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lung cancer Flashcards

(65 cards)

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1
Q

more pts die of lung ca than..

A

colorectal, breast, prostate ca combined

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2
Q

this causes 85-90% lung ca

A

smoking

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3
Q

over past 30 years: mortality dec or inc in MEN? why?

A

dec, change in tobacco use

Females: started falling in 2003

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4
Q

median age of dx

A

70

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5
Q

worldwide, this % of M/F lung ca pts are nonsmokers

why?

A

15% men, 50% women

biomass cooking

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6
Q

other risk factors

A

radon gas
asbestos
metals (arseninc, chromium, Ni, iron oxide)
industrial carcinogens
familial predis.
preexisting disease: pulm. fibrosis, COPD (4x inc.), sarcoidosis

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7
Q 
lung ca breakdown: 
30-40% 
22%
13-20%
16%
2%
A 
adenocarcinoma
SqCC
SmCC
non-small cell
large cell
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8
Q

SqCC

A

From the bronchial epithelium, centrally located, can be intraluminal sessile or polyps
More likely to present with hemoptysis; can cavitate
Highly associated with smoking history
Tend to spread locally and may be associated with hilar adenopathy

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9
Q

adenocarcinoma

A

From mucous glands or epithelial cells in terminal bronchioles
Never smokers, higher rate of metastatic disease
Peripheral nodules/masses
Adenocarcinoma in Situ (previously Bronchoalveolar cell carcinoma)
Spreads along preexisting alveolar structures without evidence of invasion

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10
Q

large cell carcinoma

A

Relatively undifferentiated cancers that do not fit into other categories but share large cells
Aggressive clinical course with rapid doubling times
Central OR peripheral masses

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11
Q

non-small cell carcinoma

A

Can’t be better differentiated on pathological review

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12
Q

SmCC

A

Bronchial origin typicall centrally located
Highly associated with smoking
Infiltrates submucosa causing narrowing or obstruction of the bronchus without discrete luminal mass
Often involves lymph nodes

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13
Q

for staging, divided into

A

SmCC vs non-SmCC (included other 4)

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14
Q

what type is more prone for hematogenous spread and rarely approp. for surg. resection
more or less aggressive course?
median survival?

A

SmCC
MORE aggressive
only 6-18 wk survival

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15
Q

s/s lung ca

A 
anorexia, wl, asthenia
new/change in cough
hemoptysis
pain (bony, nonsp. chest)
postobstr. pneumonia
pleural effusion (12-33%)
change in voice (rec. lary. n)
SVC syndrome
Horner's 
invol. inf cervical ganglion, paravert. symp. chain
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16
Q

brain metastasis more common in these lung ca

and cause ???

A

adenocarcinoma, SmCC

cause ha, nausea, seizures, dizziness, AMS

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17
Q

paraneoplastic syndrome caused by

occurs in what %

A

immune-med. or secretory effects of neoplasms

in 10-20% lung ca pts

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18
Q

PNP syndrome comps

A

SIADH (10-15% SmCC)
hypercalcemia (10% SqCC)
inc. ACTH, anemia, hypercoag, peripheral neuropathy, labert eaton myasthenic syndrome

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19
Q

lung ca dx

A 
sputum cytology
thoracentesis
thoracoscopy
fine needle aspiration 
fiberoptic bronchoscopy
mediastinoscopy
video assisted thorascopic surgery (VATS)
open thoracotomy
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20
Q

sputum cytology: sp or sn?

more like to be positive if ??? lesion

A

highly specific, v. insensitive

central lesion

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21
Q

thoracentesis used for..
sens. of ??
do this to inc. yield

A

malignant pleural effusion
sn 50-60%
repeat 3x

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22
Q

thorascoscopy for..

preferred over ??

A

malignant pleural effusion

pref. over blind pleural biopsy

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23
Q

what is fine needle aspirated?

A

supraclavicular LNs

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24
Q

fiberoptic bronchoscopy allows visualization of ??

accompanies…

A

major airways

w/ BAL of lung segs + cytology/biopsy

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25
can also FNA ?? | blindly or with ??
mediastinal LNs | endobronchial US guidance (EBUS)
26
this helps properly biopsy peripheral nodules
electromagnetic navigational bronchoscopy
27
this is a high risk for pts (peripheral nodules) esp. with ??
*pneumothorax!* | underlying emphysema
28
this can be used then less invasive techniques fail
mediastinoscopy, VATS, open thoracotomy -wedge biopsy-imm. analysis on simult. tx/lobectomy (wait on management as frozen sects. can be inaccurate?)
29
if multiple nodules on imaging, be more suspicious for ??? than ???
metastatic disease | primary lung ca
30
TNM staging used for..
tx guidance, prognosis, to standardize trials
31
TNM...
T: tumor (primary) size/location (where, how big?) N: nodal metastasis presence/location (+/-, where?) M: metastasis (distant) presence/absence (+/-)
32
TNM stages grouped into prognostic categories
stages I-IV
33
need to ?? in order to stage
evaluate LNs
34
if no LNs on imaging larger than 1 cm...
resection of primary tumor and sample mediastinum at thoracotomy
35
if suspect metastatic disease, LNs > 1-2 cm
CT guided FNA, mediastinoscopy, EBUS, EUS, limited thoracotomy to eval. LNs (prior to decision about thoracotomy?)
36
PET scanning uses ??? to identify ??? | specificity depends on ??
18F fluoro-2-deoxyglucose (FDG) to ID metastatic foci | size of mediastinal LN
37
freq. obtain this to eval. for metastatic disease and determine surgical candidates limited resolution if ??? false positive if ???
whole body fusion PET-CT imaging | if nodule
38
with PET, need separate ??? to r/o brain metastasis in pts with at least Stage ??? disease
MRI of brain | Stage II
39
periop. assessment for tumor resection is necessary b/c most pts have ??? most pts req ??? to evaluated how tolerate post-resection ???
other chronic lung diseases spirometry pulmonary insufficiency
40
if pre-op. FEV1 is ??? have low risk of compl. from lobectomy/pneumonectomy
>2L
41
if FEV1 ??? need to calculate an est. ??? | if ??? have low incident peri-op complications
800mL
42
if borderline spirometry, can do ??? to determine if resection is an option ??? is desired
cardiopulmonary exercise testing | high max. O2 uptake
43
national lung screening trial done on..
former heavy smokers
44
USPSTF recommends annula screening for lung ca w/ ??? | for ages ??? who have ??? smoking hx or ???
low-dose CT (LDCT) 55-80 yo 30 pk-yr hx and currently smoke or have quit w/in past 15 years
45
screening should discontinue once person has not smoked in ??? OR develops ???
15 years | health problem that subst. limits life expectancy or willingness to have curative lung surgery
46
ddx for solitary pulmonary nodule
``` non-sp. healed granuloma hamartoma lymphoma fibroma lunc abscess round atelectasis AVM (art-ven malform.) hematoma granulomatosis w/ polyangiitis ```
47
radiological prob. of ca increases if...
inc. diameter spiculation upper lobe location
48
if ??? zero likelihood of ca
calcified completely
49
non-SmCC (NSCLC) tx: | first ID if ??? is feasible and if pt can tolerate it
complete surgical resection
50
these prevent surgery
Extrathoracic metastases, malignant pleural effusion, tumor involving heart, pericardium, great vessels, esophagus, trachea, contralateral mediastinal LNs
51
NSCLC Stage I and II
surgical resection (when possible)
52
NSCLC IB and II
adjuvant chemotherapy
53
NSCLC Stage IIIA
resection and chemo and/or radiotherapy
54
NSCLC Stage IV
chemotherapy and palliation
55
??? for early stage primary NSCLC -non-surg. candidate
stereotactic body radiotherapy (Cyberknife)
56
??? gives antineoplastic drugs in advance of sx or radiation | used in stages ???
``` neoadjuvent chemotherapy (NSCLC) Stage IIIA/B (no impact I/II) ```
57
??? admin antineoplastic drugs FOLLOWING sx, radiation | ??? regimens for stages ???
``` adjuvent chemotherapy (NSCLC) Cisplatin, Stage II or IB ```
58
chemo in Stages IIIB and IV (NSCLC): curative? improves survival from ?? to ?? also improves ??
not curative 5 mos-->7-11 mos improved quality of life and symptom control
59
chemo drugs for NSCLC Stage IIIB, IV
cisplatin or carboplatin combined with pemetrexed, gemcitabine, taxane or vinorelbine
60
NSCLC advanced molecular profiling: target tx for these mutations
EGFR, EML4-ALK, more
61
SCLC tx: response to ??? are excellent (80-90%) in ??? and 60-80% partial response in ???
cisplatin and etoposide limited stage disease extensive disease
62
SCLC tx: remission is ?? and if recurred med. survival is ??
short-lived | 3-4 mos
63
overall 2 yr survival ??? in limited stage and ?? in extensive stage
20-40% | 5%
64
pallliative tx relieves ??? and also ???
endobronchial obstruction | improves dyspnea, contols hemoptysis
65
this improves quality of life if no evidence of other metastatic disease
resection for solitary brain metastasis

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