Lung Cancer Flashcards
What percentage of lung cancer is caused by secondhand smoke?
25%
Other than tobacco use, what are the two biggest risk factors for lung cancer?
Tobacco
Radon
COPD diagnosis
What is the most common type of lung cancer?
32% = adeno 29% = squamous 18% = small cell 9% = large cell 12% = undifferentiated
Type of lung cancer most commonly associated with HPO (Hypertrophic Pulmonary Osteoarthropathy)?
Sqamous cell
What type of lung cancer?
Peripheral, never smokers
Adenocarcinoma
What type of lung cancer?
Smokers, central, metastatic at presentation
Small cell
What type of lung cancer has most types of paraneoplastic syndromes, except HPO? (E.g., SIADH, Eaton-Lambert)
Small cell
What type of lung cancer has a false negative PET scan?
Bronchoalveolar Cell Carcinoma
type of Adenocarcinoma
Bronchorrhea and salty sputum are typical of what type of lung cancer?
Bronchoalveolar Cell Carcinoma
type of Adenocarcinoma
Implementing lung cancer screening has what effect on mortality?
20% decrease in lung cancer mortality
7% decrease in all-cause mortality
What is the bad calcification pattern of pulmonary nodules?
“Scar of carcinoma” = eccentric calcification pattern
What is the probability of a chest tube in performing a CT-guided needle biopsy of a SPN?
15%
What can cause false-positive PET scans?
Granulomatomous infection
Inflammation
What can cause false-negative PET scans?
<1cm
Well differentiated adenocarcinoma
Bronchoalveoloar cell carcinoma
Carcinoid
What is the next step for staging lung cancer after 2 negative thoracentesis procedures?
VATS or pleuroscopy biopsy of pleura
Describe the size staging for T1-4 for lung cancer.
T1a: <1cm T1b: 1-2cm T1c: 2-3cm T2a: 3-4cm T2b: 4-5cm T3: 5-7cm T4: >7cm
What is the definition of “central tumors”, and what is the implication for staging?
“Central” tumor = mainstem bronchus
Makes T2
Describe the lymph node staging for lung cancer.
N0 = no lymph nodes N1 = ipsilateral hilar, peribronchial, intrapleural LNs N2 = ipsilateral mediastinal, subcarinal N3 = contralateral mediastinal -or- supraclavicular
Describe the metastasis staging for lung cancer
M0 = no mets M1a = pleural / pericardial implants. Malignant pleural / pericardial effusion. 2nd cancer nodule in contralateral lung M1b = Single distant met M1c = multiple distant mets
What values for pre-operative FEV1 are associated with low perioperative mortality risk for pulmonary resection?
FEV1 > 2L for pneumomectomy and 1.5L for lobectomy
What is the most accurate way of estimating predicted post-operative lung volumes?
Perfusion scanning is better than segment counting & quantative CT
What is the Post-op Predicted Product, and what is it used for?
PPP = DLCO x FEV1.
PPP < 1650 predicts mortality in pulmonary resection
What is the general strategy regarding high-tech, low-tech, or no exercise testing based on ppoFEV1 and ppoDLCO?
Calculate ppoFEV1 and ppoDLCO based on V/Q.
- Both >60% => No testing
- Either/both 30-60% => low-tech testing
- Either/both <30% => CPET
What is a ‘passing’ score for a Shuttle Walk Test?
400m
What is a ‘passing’ score for Stair Climb Test?
22m
What are low/moderate/high risk results for VO2 max on CPET?
Low-risk: >20, >75% predicted
Moderate-risk: 10-20, 35-75% predicted
High risk: <10, <35% predicted
What pre-op assessment is required for peripheral, clinical stage IA tumors with negative PETs?
None
What is treatment for stage II lung cancer?
Surgery + Adjuvant chemotherapy
What is treatment for stage IIIA lung cancer?
Chemoradiotherapy + adjuvant immunotherapy
-or-
Neoadjuvant chemoradiotherapy, followed by surgery
N2 makes lung cancer what clinical stage (minimum)?
Stage IIIA
What immunotherapy is most common for stage III lung cancer? What does it target?
Durvalomab (Ifminzi) blocks PDL1 (Programmed Death Ligand 1)
What is treatment for stage IIIB lung cancer?
Good performance status - concurrent chemoradiotherapy. Consolidation durvalomab
Poor performance status - XRT only.
What is treatment for stage IV lung cancer?
- Platinum-based chemotherapy doublet (any cisplatin combo)
- Targeted chemotherapy
- Immunotherapy
What is pemetrexed indicated for?
Maintenance therapy for non-squamous NSCLC after therapy.
Name 9 complications of immunotherapy for lung cancer
Fatigue Diarreha Rash Hypothyrodism Pneumonitis Colitis Hypophysitis Pancreatitis Uveitis
What is the timeframe for pneumonitis occurring after immunotherapy?
2.5 months
What is the treatment for pneumonitis occurring after immunotherapy?
Drug discontinuation
Treatment for extensive small cell lung cancer?
Cisplatin + Etoposide
Duration of treatment for extensive small cell lung cancer?
2 induction cycles, then reassess. Then, another 2-4 cycles for consolidation. No more than 6 cycles.
Treatment for limited small cell lung cancer?
Etoposide + Cisplatin (same as extensive), plus
radiotherapy.
-PCI (Prophylactic Cranial Radiation) improves survival and QoL.
