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CSI > lung cancer > Flashcards

lung cancer Flashcards

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
Q

can also FNA ??

blindly or with ??

A

mediastinal LNs

endobronchial US guidance (EBUS)

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26
Q

this helps properly biopsy peripheral nodules

A

electromagnetic navigational bronchoscopy

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27
Q

this is a high risk for pts (peripheral nodules) esp. with ??

A

pneumothorax!

underlying emphysema

28
Q

this can be used then less invasive techniques fail

A

mediastinoscopy, VATS, open thoracotomy
-wedge biopsy-imm. analysis on simult. tx/lobectomy
(wait on management as frozen sects. can be inaccurate?)

29
Q

if multiple nodules on imaging, be more suspicious for ??? than ???

A

metastatic disease

primary lung ca

30
Q

TNM staging used for..

A

tx guidance, prognosis, to standardize trials

31
Q

TNM…

A

T: tumor (primary) size/location (where, how big?)
N: nodal metastasis presence/location (+/-, where?)
M: metastasis (distant) presence/absence (+/-)

32
Q

TNM stages grouped into prognostic categories

A

stages I-IV

33
Q

need to ?? in order to stage

A

evaluate LNs

34
Q

if no LNs on imaging larger than 1 cm…

A

resection of primary tumor and sample mediastinum at thoracotomy

35
Q

if suspect metastatic disease, LNs > 1-2 cm

A

CT guided FNA, mediastinoscopy, EBUS, EUS, limited thoracotomy to eval. LNs (prior to decision about thoracotomy?)

36
Q

PET scanning uses ??? to identify ???

specificity depends on ??

A

18F fluoro-2-deoxyglucose (FDG) to ID metastatic foci

size of mediastinal LN

37
Q

freq. obtain this to eval. for metastatic disease and determine surgical candidates
limited resolution if ???
false positive if ???

A

whole body fusion PET-CT imaging

if nodule

38
Q

with PET, need separate ??? to r/o brain metastasis in pts with at least Stage ??? disease

A

MRI of brain

Stage II

39
Q

periop. assessment for tumor resection is necessary b/c most pts have ???
most pts req ??? to evaluated how tolerate post-resection ???

A

other chronic lung diseases
spirometry
pulmonary insufficiency

40
Q

if pre-op. FEV1 is ??? have low risk of compl. from lobectomy/pneumonectomy

A

> 2L

41
Q

if FEV1 ??? need to calculate an est. ???

if ??? have low incident peri-op complications

A

800mL

42
Q

if borderline spirometry, can do ??? to determine if resection is an option
??? is desired

A

cardiopulmonary exercise testing

high max. O2 uptake

43
Q

national lung screening trial done on..

A

former heavy smokers

44
Q

USPSTF recommends annula screening for lung ca w/ ???

for ages ??? who have ??? smoking hx or ???

A

low-dose CT (LDCT)
55-80 yo
30 pk-yr hx and currently smoke or have quit w/in past 15 years

45
Q

screening should discontinue once person has not smoked in ??? OR develops ???

A

15 years

health problem that subst. limits life expectancy or willingness to have curative lung surgery

46
Q

ddx for solitary pulmonary nodule

A 
non-sp. healed granuloma
hamartoma
lymphoma
fibroma
lunc abscess
round atelectasis
AVM (art-ven malform.)
hematoma
granulomatosis w/ polyangiitis
47
Q

radiological prob. of ca increases if…

A

inc. diameter
spiculation
upper lobe location

48
Q

if ??? zero likelihood of ca

A

calcified completely

49
Q

non-SmCC (NSCLC) tx:

first ID if ??? is feasible and if pt can tolerate it

A

complete surgical resection

50
Q

these prevent surgery

A

Extrathoracic metastases, malignant pleural effusion, tumor involving heart, pericardium, great vessels, esophagus, trachea, contralateral mediastinal LNs

51
Q

NSCLC Stage I and II

A

surgical resection (when possible)

52
Q

NSCLC IB and II

A

adjuvant chemotherapy

53
Q

NSCLC Stage IIIA

A

resection and chemo and/or radiotherapy

54
Q

NSCLC Stage IV

A

chemotherapy and palliation

55
Q

??? for early stage primary NSCLC -non-surg. candidate

A

stereotactic body radiotherapy (Cyberknife)

56
Q

??? gives antineoplastic drugs in advance of sx or radiation

used in stages ???

A 
neoadjuvent chemotherapy (NSCLC)
Stage IIIA/B (no impact I/II)
57
Q

??? admin antineoplastic drugs FOLLOWING sx, radiation

??? regimens for stages ???

A 
adjuvent chemotherapy (NSCLC)
Cisplatin, Stage II or IB
58
Q

chemo in Stages IIIB and IV (NSCLC): curative?
improves survival from ?? to ??
also improves ??

A

not curative
5 mos–>7-11 mos
improved quality of life and symptom control

59
Q

chemo drugs for NSCLC Stage IIIB, IV

A

cisplatin or carboplatin combined with pemetrexed, gemcitabine, taxane or vinorelbine

60
Q

NSCLC advanced molecular profiling: target tx for these mutations

A

EGFR, EML4-ALK, more

61
Q

SCLC tx: response to ??? are excellent (80-90%) in ??? and 60-80% partial response in ???

A

cisplatin and etoposide
limited stage disease
extensive disease

62
Q

SCLC tx: remission is ?? and if recurred med. survival is ??

A

short-lived

3-4 mos

63
Q

overall 2 yr survival ??? in limited stage and ?? in extensive stage

A

20-40%

5%

64
Q

pallliative tx relieves ??? and also ???

A

endobronchial obstruction

improves dyspnea, contols hemoptysis

65
Q

this improves quality of life if no evidence of other metastatic disease

A

resection for solitary brain metastasis

CSI (75 decks)

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