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MP Oncology > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What can give a false Negative result in CT-PET of suspected NSLC?

A
  1. DM
  2. Lesion < 8mm
  3. Slow growing Tumor
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2
Q

False positive CT pet

A
  1. Certain infection and granulomatous disease (TB)
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3
Q

Major contraindications to potential curative resection

A
  1. Extrathoracic Mets
  2. SVC Syndrome
  3. Vocal cord paralysis
  4. Phrenic nerve paralysis
  5. Malignant pleural effusion
  6. Cardiac tamponade
  7. Tumor within 2 cm of the carina (potentially curable with combined chemo)
  8. Mets to supraclavicular Lymph nodes
  9. Contralateral mediastinal node Mets (potentially curable with combined chemo)
  10. Involvement of main pulmonary artery
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4
Q

Fraction of patients with NSLC with mediastinal LN Mets at the time of diagnosis

A

1/4 to 1/2 of patients

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5
Q

Recommended staging work up for SCLC

A

PET-CT scan
MRI of the brain

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6
Q

If with mSCC S/Sx, what diagnostic should be done?

A

Spinal CT or MRI scan
Spinal Tap for CSF cytology

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7
Q

Besides cigarette smoking, what are other risk factors for Lung cancer ?
Occupational exposure

A

Asbestos
Arsenic
Bischloromethyl ether
Hexavalent chromium
Mustard gas
Nickel

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8
Q

Which subpopulation of people with asbestosis exposure has increased risk of developing Lung cancer

A

Risk of lung cancer is only increased only in those with underlying asbestosis

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9
Q

Besides cigarette smoking, what are other risk factors for Lung cancer ?

Ionizing radiation

A

Among survivors of atomic bombing
Workers in underground uranium mining

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10
Q

Prior lung diseases that are risk factors to lung. Ca

A

COPD
TB

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11
Q

WHICH POLYMORPHISM PREDISPOSES TO LUNG CANCER?

A

Genetic polymorphisms of P450 system especially CYP1A1- affect carcinogen metabolism

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12
Q

Excess risk of 1st degree relatives of lung cancer patients

A

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)

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13
Q

What are the 3 genetic foci of lung cancer?

A

• 5p15
• 6p21
• 15q25

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14
Q

Which germline mutation maybe linked to lung cancer among never smokers?

A

Germline mutation (T790M) involving the EGFR

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15
Q

Small cell lung cancer is distinguished from NSCLC by presence of these 4 neuroendocrine markers

A
  1. CD56
  2. NCAM
  3. Synaptophysin
  4. Chromogranin
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16
Q

These patients can tolerate a PNEUMONECTOMY;

A

FEV1>2L
OR
> 80% of predicted

17
Q

These patients can tolerate a LOBECTOMY;

A

Patients with FEV1 >1.5L have enough reserve for lobectomy

18
Q

If with borderline lung function but a resectable Tumor, which diagnostic should be done?

A

CARDIOPULMONARY EXERCISE TESTING

19
Q

What are the contraindications to thoracic surgery?

A
  1. Myocardial infarction within the past 3 months - 20 % will die of reinfarction
  2. Infarction in the past 6 mos - relative contraindications
  3. Uncontrolled arrhythmia
  4. FEV <1L
  5. CO2 retention (resting PCO2 >45mmHg)
  6. DLco <40%
  7. Severe pulmonary hypertension
20
Q

What is a solitary pulmonary nodule in NSCLC?

A

X-ray density , 1-6 cm greatest diameter,
Completely surrounded by normal aerated lung
Any shape

21
Q

What are the independent predictors of malignancy if no diagnosis is apparent?
Clinical characteristics

A

Age
Cigarette smoking status
Prior cancer diagnosis

22
Q

What are the independent predictors of malignancy if no diagnosis is apparent?
Radiologic characteristics

A

Nodule diameter
Spiculation
Upper lobe location

23
Q

What are the only 2 radiographic criteria predictive of BENIGN NATURE of a solitary pulmonary nodule?

A
  1. Lack of growth over a period of >2 years
  2. Characteristic pattern of calcification:
    a dense central nidus,
    multiple punctuate foci, and
    “bull’s eye” (granuloma) and “popcorn ball” (hamartoma) calcifications
24
Q

Characteristic of possible malignant lesion

A
  1. Relatively large lesion
  2. Lack of or asymmetric calcification
  3. Chest symptoms
  4. Associated atelectasis or pneumonitis
  5. Growth of the lesion
  6. Positive PET scan
25
Q

Approved second line treatment for SCLC

A
  1. Topotecan
  2. Lurbinectedin
26
Q

Treatment of LIMITED DISEASE SCLC

A

Concurrent chemo radiation with cisplatin- etoposide x 4 cycles

27
Q

eatment of Extensive Disease SCLC

A

Cisplatin/carboplatin
+
Etoposide
+
Atezolizumab OR Durvalumab

28
Q

EGFR Mutations targeted therapy
Sensitizing Mutations - highly sensitive to which medications?

A

EGADO
Erlotinib
Gefitinib
Afatinib
Dacomitinib
Osimertinib

29
Q

EGFR
Resistance mutation therapy

A

T790M mutation responds to OSIMERTINIB

30
Q

Treatment for ALK Rearrangement

A

BLACC
Brigatinib
Lorlatinib
Alectinib
Ceritinib
Crizotinib

31
Q

ROS1 rearrangement treatment

A

CRIZOTINIB

32
Q

BRAF V600E treatment

A

DABRAFENIB
+
TRAMATINIB

33
Q

FIRST LINE REGIMEN FOR NONSQUAMOUS

A

PLATINUM
+
PACLITAXEL OR PMETREXED
+/- BEVACIZUMAB

34
Q

FIRST LINE TREATMENT FOR SQUAMOUS

A

PLATINUM
+
PACLITAXEL OR GEMCITABINE OR ETOPOSIDE

MP Oncology (4 decks)

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