Lung Cancer

Question 1

Symptoms of Lung cancer

Answer 1

Cough, dyspnea, stridor, hemoptysis, recurrent pneumonia, pleural effusion, chest, shoulder, arm pain. Supreclavicular lymphadenopathy, Hypertrophic osteo…
SPEECH: SVCS, Phrenic nerve (paralysis of diaphragm), Ectopic hormines (SIAD, Cushings), eaton Laber syndrome, clubbing, Horner/hoarsness

Question 2

What type os lung cancer is the most common to cause SVCS

Answer 2

SCLC

Question 3

How to diagnose lung cancer

Answer 3

Hx, PE, CXR, CT, PET (LN and distant metastasis), histology, EBUS/EUS, thoracostcopy and thoracosentesis

Question 4

Site of metastasis of NSCLC

Answer 4

Bone, liver, adrenals, brain

Question 5

What type of lung cancer is more frequently related to smoking?

Answer 5

SCLC

Question 6

How do you stage Lung cancer

and at what stage is the pts in if he/she has pleural effusion?

Answer 6

TNM

Stage 4: pleural effusion is a type of metasasis

Question 7

Where is squamous cell carcinoma located

Answer 7

Centrally (often spread to local LN)

Question 8

Characteristics of adenocarcinoma (NSCLC)

MCC of Lung cancer

Answer 8

Female predom, peripheral location, often asymptomatic, High metatstatic potential to CNS!!. Do not destroy alveoli or small bronchi

Question 9

Most common surgical resection of lung cancer

Answer 9

Lobectomy or segmentectomy

Question 10

When to use adjuvant radiotherapy i NSCLC

Answer 10

N2 +
R1 (positive margins on histology)
Narrow marging,

Question 11

when to use radiotherapy (singel modality) in NSCLC

Answer 11

medically unfit to undergo surgery, declines surgery, T1-2 N0M0 peripheral tumor
Palliative: bone brain and local control.

Question 12

Adjuvant chemo in NSCLC

Answer 12

Cisplatin + vinorelbne 4 cycles every 3 weeks, if PS =2 or more patient can not undergo chemo.

Question 13

Difference between chemo radiotherapt:

Concurrent and sequential

Answer 13

Concurrent: better outcome, high toxicity,
Sequential: worse outcome, lower toxicity.

Question 14

metatstis disese: stage 4 treatemnt NSCLC

Answer 14

Palliative chemo therapy: two durg combo = cisplatin + pemetrexed = adeno
cisplatin + gamcitabin = squamous, 2nd line theapy: Erotinib and gefitiniv (tyrosine kinase inhibitors: female, asian and never smokers.

Question 15

Small cell lung cancer characteristics

Answer 15

13 % of LC, neuroendocrine differentiation (leading to paraneoplastic syndromes –> SIADH, cushings synd). ALWAYS do neuroimaging. Large mass, hilar and mediastinal adenopathy = SVCS. Very high metatatic potential. Treatment: chemo. cisplatin and etopside for LD and ED: cisplatin and etoposide, if

Question 16

Staging of SCLC

Answer 16

Limited disease: do not exceed half of chest, can radiate all at once, always do PCI, chemo: cisplatin and etoposide. Extended disease: cisplatin and etoposide, if response = PCI