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Pulmonology Board Review > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the most common cause of death world wide

A

Lung cancer

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2
Q

What is the most common cancer in men and women

A

Prostate in men, breast in women

Lung is the most common cause of cancer deaths in both

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3
Q

What percentage of lung cancer is caused by smoking and what from passive smoke exposure

A

80-90% from smoke directly

Up to 25% for passive (mostly 2.5-5%)

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4
Q

What is the breakdown of histologic classes of lung cancer and percentages

A

Adenocarcinoma = 32%

Squamous cell = 29%

Small cell = 18%

Large cell = 9%

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5
Q

5 key features of squamous cell lung cancer

A
  1. 95% are smokers
  2. Usually centrally located
  3. May cavitate
  4. Associated with Hypertrophic Pulmonary Osteoarthropathy
  5. Associated with hypercalcemia
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6
Q

4 key features of adenocarcinoma lung cancer

A
  1. Most common subtype
  2. Increased incidence in never smokers
  3. Peripherally located
  4. Metastatic at presentation usually
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7
Q

4 key features of small cell lung cancer

A
  1. Considered metastatic at presentation
  2. Almost all smokers
  3. Central location
  4. Highly associated with paraneoplastic syndromes (except hypercalcemia)
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8
Q

7 Key features of Bronchoalveolar Cell carcinoma of the lung

A
  1. ALso called adenocarcinoma in situ
  2. Subtype of adenocarcinoma (about 5%)
  3. Often in smokers and females
  4. Presents as either a
    1. Solitary nodule
    2. Lobar consolidation (pneumonia that won’t go away)
    3. Multiple nodules
  5. Classic symptoms of hyperproduction of mucous and “salty tasting” sputum
  6. Extremely slow growing
  7. Less likely to be PET positive
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9
Q

What percent of lung cancers will have paraneoplastic syndrome?

A

5%

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10
Q

% of lung cancers that are asymptomatic

A

5-15%

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11
Q

4 Key facts from the National Lung Screening Trial

A
  1. Randomized 50,000 persons to LDCT or CXR
  2. 20% reduction of lung cancer specific mortality in CT arm
  3. 7% reduction in overall mortality
  4. 25% of the CT screens showed an abnormality
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12
Q

Criteria for lung cancer screening

A
  1. Age 55-74 (77 for Medicare)
  2. Smoking history of at least 30 pack years unless quit 15 years ago or more
    3.
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13
Q

Minimum size for a nodule to be classified as a mass

A

3 cm

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14
Q

3 patient characteristics that increase risk of solitary nodule being malignant

A
  1. Increased age
  2. Smoking history
  3. History of extrathoracic malignancy
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15
Q

3 nodule characterstics for a solitary nodule that increase the risk of malignancy

A
  1. Larger size
  2. Spiculation
  3. Upper lobe location (2/3 of mets are upper lobe)
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16
Q

Which solitary nodule risk formula should you use for incidental nodules and which for screening detected

A
  1. Screening detected = Brock
  2. Incidental = Mayo
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17
Q

% chance of malignancy based off size of nodule

A
  • 2-5 mm = 1%
  • 6-10 mm = 24%
  • 11-20 mm = 33%
  • 21-45 mm = 80%
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18
Q

Likelihood ratio for malignancy based off nodule border type

A
  • Smooth = 0.2
  • Lobulated = 0.5
  • Spiculated = 5.0
  • Corona radiata = 14
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19
Q
A
  1. Benign
    1. A = Central
    2. B = Laminate
    3. C = Diffuse
    4. D = Popcorn
  2. Indeterminante
    1. E = Stippled
    2. F = Eccentric (“scar carcinoma”)
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20
Q

Low, Intermediate, and High risk pulmonary nodule % and treatment

A
  • Low = < 5%
    • Serial CTs
  • Intermediate = 5 - 60%
    • PET, TTNA, Bronch
  • High = > 60%
    • Excisional biopsy with frozen section
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21
Q

A non-diagnostic biopsy is how much more favorable of benign disease

A

5x

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22
Q

Probability of pneumothorax with CT guided biopsy and how many of those need chest tube

A

15% median probability with 6% needing chest tube

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23
Q

2 causes of false negative and 1 cause of false positive PET scan

A
  • False Negative
    • Small nodules (< 8-10 mm)
    • Well-differentiated adenocarcinoma (BAC) and carcinoid
  • False positive
    • Granulomas/infection
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24
Q

3 steps to diagnosis of malignant pleural effusion

A
  1. Tap fluid and send (only 50% chance of getting malignancy)
  2. Tap fluid again if negative
  3. If still negative, send for VATS or pleuroscopy
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25
Q

T staging of a Nodule < 1 cm

A

T1a

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26
Q

T staging of a 1-2 cm lesion

A

T1b

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27
Q

T staging of a 2-3 cm lesion

A

T1c

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28
Q

T staging of a 3-4 cm lesion

A

T2a

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29
Q

T staging of a 4-5 cm lesion

A

T2b

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30
Q

T staging of a 5-7 cm lesion

A

T3

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31
Q

T staging of a lesion > 7 cm

A

T4

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32
Q

T staging of a central (mainstem bronchus) tumor regardless of distance from carina or atelectasis

A

T2

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33
Q

Does invasion of the mediastinal pleura count for T staging?

A

No, previously was T4

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34
Q

N1, N2, and N3 nodes location

A
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35
Q

Node Location Anatomy

A
36
Q

M staging with pleural/pericardial mets, malignant pleural or pericardial effusion, or a 2nd cancer nodule in the contralateral lung

A

M1a

37
Q

M staging with a single distant metastasis

A

M1b

38
Q

M staging for multiple distant metastases

A

M1c

39
Q

Limited stage small cell definition

A

Tumore confined to 1 hemithorax, mediastinum, or supraclavicular nodes

40
Q

Extensive stage small cell lung cancer definition

A

Clinically detectable distant metastasis or any involvement of the pleura or pericardium

41
Q

4 most common sites of involvement for small cell lung cancer mets

A

Bone, liver, CNS, adrenals

42
Q

FEV1 threshold on PFT for pneumonectomy and lobectomy

A
  • Pneumonectomy = 2L
  • Lobectomy = 1.5L
43
Q

FEV1 % predicted threshold that increases risk for respiratory complications

A

< 60%

44
Q

Pre-op DLCO threshold that predicts respiratory complications and mortality

A

< 60%

45
Q

Post OP FEV1 threshold linked to 50% chance mortality

A

< 40%

46
Q

Test needed before pneumonectomy to predict post op FEV1

A

VQ scan

47
Q

Algorithm for major anatomic resection

A
48
Q

Follow up for low risk solid nodule < 6 mm

A

None

49
Q

Follow up low risk nodule 6-8 mm

A

CT at 6-12 months,

then consider at 18-24 months

50
Q

Follow up low or high risk solid nodule > 8 mm

A

Consider CT, PET, or tissue sampling at 3 months

51
Q

Follow up high risk solid nodule < 6 mm

A

Optional CT at 12 months

52
Q

Follow up high risk solid nodule 6-8 mm

A

CT at 6-12 months

Repeat at 18-24 months

53
Q

Follow up low risk multiple nodules < 6 mm

A

None

54
Q

Follow up low risk multiple nodules 6-8 mm

A

CT 3-6 months

Consider repeat at 18-24 months

55
Q

Follow up low risk multiple nodules > 8 mm

A

CT 3-6 months

Consder repeat at 18-24 months

56
Q

Follow up high risk mulitiple nodules < 6 mm

A

Optional CT at 12 months

57
Q

Follow up high risk multiple nodules 6-8 mm

A

CT at 3-6 months

Repeat at 18 - 24 months

58
Q

Follow up high risk multiple nodules > 8 mm

A

CT at 3-6 months

Repeat at 18-24 months

59
Q

Follow up ground glass nodule < 6 mm

A

None

60
Q

Follow up ground glass nodule > 6 mm

A

CT 6-12 months to confirm persistence

Then every 2 years until 5 years

61
Q

Follow up parly solid nodule < 6mm

A

None

62
Q

Follow up partly solid nodule > 6 mm

A

CT at 3-6 months to confirm persistence

If unchange AND solid component < 6 mm, annual CT for 5 years

63
Q

Follow up multiple subsolid nodules < 6 mm

A

CT 3-6 months

If stable, consider at years 2 and 4

64
Q

Follow up multiple subsolid nodules > 6 mm

A

CT 3-6 months

Use most suspicious nodule to guide decision from there

65
Q

Treatment of Stage 1 NSCLC

A

Lobectomy with mediastinal node dissection

66
Q

5 patients with stage 1 NSCLC for whom sublobar resection is acceptable

A
  1. Poor cardiopulmonary reserve
  2. Elderly
  3. Second primary tumor
  4. Very small tumor
  5. Those with BAC
67
Q

Patients for whom a mediastinal staging is not required

A

T1A with PET/CT negative nodes

68
Q

NSCLC follow post treatment

A

CT every 6 months for 2 years, then annually till year 5

69
Q

Radiation treatment for non-surgical NSCLC patients

A

Stereotactic Body Radiotherapy (SBRT)

AKA

Stereotactic Ablative Radiotherapy (SABR)

70
Q

Treatment for NSCLC Stage 2

A

Surgery with adjuvant chemotherapy

71
Q

Treatment for NSCLC stage IIIA

A

Chemotherapy with adjuvant immunotherapy

72
Q

Treatment for NSCLC stage IIIB

A

Chemo and radiation if good functional status

Radiation only if poor functional status

73
Q

Treatment NSCLC Stage 4

A

Platinum based chemotherapy doublet

Targeted therapy

Immunotherapy

Supportive care

74
Q

4 platinum based chemotherapy regimens for NSCLC

A

Cisplatin/Paclitaxel

Carboplatin/Paclitaxel

Cisplatin/Docetaxel

Cisplatin/Gemcitabine

(NO benefit one over the other)

75
Q

4 approved drugs for EGFR mutation NSCLC

A
  1. erlotinib
  2. gefitinib
  3. afatinib
  4. osimertinib
76
Q

4 approved drugs for ALK fusion NSCLC

A
  1. Crizotinib
  2. Alectinib
  3. Ceritinib
  4. Brigatinib
77
Q

Single drug approved for ROS1 fusion NSCLC

A

Crizotinib

78
Q

2 drugs approved for BRAF V600E mutation NSCLC

A
  1. Dabrafenib
  2. Trametinib
79
Q

4 patients that are likely to be EGFR positive in NSCLC

A
  1. Adenocarcinoma
  2. Never smokers
  3. Females
  4. East asian heritage
80
Q

Duration of treatment for chemotherapy responsive NSCLC

A
  • 4-6 cycles, then observe
  • Non-squamous cell can be maintained on pemetrexed
  • Some reports of maintenance erlotinib
81
Q

Mutation associated with resistance to EGFR drugs

A

EGFR T790M

82
Q

Timing of pneumonitis after immunotherapy for NSCLC

A

Median time around 2.5 weeks

83
Q

Standard regimen for small cell lung cancer extensive stage

A

Cisplatin and VP-16 (etoposide)

Carboplatin and VP-16 may be less toxic

Cisplatin and irinotecan is an option

84
Q

Treatment duration for small cell lung cancer extensive stage

A

2-4 cycles

No benefit after 6 cycles

85
Q

Treatment regimen for limited stage small cell lung cancer

A

Cisplatin and etoposide for 2-4 cycles

Adds XRT

Also gets prophylactic cranial radiation

Pulmonology Board Review (32 decks)

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