Lung Cancer Flashcards
What can give a false Negative result in CT-PET of suspected NSLC?
- DM
- Lesion < 8mm
- Slow growing Tumor
False positive CT pet
- Certain infection and granulomatous disease (TB)
Major contraindications to potential curative resection
- Extrathoracic Mets
- SVC Syndrome
- Vocal cord paralysis
- Phrenic nerve paralysis
- Malignant pleural effusion
- Cardiac tamponade
- Tumor within 2 cm of the carina (potentially curable with combined chemo)
- Mets to supraclavicular Lymph nodes
- Contralateral mediastinal node Mets (potentially curable with combined chemo)
- Involvement of main pulmonary artery
Fraction of patients with NSLC with mediastinal LN Mets at the time of diagnosis
1/4 to 1/2 of patients
Recommended staging work up for SCLC
PET-CT scan
MRI of the brain
If with mSCC S/Sx, what diagnostic should be done?
Spinal CT or MRI scan
Spinal Tap for CSF cytology
Besides cigarette smoking, what are other risk factors for Lung cancer ?
Occupational exposure
Asbestos
Arsenic
Bischloromethyl ether
Hexavalent chromium
Mustard gas
Nickel
Which subpopulation of people with asbestosis exposure has increased risk of developing Lung cancer
Risk of lung cancer is only increased only in those with underlying asbestosis
Besides cigarette smoking, what are other risk factors for Lung cancer ?
Ionizing radiation
Among survivors of atomic bombing
Workers in underground uranium mining
Prior lung diseases that are risk factors to lung. Ca
COPD
TB
WHICH POLYMORPHISM PREDISPOSES TO LUNG CANCER?
Genetic polymorphisms of P450 system especially CYP1A1- affect carcinogen metabolism
Excess risk of 1st degree relatives of lung cancer patients
2-3x excess of lung cancer and other cancers mostly not related to smoking
(Inherited mutations in RB gene (retinoblastoma living to adulthood) and p53 (Li-Fraumeni Syndrome)
What are the 3 genetic foci of lung cancer?
• 5p15
• 6p21
• 15q25
Which germline mutation maybe linked to lung cancer among never smokers?
Germline mutation (T790M) involving the EGFR
Small cell lung cancer is distinguished from NSCLC by presence of these 4 neuroendocrine markers
- CD56
- NCAM
- Synaptophysin
- Chromogranin
These patients can tolerate a PNEUMONECTOMY;
FEV1>2L
OR
> 80% of predicted
These patients can tolerate a LOBECTOMY;
Patients with FEV1 >1.5L have enough reserve for lobectomy
If with borderline lung function but a resectable Tumor, which diagnostic should be done?
CARDIOPULMONARY EXERCISE TESTING
What are the contraindications to thoracic surgery?
- Myocardial infarction within the past 3 months - 20 % will die of reinfarction
- Infarction in the past 6 mos - relative contraindications
- Uncontrolled arrhythmia
- FEV <1L
- CO2 retention (resting PCO2 >45mmHg)
- DLco <40%
- Severe pulmonary hypertension
What is a solitary pulmonary nodule in NSCLC?
X-ray density , 1-6 cm greatest diameter,
Completely surrounded by normal aerated lung
Any shape
What are the independent predictors of malignancy if no diagnosis is apparent?
Clinical characteristics
Age
Cigarette smoking status
Prior cancer diagnosis
What are the independent predictors of malignancy if no diagnosis is apparent?
Radiologic characteristics
Nodule diameter
Spiculation
Upper lobe location
What are the only 2 radiographic criteria predictive of BENIGN NATURE of a solitary pulmonary nodule?
- Lack of growth over a period of >2 years
- Characteristic pattern of calcification:
a dense central nidus,
multiple punctuate foci, and
“bull’s eye” (granuloma) and “popcorn ball” (hamartoma) calcifications
Characteristic of possible malignant lesion
- Relatively large lesion
- Lack of or asymmetric calcification
- Chest symptoms
- Associated atelectasis or pneumonitis
- Growth of the lesion
- Positive PET scan
