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BREAST CANCER > LUNG CANCER > Flashcards

LUNG CANCER Flashcards

1
Q

What is the epidemiology of lung cancer?

A

The most invasive malignancy in US

Risk factors:

  • smokers 30% higher risk than non-smokers
  • number packs/year, use of unfiltered cigarettes, smoking duration
  • COPD (Chronic obstructive pulmonary disease), aka. Chronic bronchitis or Emphysema due to long-term smoking

Incidence:
M 1: 1 F
increasing incidence among women
5 year survival: 13% (really poor)

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2
Q

What is the etiology of lung cancer?

A
  • TOBACCO exposure (most common), more than 1 pack/day
  • Asbestos (first for mesothelioma)
  • Second hand smoke, higher 30% risk for a spouse
  • Coal tar
  • Heavy metals
  • Arsenic
  • Uranium & Radon (home construction)
  • Pollution
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3
Q

What are the 4 prognostic factors for lung cancer?

A
  • Tumor stage (TNM) and extent
  • Histological grade
  • KPS (Karnofsky Performance Status)
  • Lymph Node status
  • Weight loss (>5% in 3 months)
  • Sex, male is worse than female
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4
Q

What are the OARs when treating lung cancer? Give their TD 5/5.

A
  • Contralateral lung 20 Gy
  • Spinal cord 45 Gy
  • Heart 43 Gy
  • Esophagus 50 Gy
  • Liver 35 Gy
  • Skin 55 Gy
  • Bone 65 Gy
  • Bone Marrow 25 Gy
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5
Q

What is the natural history of a case of lung cancer?

A
  • Site of origin in the lung
  • Tumor progression
  • Recurrence
  • Distant metastasis
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6
Q

What is the most common clinical presentation of lung cancer?

A

Local Disease

  • Coughing (75% cases)
  • Hemoptysis**
  • Dyspnea (shortness of breath, difficulty breathing)
  • Chest pain
  • Shoulder, arm pain

Regional Disease

  • Chest pain
  • Coughing
  • Dyspnea
  • Abscess formation
  • Dysphagia (difficulty swallowing), due to esophageal compression
  • SVC obstruction if right lobe
  • Orthopnea (inability to lie flat)
  • Cyanosis (blue lips tint)
  • Hoarseness, due to laryngeal nerve compression

METS Disease

  • Anorexia
  • Weight loss
  • Fatigue
  • Paraneoplastic syndromes
  • Hypertrophic pulmonary osteoarthopathy (clubbing of distal phalanges of fingers)
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7
Q

What are the detection and diagnostic tools for lung cancer?

A
  • History of patient
  • Physical examination
  • CT scan
  • Biopsy
  • PET scan and FDG( F-2-Deoxy-D-Glucose)
  • Bone scan
  • Chest X-ray, high # of false positives
  • Lab studies: sputum cytology, bone marrow biopsy, CBC
  • Surgery
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8
Q

What is the most common type and histopathology of lung cancer?

A
  • NSCLC (non-small cell lung carcinoma)
    80% of cases
    slow progress
    slow spread
    Squamous cell carcinoma, central and peripheral now, smoking associated 40%
    Adenocarcinoma, peripheral (pancoast tumor can cause Horner’s syndrome), most common in non-smokers, 30%
    Large cell, mediastinal, 10%, worst prognosis, rapid growth

Horner’s syndrome

- SCLC (small cell lung carcinoma) 
20% of lung cancer cases
oat cell cancer
aggressive, rapid growth, spread at diagnosis
central occurrence
caused by smoking
-Mesothelioma
cancer of pleura
asbestos exposure
hard to treat
pleurectomy with decortication
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9
Q

What is the histopahologic grade of lung cancer?

A

Occult carcinoma Tx N0 M0
Stage 0 Tis N0 M0
Stage IA T1 N0 M0
Stage IB T2 N0 M0
Stage IIA T1 N1 M0
Stage IIB T2 N1 M0
T3 N0 M0
Stage IIIA T1 N2 M0
T2 N2 M0
T3 N1 M0
T3 N2 M0
Stage IIIB Any T N3 M0
T4 Any N M0
Stage IV Any T Any N M1

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10
Q

What is the typical RT dose and fractionation for lung cancer?

A

-Curative
44 Gy/ 22 fx
45 Gy/ 25 fx
54 Gy/ 27 fx

-Palliative
30 Gy/ 15 fx
800 cGy/ 1 fx (one shot)

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11
Q

What is the route of spread of lung cancer?

A
  • Direct invasion, local extension in the lung
  • Lymphatic, regional extension
  • Hematogenous through thoracic duct and aorta
  • Distant METS: contralateral lung, liver, brain, adrenal glands, kidneys
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12
Q

What is the rationale of using SURGERY to treat lung cancer?

A

SCLC spread aggressively, Surgery is usually not an option by the time of diagnosis
limited stage - RT concurrently with Chemotherapy
extended stage - Chemotherapy only
Preventive - PCI given after tumor cells disappear after Chemotherapy and RT

NSCLC
Stage 1 - Surgery, tumor confined to lung only
Stage 2 - Surgery, tumor + nearby lymph nodes
Stage 3 - Surgery if still possible, tumor has spread to mediastinal lymph nodes already
Stage 4 - Surgery is not an option

  • Partial pneumonectomy, part of lung only
  • Total pneumonectomy, whole lung
  • Lobectomy, only lobe with tumor
  • Segmental resection, tumor + large part of lung
  • Wedge resection, tumor + small part of lung

GOAL: to excise all disease + conserve as much LUNG as possible

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13
Q

What is the rationale of using CHEMOTHERAPY to treat lung cancer?

A

Palliative, recurrence, or METS purpose.

SCLC, because the cancer has spread aggressively, the systemic treatment is the treatment of choice

NSCLC
Stage 1 - Chemotherapy can be used alone or with RT
Stage 2 - Chemotherapy recommended due to lymph node involvement, RT can be given adjuvently
Stage 3 - Chemotherapy recommended with RT
Stage 4 - Chemotherapy only, no RT

Chemotherapeutic drugs:

  • Cyclophosphamide
  • Adriamycin
  • Vincristine
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14
Q

What is the rationale to use RADIATION THERAPY to treat lung cancer?

A
  • Relieve symptoms for swelling and breathing problems
  • Relieve pain caused by tumor spread to bones
  • Given concurrently with CHEMOTHERAPY when SURGERY is not an option or unresectable

-Multi-field EBRT

-Brachytherapy
help open almost-blocked lung airway
help stop bleeding
retreat previously irradiated lung cancer
adjuvant to RT to increase dose
used alone for in-situ (very early lung cancers)

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15
Q

Explain the rationale to use combined treatment modalities to treat lung cancer?

A

-Specific to stage and pathology

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16
Q

What are the imaging/reports available of previous medical studies in lung cancer?

A
  • Radiological modalities, X-rays
  • Nuclear Medicine, PET scan
  • MRI
  • US
  • Health records
  • Laboratory reports
17
Q

Discuss the emerging technologies relevant to managing treatment of lung cancer?

A
  • PET/CT
  • Gated RT
  • Adaptive RT
18
Q

What are the predicted results of lung cancer based on stage/grade? (5 year survival rates)

A 
SCLC
Early stage  21 %
Late stage  11 %
Overall  6 %
Extensive disease 2 %
NSCLC
Stage IA  75%
Stage IB  55%
Stage IIA  50%
Stage IIB  40%
Stage IIIA 10-35%
Stage IIIB  <5%

Mesothelioma
22 %
No treatment 4-8 months
With treatment 11 months

19
Q

What are the predicted results of lung cancer based on treatment modalities?

A

…

20
Q

What is the radiation treatment technique for lung cancer? Explain the procedures.

A

EBRT

  • POP fields, AP/PA, PTV +2.0-2.5 cm margin, Pb blocks or MLC shielding, Plan 1 44 Gy/ 22 fx, Plan 2 oblique fields
  • Multiple fields using IMRT, volume of heart treated is crucial

Brachytherapy

21
Q

What are the RT side effects for lung cancer?

A

Acute:

  • Dermatitis
  • Erythema
  • Esophagitis

Chronic:

  • Dry cough
  • Lung fibrosis
  • Mucositis
  • Pneumonitis
  • Chest pain
  • Radiation myelitis (spinal cord inflammation)
22
Q

What is the patient care to be performed for lung cancer?

A

-Routine skin care!

23
Q

What is the staging system for lung cancer?

A

Tumor (T)
TX Primary tumor cannot be assessed, visualized by imaging
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor less than 3 cm, surrounded by lung/visceral pleura, no bronchoscopic invasion
T2 Tumor more than 3 cm -Involving main bronchus (2 cm or more distal to carina), or
-Invading visceral pleura, -Associated with atelectasis ( closure of alveoli = reduced or no gas exchange) or obstructive pneumonitis extending to hilar region bur not to entire lung
T3 Tumor of any size directly invading into the:
-Chest wall, diaphragm, mediastinal pleura, parietal pericardium
-Tumor in main bronchus, 2 cm or less distal and no involvement to carina
-Associated atelectasis or obstructive pneumonitis
T4 Tumor of any size invading:
-Mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina
-Separate nodules in same lobe
-Tumor with malignant pleural effusion

24
Q

What is the staging system for lung cancer?

A

Lymph Nodes (N)
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph nodes metastasis
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes
N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes
N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene (neck area) or supraclavicular lymph nodes

Distant Metastasis (M)
MX Metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis present

25
Q

What are the anatomy and physiology around the respiratory system?

A
  • Nose
  • Pharynx
  • Larynx
  • Trachea C6-T5 aka windpipe
  • Lungs
  • Carina T4-T5, bifurcation of trachea into right and left primary bronchi
  • Hilum
  • Mediastinum (heart, esophagus, thymus, great vessels, trachea)
  • Pleura, parietal pleura (outer layer), visceral pleura (inner layer)
26
Q

What is the rationale for the use of PCI (prophylactic Cranial Irradiation) in lung cancer?

A

It is a preventive Radiation Therapy to the Brain to make sure tumors cells that may have spread there die, commonly used for SCLC.
Brain is a sanctuary site for tumor cells, PCI is used to kill those hidden cells.

27
Q

What is the lymphatic drainage of lung cancer?

A 
-Mediastinal Nodes
Superior mediastinal
Tracheal
Aortic
Carinal and subcarinal
Pulmonary ligaments

-Intrapulmonic (hilar, bronchopulmonic) nodes
Mainstem bronchus
Interlobar
Lobar

BREAST CANCER (9 decks)

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