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principles and procedures > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the most common cause of Lung cancer? (1 answer)

A

Tobacco Exposure

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2
Q

What is the most common cause of cancer deaths in U.S. ?

A

Lung Cancer

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3
Q

What is another name for any type of lung cancers?

A

Bronchogenic Carcinomas

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4
Q

What are the two classifications of Lung cancers? (2 answers)

A

Small Cell (SCLC) and Non-Small Cell (NSCLC)

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5
Q

What is the standard technique of care for lung cancer? (2 answers)

A

3DCRT or IMRT

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6
Q

What is an emerging treatment technique for lung cancers?

A

SBRT w or w/o gating

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7
Q

What are some of the organs at risk? (5 answers)

A

Heart, Lung, Spinal Cord, liver, and other abdominal structures depending on the treatment

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8
Q

What is SVC syndrome?

A

When a tumor/mass extends and compressed the SVC causing a life-threatening situation

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9
Q

What are the prognostic indicators of Lung Cancer? (3 answers)

A

Stage (Extent of disease), Karnofsky Performance Score, Weight Loss

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10
Q

What cancer is the leading cause of death in the United States?

A

Lung Cancer

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11
Q

What is the 5-year survival rate for Lung Cancer?

A

21%

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12
Q

What percentage of cancer deaths is from lung cancer?

A

22%

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13
Q

What are some etiological factors contributing to Lung Cancer? (5 answers)

A

Tobacco (>1 pack per day), Second-hand smoke, Radon, Occupational Exposure, and Fumes (Nickel, Arsenic, Chromium, and Radon)

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14
Q

What is the major airway in the thoracic cavity?

A

Trachea

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15
Q

What is the composition of the trachea?

A

Rings of cartilage, smooth muscle and connective tissue

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16
Q

What type of cells line the trachea?

A

epithelial cells

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17
Q

At the carina, the trachea bifurcates into what structures? (2 answers)

A

Left and Right main bronchi

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18
Q

How many lobes are in the lungs?

A

5 Lobes; 3 in the right and 2 on the left

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19
Q

What cavity lies between the lungs?

A

Mediastinum

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20
Q

What does the respiratory unit include? (3 answers)

A

Bronchioles, Alveolar ducts and Alveoli

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21
Q

What is the responsibility of the respiratory unit?

A

place where gas exchange occurs

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22
Q

What’s the difference between external and internal respiration?

A

External respiration is the exchange of oxygen between the ducts and capillaries of the lung, while internal is the exchange with the organ structures blood supply and cells

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23
Q

What is the mediastinum?

A

The area between the lungs where the heart, thymus, and great vessels lie

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24
Q

Explain the physiology of blood oxygenation.

A

CO2 rich blood enters the lung via the pulmonary veins, gas exchanges occurs at the alveoli to which the new O2 rich blood is transported back to the body via the heart

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25
Q

What is the major route of spread for lung cancer?

A

Lymphatics

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26
Q

Why is lymphatics the most deadly and probable cause route of spread for lung cancer?

A

The lymphatics are attached to both pulmonary and cardiac vasculature making the spread have an unpredictable pattern, causing an increase in mortality

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27
Q

What are the sections of lymphatic drainage for lung cancer? (4)

A

Intrapulmonary, Bronchopulmonary (Hilar), Mediastinal (Sup & Inf), Pulmonary ligament

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28
Q

What are the pulmonary nodes? (5 answers)

A

Peribronchial, Intrapulmonic (interlobar), Hilar and Segmental

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29
Q

What are the superior mediastinal nodes? (5 answers)

A

Superior Mediastinal, Pretracheal, Retrotracheal, paratracheal, Lower paratracheal

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30
Q

What are the inferior mediastinal nodes? (4 answers)

A

Carinal, Subcarinal, Paraesophageal, Pulmonary Ligament

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31
Q

What are the aortic nodes? (2 answers)

A

Subaortic and Para-aortic

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32
Q

If there is lymphatic nodes, involvement, what is essential to be included in the treatment field? (3 answers)

A

Tumor, Lymphatics and draining blood

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33
Q

What are the presenting features of lung cancer?

A
  1. Disease in Bronchopulmonary Tissue
  2. Regional extension to LN, chest wall, and neurologic structures
  3. Distant dissemination
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34
Q

Cough is present in what percentage of local disease lung cancer patients?

A

75%

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35
Q

hemoptysis is present in what percentage of local disease lung cancer patients?

A

60%

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36
Q

dyspnea is present in what percentage of local disease lung cancer patients?

A

15%

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37
Q

What are some symptoms that regional disease lung cancer patients present with? (5 answers)

A

pain, coughing, dyspnea, dysphagia, and SVC Syndrome

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38
Q

What are the least common tumors of lung cancers?

A

Apex tumors

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39
Q

besides apex tumor, what is the other lung tumor?

A

Pancoast tumor

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40
Q

What are the characteristics of a Pancoast tumor?

A
  1. pain around the shoulders and down the arm 2. Atrophy of the hand muscles 3. Horners syndrome 4. Bone erosion of the ribs and occasionally the vertebrae
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41
Q

What is a Pancoast tumor?

A

Tumor in the superior sulcus

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42
Q

Not all apical tumors are Pancoast tumors. True or False?

A

True

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43
Q

What causes horners syndrome?

A

The location of pancoast in near the brachial plexus can suppress some nerve capabilities

44
Q

What are some symptoms of horners syndrome? (4 answers)

A

Miosis, Ptosis, Enophthalmos, Anhydrous`

45
Q

What are some symptoms of metastatic disease? (3 answers)

A

Anorexia, Weight loss, Fatigue

46
Q

What is the primary method of detection for Lung cancer?

A

Chest X-ray (PA and Lateral)

47
Q

What is the purpose of using a CT for diagnostics? (3 answers)

A
  1. Tumor findings 2. Nodal involvement 3. pleura/extrapleura involvement
48
Q

What are some other test used for detection? ( 3 answers)

A

Ultrasound-guided bronchoscopy (90% true-positive), Pleural Biopsy (mesothelioma), Thoracentesis (removal chest fluid)

49
Q

What is a wedge resection?

A

When a wedge portion of the lung is removed

50
Q

What are the two most common types of histology of lung cancer?

A

Non-small cell lung cancer (NSCLC) and Small Cell lung cancer (SCLC)

51
Q

What percentage of lung cancers are NSCLC?

A

85-90%

52
Q

What percentage of lung cancers are SCLC?

A

15-20%

53
Q

What is the other name for squamous cell lung cancer?

A

Epidermoid Carcinoma

54
Q

What are some factors about squamous cell lung cancer? (4 answers)

A

associated w/ tobacco use, frequently in men, Cells within the airways cause arise of this

55
Q

What are some factors about adenocarcinoma of lung cancer? (2 answers)

A

more frequent in women, develop from mucous cells that

56
Q

What are some factors about Large Cell carcinoma of the lung? (4 answers)

A

large, round, and microscopically, grows quickly

57
Q

What are some factors about small cell anaplastic of the lung? (2 answers)

A
  1. found in layer of tissue between mucous membranes 2. metastasized rapidly
58
Q

What is mesothelioma?

A

cancer of the pleural lining

59
Q

What causes mesothelioma?

A

people exposed to asbestos fibers, primarily men,

60
Q

What happens when asbestos fibers settle in the abdomen?

A

peritoneal mesothelima

61
Q

what are some symptoms of a true pancoast tumor? (3 answers)

A

Pain around shoulder, atrophy of the hand muscles, horners syndrome

62
Q

What is the cause of metastatic tumors in the lung?

A

spread from other tumors as the lungs are a common site of metastasis, important to determine if primary or secondary

63
Q

What are some symptoms of metastatic tumors in the lung? (3 answers)

A

Anorexia, Weight loss and fatigue

64
Q

What is the 3-year survival rate for SCLC?

A

10-15%

65
Q

What is the 3-year survival rate for NSCLC?

A

15-20%

66
Q

Survival has a higher probability with early-stage lung disease. True or False?

A

True

67
Q

What staging system is used for lung cancer?

A

TNM

68
Q

Explain the direct extension spread of lung cancer.

A

cancer grows into other adjacent structure, T3/Stage III tumors, if not encapsulated can become fixed which have a worse outcome

69
Q

Explain the lymphatic spread of lung cancer.

A

Cells break off from the tumor and enter the lymphatics vessels: 1. Cell can be trapped in node, grow and extend down the lymphatics. 2. Cells can grow through lymphatics and enter the blood supply

70
Q

Explain the hematogenous spread of lung cancer.

A

Lymphatics at the tracheal bifurcation converge with other respiratory and digestive structures to which drainage has access to the rest of the body via the thoracic duct or aorta

71
Q

What are common sites of metastasis of lung cancer? (7 answers)

A

Liver, Brain, Cervical Nodes, Bones, Adrenal Glands, Kidneys, contralateral lung

72
Q

What is the treatment type for no evidence of extra-thoracic extension LC?

A

Curative/Definitive (despite poor outcome)

73
Q

What is the treatment type for evidence of extra-thoracic extension LC?

A

Palliative

74
Q

What are some of the characteristics of a surgical candidate for lung cancer? (3 answers)

A
  1. Intra-thoracic disease
  2. Without pleural effusion
  3. No mediastinal Extension
75
Q

What is the five-year survival rate for surgical resection w/ no margins/Pos. Nodes for lung cancer (STAGE 1A)?

A

65%

76
Q

What is the five-year survival rate for Stage 1B lung cancer?

A

68%

77
Q

What is the five-year survival rate for Stage 3A lung cancer?

A

9-15%

78
Q

What is the generally preferred surgical procedure for lung cancer?

A

Lobectomy but wedge resection shows good outcome in early stage disease

79
Q

What is the preferred surgical procedure for lung cancer that is centralized and involves pulmonary structures such as the bronchus?

A

Total pneumonectomy

80
Q

Many lung cancer show response to chemo agents, however, the results are long-lived. True or false?

A

False, they are short-lived

81
Q

How does post-op XRT affect the survival rates of lung cancer with + LN and local residual disease

A

Improve survival rates

82
Q

What is the standard of care for Lung Cancer?

A

Post-op XRT with Chemotherapy

83
Q

What is the standard prescribed dose for lung cancer treatment?

A

45-60 Gy

84
Q

What is the highest possible prescribed dose for lung cancer treatment?

A

74 Gy with special exceptions such as IMRT and gaiting

85
Q

What are some other methods of XRT that are being utilized besides IMRT for lung cancer?

A
  1. SBRT
  2. ABC
  3. Compression
  4. IGRT
86
Q

What are the treatment portal size based on for lung cancer treatment?

A
  1. Primary Tumor
  2. Location of Tumor
  3. Nodal Involvement
87
Q

What is the PTV for lung cancer generally set as?

A

2-2.5 cm margin around the tumor and any nodes

88
Q

What is the importance of patient positioning for lung cancer? (5 answers)

A
  1. accuracy
  2. arm position to avoid irradiation
  3. casting to make sure there is no movement
  4. Chin extension to prevent radiation
  5. Spinal cord doses
  6. Spine curvature
89
Q

What are some factors to consider during positioning the patient for lung cancer? (4 answers)

A
  1. Breathing problems
  2. Bolus biopsy site
  3. preserve modesty
  4. collapsed lung
90
Q

What is are the general standard of boost plan for lung cancer? (4 answers)

A
  1. AP/PA fields then obliques off the cord
  2. IMRT
  3. Multi-smaller 3DCRT fields
  4. Positioning is critical
91
Q

What are the two reasons for shrinking fields for lung cancer treatment?

A
  1. Describe in tumor size

2. limit doses to normal structure

92
Q

What are some forms of shrinking fields for lung cancer treatment? (3 answers)

A
  1. Change field Size
  2. Add shielding
  3. Independent Jaw adjustments
93
Q

Why is palliative treatment chosen for advanced lung disease?

A

To treat the bone and brain Mets

94
Q

What are some other areas affected by advanced lung disease?

A

Vertebral body compression or fracture

95
Q

What is the general dosage for advanced-stage lung disease?

A

30-40 Gy

96
Q

What is SVC Syndrome?

A

The tumor presses on the SVC causes for an emergent radiotherapy treatment

97
Q

What is the dosage given to patients that suffer from SVC syndrome?

A

45-50 Gy but differ based on the fractionated dose from first days to remaining treatment

98
Q

What are some side effects to be exhibited during radiotherapy for lung cancer? (4 answers)

A
  1. Dermatitis
  2. Erythema
  3. Esophagitis
  4. Dysphagia
99
Q

What are some chronic side effects of radiotherapy for lung cancer?

A
  1. Dry cough
  2. Lung fibrosis
  3. Subcutaneous fibrosis
100
Q

What are the 3 critical structures considered during planning for lung cancer treatment and their limited doses?

A
  1. Heart (43 Gy)
  2. Spinal Cord (45 Gy)
  3. Normal Lung (20 Gy)
101
Q

What are some effects of over radiating the spinal cord? (3 answers)

A
  1. Myelitis
  2. Quadraplegia/paraplegia
  3. Necrosis
102
Q

What is the dosage of treatment dependent on? (2 answers)

A

Patient and Intent (Curative= Higher, Palliative= Lower)

103
Q

What is the dosage for curative treatment of SCLC?

A

45 Gy

104
Q

What is the dosage for curative treatment of NSCLC?

A

60 Gy

105
Q

What is the dosage for palliative treatment of NSCLC/SCLC?

A

40-50 Gy

principles and procedures (27 decks)

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