. big & localized
3. lymph node or locally advanced
4. metastatic or incurable

Question 13

4 most common sites for metastasis

Answer 13

• other lung
• adrenal glands
• liver
• bones
• brains

Question 14

4 general paraneoplastic effects of lung cancer

Answer 14

• clubbing/hypertrophic pulmonary osteoarthropathy
• eatin-lambert
• hypercalcemia
• endocrine abnormalities

Question 15

which type of lung cancer is eatin-lambert strongly associated with?

Answer 15

SCLC

Question 16

what does eatin-lambert look like

Answer 16

proximal symmetric muscle weakness

Question 17

2 endocrine abnormalities

Answer 17

• ectopic ACTH production– cushings, DM, HTN
• hyponatremia/SIADH

Question 18

generally speaking, with which type of lung cancer can you cut out if no C/I?

Answer 18

NSCLC

Question 19

who gets surgery?

Answer 19

• NSCLC w/o mediastinal LN or distant disease
  aka stage 1 and 2

Question 20

when can you do post-op chemo for NSCLC treatment?

Answer 20

• large primary tumor > 1cm
• positive nodes

Question 21

most common treatment for stage 3

Answer 21

• chemo + radiation
• immunotherapy improves outcome

Question 22

what is ‘performance status’?

Answer 22

Rough measure of how well someone will do on therapy of any kind

Question 23

true or false

Bad idea to give chemo to ppl in bed or chair for more than half the day

Answer 23

true

Question 24

while metastatic dz is primarily treated with chemo, what treament beats chemo?

Answer 24

targeted agents (EGFR, ALK/ROS, PD-L1)

Question 25

____ is first line combination with chemo

Answer 25

immunotherapy

Question 26

tx for LS-small cell lung cancer

Answer 26

aggressive chemo (platinum + etoposide)+ radiotherapy

Question 27

imaging for lung cancer

Answer 27

• CT scan– good for anatomy but cant tell cancer from not cancer
• PET— brain blind but active in bone
• MRI– brain

Question 28

which cancer is

• very responsive but briefly
• distant relapse to brain bones or liver is common
• maintenance immunotherapy
• Role of prophylactic cranial irradiation
• Limited role of surgery

Answer 28

limited state small cell

Question 29

tx for extensive stage SCLC

Answer 29

chemo+ immunotherapy

(platinum + etoposie + atezolizumab)

Question 30

which type of cancer

• limited role for radiation
• surgery has almost no role
• certain systemic relapse

Answer 30

• extensive stage SCLC

Question 31

3 sx that palliative care is focused on

Answer 31

pain
nausea
dyspnea

Question 32

performance status 0 vs 2 vs 3

Answer 32

0= symptomatic
2= symptomatic but can carry on
3= bed or chair for most of the day

Greater than 2 should NOT get chemo

Question 33

3 screening tools

Answer 33

• Serial CXR
• Sputum cytology
• Low dose CT scan

Question 34

top 3 treatment for metastatic NSCLC

Answer 34

• targeted therapy
• immunotherapy
• cytotoxic chemo