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Clin Med II Exam 2 (Lauren) > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What are the risks for lung cancer?

A

Smoking

Secondhand smoke

Genetic predispostion

Asbestos, radon, arsenic, radiation, polycyclic aromatic hydrocarbons

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2
Q

Do cancer cells do apoptosis

A

No they avoid it thats why they grow so much

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3
Q

What is another name for a Solitary Pulmonary Nodule?

A

“Coin Lesion”

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4
Q

What is a solitary pulmonary nodule (SPN)?

A

An isolated lung nodule that is less than 3cm and round

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5
Q

Are most SPNs benign or malignant?

A

Benign

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6
Q

What do benign SPNs look like?

A

Smooth, well-defined edges

Dense central calcification

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7
Q

Most benign SPNs end up being________

A

Infectious granulomas

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8
Q

If a lesion is spiculated, it is (good/bad)

A

Bad

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9
Q

If a nodule is calcified, it is (good/bad)

A

Good

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10
Q

What is the difference between a nodule and a mass?

A

A mass is greater than 3cm

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11
Q

How does size of a lung mass relate to its chance for malignancy?

A

The bigger the mass, the more likely it’s malignant

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12
Q

Other than infectious granulomas, what are other possible causes of benign SPNs?

A

Hamartoma (tumor of cells from somewhere else like hair cells)

Vascular

Inflammation

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13
Q

Who is more likely to have a lung malignancy: males or females

A

Females

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14
Q

How does age relate to likelihood of malignancy

A

Older = higher risk

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15
Q

Most SPNs in Arizona are _____

A

Cocci (valley fever)

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16
Q

Most SPNs in patient who have had cancer before are ______

A

Metastasis

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17
Q

If an SPN is 5cm or bigger, what are the chances its cancerous

A

90%

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18
Q

What is the 1st step in evaluating an SPN?

A

Review old films

Malignant nodules grow FAST

Minimal growth in 2 years suggests a benign lesion

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19
Q

Smooth, well defined edges on an SPN indicate that it is most likely (benign/malignant)

A

Benign

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20
Q

What kind of chest CT do you need to do to evaluate a suspicious SPN?

A

Without contrast

Low radiation

Thin 1mm slices

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21
Q

What should you do if you find a solid nodule that is over 8mm?

A

You determine the probability of it being malignant and then go from there

Low probability <5%

Intermediate probability 5-65%

High probability >65%

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22
Q

What should you do if you find a solid nodule that is over 8mm and has a LOW probability of being malignant?

A

Get a CT 3 months later

No growth= serial CTs at 9-12 months and 18-24 months

Growth= needs Pathologic evaluation

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23
Q

What should you do if you find a solid nodule over 8mm and there is an intermediate probability of it being malignant?

A

Do an FDG PET/CT and/or biopsy

If “FDG avid”= biopsy/excision

If PET/CT unavailable, negative, or indeterminate= you can do individualized management based on suspicion (??)

CT scans at 3, 9-12, and 18-24 months is an acceptable alternative to biopsy

I hate this

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24
Q

What does “FDG avid” mean?

A

It means the PET/CT showed that it was abnormal

FDG is fluorodeoxyglucose

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25
Q

What should you do if you find a solid nodule that is over 8mm and there is HIGH probability that it is malignant?

A

Biopsy/excision

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26
Q

What should you do if you find a solid nodule that is smaller than 8mm?

A

6-8mm= do a CT in 6-12 months

<6mm do not require follow up

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27
Q

What are the 3 types of NSCLC?

A

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

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28
Q

What is another name for small cell lung cancer?

A

Oat cell carcinoma

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29
Q

Where does Small Cell LC show up

A

Central airways
*******

Was in red

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30
Q

What does small cell LC look like?

A

Large hilar mass with bulky mediastinal adenopathy

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31
Q

Is small cell lung cancer aggressive?

A

HIGHLY aggressive. THE MOST aggressive. 70% of patients have metastatic disease when they are first diagnosed.

6-18 WEEK survival without treatment

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32
Q

What are the 2 categories of Small Cell Lung Cancer?

A

Limited- one lung and nodes on same side

Extensive- both sides of chest

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33
Q

What should you be really worried about if you have a small cell lung cancer in the right side?

(Other than dying…. 😞)

A

SVC syndrome

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34
Q

What is the most common form of non small cell lung cancer

A

Adenocarcinoma

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35
Q

What kind of tissue gives rise to adenocarcinoma?

A

Mucous glands

Epithelial cells in or distal to terminal bronchioles

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36
Q

Where do adenocarcinomas metastasize to?

A

Distant organs

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37
Q

Where in the lung does adenocarcinoma show up?

A

Periphery

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38
Q

Where in the lung does squamous cell carcinoma show up?

A

Centrally or in main bronchus

Intraluminal growth inside the bronchus)*

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39
Q

What kind of tissue gives rise to squamous cell carcinoma?

A

Bronchial epithelium

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40
Q

What kind of non small cell LC is most likely to cause hemoptysis?

A

Squamous cell carcinoma

It’s often INSIDE the main bronchi

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41
Q

What is the most likely cause of hemoptysis?

A

BRONCHITIS*****

She said this 7386 times

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42
Q

Where does squamous cell carcinoma metastasize to?

A

Nearby lymph nodes

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43
Q

Which kind of lung cancer did she say “cavitates?”

A

Squamous cell carcinoma

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44
Q

Where does large cell carcinoma appear?

A

Anywhere

Central or peripheral

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45
Q

Where does Large cell carcinoma metastasize to?

A

Distant organs

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46
Q

What is the most aggressive non small cell lung cancer?

A

Large cell carcinoma

Small cell is the most aggressive lung cacner though

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47
Q

Are most patients symptomatic at the time of lung cancer diagnosis?

A

Yes

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48
Q

What is the most common symptom of lung cancer?

A

Cough

*******

49
Q

What are the symptoms that lung cancer patients may present with at diagnosis?

A

Cough

Weight loss

Dyspnea

Chest pain

Hemoptysis

Bone pain

Hoarseness** DO NOT FORGET

50
Q

Cough is the most common symptom of lung cancer, but what 2 types does it most frequently occur with?

A

Squamous cell

Small cell

51
Q

If a patient has weight loss, what does it mean for their prognosis?

A

BAD NEWS

52
Q

Does a CXR rule out lung cancer?>

A

No

Idk this had an exclamation point

53
Q

What causes hoarseness in lung cancer patients?

A

Left sided tumors compression the recurrent laryngeal nerve

**SHE REALLY HARPED ON THIS

54
Q

What is the most common cause of intrathoracic malignancy that causes SVC syndrome?

A

Small Cell Lung Cancer *****

55
Q

What are the symptoms of SVC syndrome?

A

Dyspnea #1

Facial swelling

Head fullness (worse when bending forward/supine)

Arm swelling

Cough

Chest pain

Dysphagia

56
Q

What will you find on physical exam in a pt with SVC syndrome?

A

Facial edema

Dilated neck veins

Prominent venous pattern on chest

57
Q

What is the GOLD STANDARD of diagnosing SVC syndrome?

A

Superior vena cavogram

taking pictures inside the SVC

58
Q

What kind of imaging can be done to diagnose SVC syndrome?

A

CXR

Duplex ultrasound

CT scan WITH contrast

Superior vena cavogram

59
Q

What kind of imaging for SVC syndrome will allow you to see the level of blockage, map collateral pathways, and ID the underlying cause?

A

CT with contrast

BUT superior vena cavogram is still the gold standard for diagnosing SVC syndrome

60
Q

How do you treat SVC syndrome?

A

Emergency Radiation Therapy

Venous stents

Chemo

Removal of cardiac devices and anticoagulation (if caused by thrombosis)

61
Q

Which patients with SVC syndrome require emergency radiation therapy?

A

Stridor from central airway obstruction

Laryngeal edema

Coma from cerebral edema

62
Q

What causes Pancoast syndrome?

A

A tumor in the superior sulcus (apical chest) compressing the brachial plexus and cervical sympathetic nerves

63
Q

What is Horner’s syndrome and what condition is it associated with?

A

Injury to the sympathetic nerves of the face

Associated with Pancoast syndrome

64
Q

What kinds of Sx will a pt with Pancoast syndrome have?

A

Right shoulder pain A LOT

Forearm, scapula and finger pain

One pupil constricted

Not sweating on one side

Eyelid drooping on one side

Rib destruction

Atrophy of hand muscles

Pain in C8, T1, T2 nerve roots

(Signs are going to be on the same side as the tumor)

65
Q

What kind of lung cancer is most likely to cause Pancoast syndrome?

A

Squamous cell

66
Q

What are paraneoplastic syndromes?

A

Sx that occur as a result of organ/tissue damage at locations remote from the site of the primary tumor/metastases

Ex: hypercalcemia due to bone destruction and SIADH

67
Q

What kinds of hematologic effects can occur due to paraneoplastic syndromes?

A

Hypercalcemia due to bone destruction

Anemia

Leukocytosis -poor prognosis

Thrombocytosis

Hypercoagulabilty

68
Q

What are the 4 endocrine effects caused by paraneoplastic syndromes?

A

PTH-like substance causing bone erosion=hypercalcemia

Excess HCG production- gynecomastia, milky nipple discharge

SIADH- hyponatremia

Cushing’s syndrome- ectopic ACTH.

69
Q

What kind of lung cancer causes a PTH-like substance to be secreted?

A

Squamous cell

70
Q

What kind of lung cancer causes excess HCG production?

A

Large Cell

71
Q

What kind of lung cancer causes SIADH and Cushing’s syndrome?

A

Small cell lung cacner

72
Q

What causes patients with Small Cell LC to develop Cushing’s syndrome?

A

Tumor secretes ectopic ACTH leading to lots of cortisol

VERY BAD PROGNOSIS

73
Q

What is Eaton-Lambert syndrome?

A

An immune mediated attack of antibodies at the NMJ causing:

Acetylcholine release

Muscle weakness

74
Q

What kind of cancer causes Eaton Lambert syndrome?

A

Small cell lung cancer

75
Q

What are the most common sites of distant metastases?

A

Liver

Bone

Adrenal glands

Brain (especially Small cell)

76
Q

What kinds of symptoms will someone with liver metastasis have

A

Elevated LFTs

77
Q

What kinds of symptoms will someone with bone metastases have

A

Back, chest, extremity pain

Elevated alkaline phosphate (from bone growth)

78
Q

What kinds of symptoms will someon with metastasis to the adrenal glands have?

A

None

79
Q

What is necessary to diagnose Lung cancer?

A

Tissue biopsy

Sputum, bronchoscopy, thoracentesis, etc

80
Q

How is Non small cell LC staged?

A

With the TNM staging system

T- Tumor

N- Nodal involvement

M-Metastasis

81
Q

How is small cell LC staged?

A

Limited vs Extensive

82
Q

What kind of tissue sample is best for central lesions?

A

Sputum culture

83
Q

How is performance status graded?

Don’t know if you have to know this?

A

0= no restriction

1= strenuous physical activity restricted

2= capable of all self care but unable to do work

3= capable of only limited self care, confined to bed or chair more than 50% of waking hrs

4= completely disabled, no self care, totally bed or chair confined

84
Q

What is the strongest indicator of post-op complications?

A

FEV1 less than 60%

85
Q

Which is better to detect metastasis:

PET or CT

A

PET

86
Q

What kind of radioactive isotope is used in PET scans?

A

fluorodeoxyglucose (FDG)

87
Q

What kind of tissue may show as a false positive on a PET scan?

A

Infections

88
Q

What tissue is NORMAL to light up in a PET scan?

A

Heart

Kidneys

Bladdder

89
Q

What is the treatment of choice for non small cell LC?

A

Surgical resection (if the disease is localized)

90
Q

Do we do surgery for Small Cell LC?

A

Not usually an option

Only if its very small primary lesion with no spread

91
Q

What is the treatment for Small Cell LC?

A

Chemotherapy

Radiation

Prophylactic cranial radiation

92
Q

How do you treat malignant effusions?

A

Thoracentesis

Pleurodesis (fusing pleura to lung tissue)

Pleura Catheter

93
Q

What are the side effects of chemotherapy?

A

Fatigue

Chemo brain

N/V

Anorexia, weight loss

Anemia

Neutropenia

Nephrotoxicity

Neurotoxicity

94
Q

How do you treat stage 1 Non small cell LC

A

Surgical resection

95
Q

How do you treat stage 2 non small cell LC

A

Surgical resection + chemo

96
Q

How do you treat Stage 3 non small cell LC?

A

Uncertain:

Dont do surgery and do chemo+ radiation

Do surgery and do chemo and add radiation if you didn’t get clear margins from surgery

97
Q

How do you treat stage 4 non small cell lung cancer

A

Palliative :(

Chemo, clinical trials

Resection of metastases

“Targeted therapy”

98
Q

Every patient with suspected lung cancer needs this kind of imaging screening:

A

Low dose helical CT

This was in orange idk

99
Q

Who needs a low dose helical CT to screen for lung Cancer?

A

Every pt with suspected lung cancer

Age 55-74 with 30 pack year history

20 pack-year history with one additional risk factor (other than secondhand smoke)

100
Q

What drugs can you prescribe to help your patients quit smoking?

A

Zyban aka Wellbutrin (Bupropion)

Chantix (Varenicline)

Nicotrol (Rx nicotine inhaler/nasal spray)

101
Q

How should you instruct your patent to take Zyban/Wellbutrin/Bupropion to quit smoking?

A

Start taking it and keep smoking

Quit smoking after 5-7 days

102
Q

What are the what does your patient need to avoid doing when taking Zyban/Wellbutrin/Bupropion?

A

Alcohol (to prevent seizures)

103
Q

What is the black box warning for zyban/Wellbutrin/bupropion?

A

Suicidal risk in children, young adults, and adolescents

104
Q

What are the adverse reactions of Zyban/Wellbutrin/bupropion?

A

Seizures***

Agitation

Weight loss

105
Q

How should you instruct your patient to take Chantix (varenicline) to quit smoking?

A

Start taking med

Stop smoking after 7 days

Keep taking it for 12-24 weeks

106
Q

What is the biggest thing you can do to help your patient quit smokiong?

A

Positive support! 🥳

107
Q

Which paraneoplastic syndromes are associated with SMall Cell Lung Cancer

A

SIADH

Cushings

Eaton-Lambert

108
Q

What parts of the lungs are usually affected by Small Cell lung cancer

A

Central lung

Hilar and mediastinal lymphadenopathy

109
Q

Thrombophlebitis and clubbing are associated with this type of cancer:

A

Adenocarcinoma

110
Q

What is the most common NSCLC

A

Adenocarcinoma

111
Q

Adenocarcinoma usually arises (centrally/peripherally)

A

Peripherally

112
Q

Which kind of LC is slower growing and metastasizes later?

A

Squamous cell

113
Q

Squamous cell LC usually arises in what part of the lung

A

Central bronchi

114
Q

Which kind of lung cancer is associated with excess PTH, which causes hypercalcemia?

A

Squamous cell

115
Q

Which kind of LC may cause cavitations?

A

Squamous cell

116
Q

Which kind of LC is associated with hemoptysis?

A

Squamous cell

117
Q

Who should get CXR screening for lung cancer?

A

NO ONE.

We don’t screen with CXRs, only CT

118
Q

True or false:

Every nodule requires a CT

A

True

119
Q

What is the most common presenting symptom of lung cacner?

A

Cough

Clin Med II Exam 2 (Lauren) (3 decks)

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