Lung Cancer Flashcards
What cancer is the leading cause of cancer death in the US?
lung
lung cancer is more common than what three types of cancers combined?
colorectal, breast, and prostate
what is the 5 yr survival rate for lung cancer?
15%
what is the 5 yr survival rate range for lung cancer if detected at an early stage and tx surgically?
20-80%
why is the 5 yr survival rate for lung cancer so low?
Because the disease is usually advanced at presentation
What percent of lung cancer cases are attributed to primary smoking?
80-90%
what percent of lung cancer cases are attributed to second hand smoke?
30%
what screening test has evidence that it doesn’t improve outcome in patient survival?
CXR
What screening test is shown to improve survival outcomes in selected pt populations?
low dose helical CT
According to the NLST, what was the result of death reduction between CXR and CT screening?
20% death reduction in pts with low dose CT screening compared to CXR
what does the USPST recommend for annual screening of lung cancer?
low dose CT in adults 55-80 who have 30 pack/yr smoking hx and currently smoke or have quit within the past 15 years
What type of infection can affect your lung cancer screening CT and therefore is a exclusion criteria for screening?
pneumonia or acute resp tract infection treated with ABX in the past 12 weeks
what is a frequent symptom of lung cancer with sudden onset?
hemoptysis
What are some early presentation symptoms/signs for lung cancer?
cough, hemoptysis, dyspnea, wheezing, stridor, fever
what are some later presentation signs/symptoms for lung cancer?
weight loss, pleural effusion, chest wall pain, hoarseness, dysphagia, horner’s syndrome (impingement of sympathetic nerves)
what percent of lung cancer pts have symptoms at time of diagnosis? what type of scan does a symptomatic pt get first and then second?
90-95%
CXR and then CT with IV contrast
what percent of lung cancer pts are asymptomatic at presentation? what scan would this patient get?
up to 10%
would skip the CXR and get a low dose CT scan
Besides a CT with IV contrast for a symptomatic patient what other type of CT might you order? what two body parts would this evaluate?
abdominal CT to evaluate the liver and adrenal glands (2 of the most common sites of intra-abdominal metastasis)
what test should be done on a lung cancer patient who might be a surgical candidate?
PFTs- important for anesthesia
when are quantitative V/Q scans performed?
when PFTs don’t give a clear picture of how surgical excision will impact the patient’s pulm function
what scan for lung cancer helps detect actively growing tissues and therefore staging of cancer?
PET (positron emission tomography)
what are the two main types of lung cancer? what is each’s percent prevalence? discuss surgery and chemo for both. which one is “better” to have?
small cell- 15%, surgery only beneficial for stage 1, chemo and radiation therefore main treatment, disease is quickly fatal (usually within 6 months without tx)
non small cell- 85%, stages I-IIIA are operable, IIIb and IV are given chemo/radiation but not as effective (better cancer to have)
What are the three subtypes of Non small cell lung cancer? which is the worst one to have?
1) . adenocarcinoma- most common (women and non smokers)
2) . squamous cell
3) . large cell- poorly differentiated, behave aggressively, poorer prognosis
what is a carcinoid tumor? describe its metastatic nature
less aggressive and well differentiated, tends to arise from major bronchi, metastasis is rare and easily resected
what size does a solitary lung nodule become very suspicious?
greater than 3 cm
what is the maintenance after detecting a solitary lung nodule?
depends on size for specific interval CXR or CT time frame (4-6 mm then 12 month CT, > 6 mm then 6 month CT) BUT followed up to 2 years
describe characteristics of benign lung nodules versus malignant ones
benign: rounded, calcified (degenerated- been there awhile), little growth over time
malignant- stellate (irregular in shape), no calcium, central necrosis, increasing in size
what are three main things PAs can do to help aid suspected or confirmed lung cancer patents?
1) . get CXR/CT as early as possible
2) . advise pt to quit smoking
3) . maximize pulm function by inhaler, nebulizer, or ABX when appropriate
What is the worst adult onset abnormality for a patient to present with?
wheezing (plus hemoptysis in an elderly person)
