Lung Cancer

Question 1

Lung cancer compared to other cancers

Answer 1

Lung CA is leading cause of CA mortality in the world

Question 2

Survival Rate

Answer 2

15% at 5 yrs

Question 3

Types

Answer 3

95% of Lung CA classified as either
Small Cell Lung Cancer (SCLC) or
Non-small Cell Lung CA (NSCLC)

Distinction is essential for staging, tx, and prognosis

Question 4

Risk Factors

Answer 4

CIGARETTE SMOKING most important risk factor
Radiation therapy - can increase risk of secondary lung CA in pts who have been tx’d for other CAs
Environmental toxins - 2nd hand smoke, asbestos, radon, metals (arsenic, chromium, nickel), ionizing radiation, polycyclic aromatic hydrocarbons
Pulm fibrosis
Genetic predisposition
Dietary factors
HIV infection
Low SE status
Low education

Question 5

Screening

Answer 5

No screening test has been shown to reduce mortality from lung CA but new screening guidelines approved for older smokers:
annual low-dose CT lung cancer screening
For pts 55 and 80yo who are at high risk for lung cancer as a result of heavy smoking

Question 6

Clinical Presentation

Answer 6

Majority of lung CA have advanced dz at clinical presentation
15% manifest asymptomatically - careful hx is important:
smoking
2nd hand
asbestos exposure
Carcinogenic exposure

Question 7

Signs and Symptoms

Answer 7

Cough
Hemoptysis
CP
Dyspnea
Bronchorhhea
Diaphragmatic paralysis
Hoarseness
Malignant PEs
superior vena cava syndrome
Upper extremity pain or edema (Pancoast's Syndrome)
Constitutional symptoms: Fatigue, Wt loss

Question 8

PE

Answer 8

Inspect Head and neck
Auscultate: wheezes, egophony, decreased breath sounds and muffled heart sounds
Extremity swelling
Palpate and percuss: enlarged lymph nodes, dullness, discrepancy in lung expansion,
Pain

Question 9

Labs

Answer 9

CBC diff
CMP (ren fxn, lytes, hepatic profile, phosphorus)
Lactate dehydrogenase
Sputum cytology

Question 10

Radiology

Answer 10

CXR 
CT chest
CT liver, adrenals
PET scan
MRI brain if mets suspected

Question 11

Other exams

Answer 11

Bronchoscopy
Mediastinoscopy
Bone scan
EKG

Question 12

Tissue Dx

Answer 12

essential for staging dz

Question 13

DD

Answer 13

Cardiac (CHF, cardiomyopathy)
Infection
Interstitial pulmonary fibrosis
Metastatic CA Non-lung CA primarily
Granulamatous dz
Malignant lung tumor
Mesothelioma
TB

Question 14

Management

Answer 14

Single or combined modality tx:
Surgery 
Radiation tx
Chemo tx
Targeted tx's

Or best supportive care

Goal: Curative or palliative?

Question 15

Referral

Answer 15

Dx and staging initiated by PCP

Then refer - medical management of lung CA is best managed by experienced oncologists

Question 16

Treatment approach Non-small Cell Lung CA

Answer 16

Resectable Stages I, II and IIIA and selected T3, N2 Lesions
Surgery
Radiotherapy for “nonoperable” patients
Adjuvant radiotherapy and chemotherapy

Nonresectable Stages IIIB and IV
Combined modality: radiation & chemotherapy
Extrathoracic radiotherapy to symptomatic local sites

Question 17

Treatment approach Small Cell Lung CA

Answer 17

Limited Stage (good performance status)
Combined modality
Prophylactic cranial radiotherapy

Extensive Stage (good performance status)
Chemotherapy
Poor Performance (all stages)
Chemotherapy; Palliative Radiotherapy

Question 18

Tx approach to all pts with Lung CA

Answer 18

Radiation for Brain Metastasis

Diagnosis and treatment of other co-morbid issues and supportive care during treatment

Smoking Cessation Strategies