Lung Cancer

Question 1

outdoor pollution/particulate matter is associated mainly w/ what cancer

Answer 1

adenocarcinoma- in smokers and non smokers

Question 2

women smokers are more likely than men to develop _____

Answer 2

adenocarcinoma

Question 3

which mutation is screened for in lung cancer

Answer 3

EGFR (epidermal growth factor receptor)- more common in women, non smokers, adeno

Question 4

what is the PD-1 receptor

Answer 4

checkpoint on T cell surface- binding to PD-L1 ligand on tumor cells and dendritic cells helps the tumor evade immune targeting, this binding inhibits T cell activity

Question 5

drugs targeting PD-1

Answer 5

by blocking this receptor, can stimulate the immune control of tumor growth

Question 6

3 types of non small cell lung cancer

Answer 6

adenocarcinoma, squamous cell, large cell

Question 7

triad seen w/ adenocarcinoma

Answer 7

Hypertrophic osteoarthritis (HPO): clubbing, periostitis in long bones, arthritis

Question 8

adenocarcinoma location

Answer 8

peripheral

Question 9

notable adenocarcinoma subtype

Answer 9

mucinous or non mucinous adenocarcinoma w/ lepidic features- mucinous can present w/ bronchorrhea sputum produciton

Question 10

location of squamous cell carcinoma

Answer 10

usually proximal airways

Question 11

sequelae of squamous cell

Answer 11

obstruction of airway w/ distal atelectasis, post obstructive pneumonia

cavitation

hypercalcemia and the assoc Sx (mental change, weakness), clubbing

Question 12

describe location of small cell lung cancer

Answer 12

bulky central tumor w/ mediastinal lymph node involvement

Question 13

2 factors that make SCLC worse

Answer 13

rapid progression and metastases

worse paraneoplastic syndrome

Question 14

what are paraneoplastic syndromes

Answer 14

clinical disorders unrelated to tumor size or metastasis

Question 15

best time to use sputum cytology

Answer 15

lesions in bronchi w/ hemoptysis

more reliable w/ squamous or small cell

Question 16

ways tumors can interfere w/ bronchus (visible w/ bronchoscopy)

Answer 16

exophytic endobronchial lesions, submucosal infiltration, peribronchial tumor causing extrinsic compression

Question 17

Dx test for peripheral lesions

Answer 17

transthroacic needle biopsy

Question 18

staging for NSCLC

Answer 18

TNM:
T-size and location, w/ atelectasis or effusion

N- node involvement

M-distant metastases

Question 19

Tx for early stage disease

Answer 19

surgery, maybe followed by chemo in stage II

Question 20

Tx for locally advanced disease (IIIa and b)

Answer 20

chemo and radiation, sometimes surgery and/or immunotherapy

Question 21

Tx for advanced metastatic (IV)

Answer 21

chemo, radiation for brain and bone, targeted genetic therapy

Question 22

staging SCLC

Answer 22

not w/ TNM system

limited stage: confined to hemithorax

extensive stage: beyond radiation port, includes malignant effusion

Question 23

tx for limited stage SCLC vs extensive

Answer 23

limited: chemo and thoracic radiation combo, prophylactic cranial radiation
extensive: chemo, radiation to bone or brain

Question 24

approved screening for lung cancer

Answer 24

low dose CT scans for 55-80 year-olds w/ 30 pack year history