Lung Cancer

Question 1

Carcinoid - Definition & Pathology

Answer 1

A borderline indolent/malignant lung tumor

Characterized by nests and ribbons of neuroendocrine cells

Question 2

Small cell carcinoma - Pathology

Answer 2

Small, easily crushed, dark blue cells of neuroendocrine origin (“Kulchitsky cells”)

High mitotic rate and abundant necrosis

Often located in the central lung

Question 3

Squamous cell carcinoma - Pathology

Answer 3

Large polygonal cells with dark nuclei and abundant cytoplasm invading into sub-epithelial tissue

May form keratin pearls

Often located in the central lung

Question 4

Adenocarcinoma - Pathology

Answer 4

Cells forming ectopic gland-like structures

Often located in the periphery of the lung

Question 5

What percentage of lung cancer cases are attributable to smoking?

Answer 5

85-90%

Question 6

Risk factors for lung cancer

Answer 6

Previous history of tobacco-reated cancer (head and neck, esophageal, colon, bladder)

Smoking

Genetics

Lung disease (COPD, Sarcoidosis, PF, ILD)

Environmental exposures (Radon, asbestos, metals, polycyclic aromatic hydrocarbons)

Question 7

Solitary pulmonary nodule - Definition

Answer 7

A solitary mass, <3cm in size, outlined by normal lung tissue and not associated with atelectasis or adenopathy

Question 8

Definition of a benign pulmonary nodule

Answer 8

Stable in size over at least 2 years

Question 9

SCLC Staging

Answer 9

Limited disease (25-30%) - tumor is limited to ipsilateral hemithorax

Extensive disease (70-75%) - tumor extends beyond the hemithorax

Question 10

NSCLC - T stages

Answer 10

T0 - no evidence of primary tumor
Tis - Carcinoma in-situ
T1a - Tumor < 2cm
T1b - Tumor 2-3 cm
T2a - Tumor 3-5 cm or present in mainstem bronchus
T2b - Tumor 5-7 cm
T3 - Tumor > 7 cm or invading chest wall/diaphragm, pleura, pericardium
T4 - Tumor of any size with invasion of mediastinum, heart, trachea, esophagus, vertebral body

Question 11

NSCLC - N staging

Answer 11

N0 - no nodal involvement
N1 - involvement of ipsilateral peribronchial or hilar nodes
N2 - involvement of ipsilateral mediastinal or subcarinal nodes
N3 - involvement of supraclavicular or contralateral mediastinal or hilar nodes

Question 12

NSCLC - M staging

Answer 12

M0 no distant metastasis
M1a - separate tumor nodules in contralateral lobe or pleura
M1b - distant metastasis - to liver, brain, adrenals

Question 13

Post-resection FEV1 lower limit

Answer 13

FEV1 > 800 mL (or > 40% predicted)

Question 14

Types of Non-small cell lung cancer (NSCLC)

Answer 14

Squamous cell carcinoma (25%)

Adenocarcinoma (40%)

Large cell carcinoma (10%)

Question 15

EGFR

Answer 15

Common mutation of adenocarcinoma; target for direct therapy with Gefitinib

Question 16

Her2

Answer 16

Common mutation in adenocarcinoma; target for direct therapy with Herceptin

Question 17

vEGF

Answer 17

Common mutation in adenocarcinma; target for direct therapy with Avastin

Question 18

Ras mutations

Answer 18

2-30% of NSCLC adenocarcinoma

Associated with resistance to TKIs

Question 19

National Lung Screening Trial (NLST)

Answer 19

Showed a 20% decrease in lung cancer mortality with low-dose CT screening vs. CXR screening over 5 years; overall, a 6.7% all-cause mortality reduction

Question 20

Who should be recommended low dose CT screening?

Answer 20

Age 55-74

30+ pack year smoking history OR former smoker quit within last 15 years

Question 21

Treatment of SCLC

Answer 21

Cisplatin and etoposide chemotherapy
Radiation improves survival in patients with limited disease and treats symptomatic metastases

SCLC is not treated surgically

Question 22

SCLC Prognosis

Answer 22

2-year survival is 20% in limited disease and 5% in extensive disease

Remissions are short, with a duration of 7-9 months; once SCLC recurs, survival if 204 months

Question 23

NSCLC - Treatment

Answer 23

Neoadjuvant chemotherapy
Surgical therapy
Adjuvant chemotherapy