Lung cancer

Question 1

What percent of lung cancers can be attributed to smoking?

Answer 1

90%

Question 2

Why is lung cancer mortality so high?

4

Answer 2

(1) Late stage of diagnosis due to (2) lack of good screening tools, (3) absence of symptoms, and (4) symptoms that may be attributed to other diseases

Question 3

What syndromes and symptoms may arise from regional lung cancer metastases?
(6)

Answer 3

(1) Esophageal compression - dysphagia
(2) Laryngeal nerve paralysis - hoarseness
(3) Cervical/thoracic nerve invasion - Horner’s syndrome (miosis, ptosis, anhydrosis)
(4) Lymphatic obstruction - pleural effusion
(5) Vascular obstruction - SVC syndrome
(6) Pericardial extension - effusion, tamponade

Question 4

What are the types of bronchogenic lung cancer?

Answer 4

(1) Small cell

(2) Non-small cell: (a) squamous cell, (b) adenocarcinoma, (c) large cell

Question 5

What percentage of all lung cancers are small cell lung cancer?

Answer 5

10-15%

Question 6

What are the characteristics of small cell lung cancer?

3

Answer 6

(1) Occurs almost completely in smokers
(2) More responsive to chemo and radiation therapy than non-small cell, but tends to grow and spread quickly and metastasize early
(3) Cause paraneoplastic syndromes: syndrome of inappropriate secretion of ADH (SIADH), ectopic ACTH secretion, and neurologic/myopathic syndromes

Question 7

How is small cell lung cancer staged?

Answer 7

(1) Limited (30% of SCLCs at time of diagnosis): tumor in one lung and nearby lymph nodes, all cancer in one radiation field
(2) Extensive (70% of SCLCs at time of diagnosis): tumors not contained in one radiation field, tumor and affected lymph nodes in contralateral lung

Question 8

What is the survival time for small cell lung cancers?

3

Answer 8

(1) Limited with treatment - 16-24 months
(2) Extensive with treatment - 6-12 months
(3) No treatment - 2-4 months

Question 9

What are metastatic sites of small cell lung cancer?

5

Answer 9

(1) Lung
(2) Bone
(3) Liver
(4) Adrenals
(5) Brain

Question 10

What are the three types of non-small cell lung cancer in order of prevalence? Where in lungs is each cancer found?

Answer 10

(1) Adenocarcinoma (40%) - mainly in smokers, also most common type in non-smokers, found in peripheral lung
(2) Squamous cell carcinoma (25-30%) - often in smokers, found in middle lung
(3) Large cell carcinoma (10-15%) - fastest-spreading NSCLC, found in all parts of lung

Question 11

What percentage of all lung cancers are non-small cell lung cancer?

Answer 11

85-90%

Question 12

What is paraneoplastic syndrome?

Answer 12

Hypercalcemia resulting from excretion of hormones by tumor cells (typically squamous cell carcinoma)

Question 13

What is TNM staging?

Answer 13

Staging for non-small cell lung cancer
T - describes size of primary tumor
N - describes spread of cancer to regional lymph nodes
M - indicates whether cancer has metastasized

Question 14

What is lead-time bias?
What has disproven this?
(2)

Answer 14

(1) The perception that earlier diagnosis (from screening) will prolong life and improve patient outcomes
(2) Low-dose chest CT scans used to screen for lung cancer caused 20% reduction in lung cancer deaths

Question 15

What are treatments for non-small cell lung cancer?

3

Answer 15

(1) Surgery - best option
Supplemental:
(2) Chemotherapy
(3) Radiotherapy

Question 16

What are treatment options for small cell lung cancer?

2

Answer 16

(1) Chemotherapy

(2) Radiotherapy