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ABIM Pulmonary > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What percentage of lung cancer is caused by secondhand smoke?

A

25%

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2
Q

Other than tobacco use, what are the two biggest risk factors for lung cancer?

A

Tobacco
Radon
COPD diagnosis

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3
Q

What is the most common type of lung cancer?

A 
32% = adeno
29% = squamous
18% = small cell
9% = large cell
12% = undifferentiated
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4
Q

Type of lung cancer most commonly associated with HPO (Hypertrophic Pulmonary Osteoarthropathy)?

A

Sqamous cell

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5
Q

What type of lung cancer?

Peripheral, never smokers

A

Adenocarcinoma

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6
Q

What type of lung cancer?

Smokers, central, metastatic at presentation

A

Small cell

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7
Q

What type of lung cancer has most types of paraneoplastic syndromes, except HPO? (E.g., SIADH, Eaton-Lambert)

A

Small cell

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8
Q

What type of lung cancer has a false negative PET scan?

A

Bronchoalveolar Cell Carcinoma

type of Adenocarcinoma

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9
Q

Bronchorrhea and salty sputum are typical of what type of lung cancer?

A

Bronchoalveolar Cell Carcinoma

type of Adenocarcinoma

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10
Q

Implementing lung cancer screening has what effect on mortality?

A

20% decrease in lung cancer mortality

7% decrease in all-cause mortality

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11
Q

What is the bad calcification pattern of pulmonary nodules?

A

“Scar of carcinoma” = eccentric calcification pattern

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12
Q

What is the probability of a chest tube in performing a CT-guided needle biopsy of a SPN?

A

15%

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13
Q

What can cause false-positive PET scans?

A

Granulomatomous infection

Inflammation

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14
Q

What can cause false-negative PET scans?

A

<1cm
Well differentiated adenocarcinoma
Bronchoalveoloar cell carcinoma
Carcinoid

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15
Q

What is the next step for staging lung cancer after 2 negative thoracentesis procedures?

A

VATS or pleuroscopy biopsy of pleura

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16
Q

Describe the size staging for T1-4 for lung cancer.

A 
T1a: <1cm
T1b: 1-2cm
T1c: 2-3cm
T2a: 3-4cm
T2b: 4-5cm
T3: 5-7cm
T4: >7cm
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17
Q

What is the definition of “central tumors”, and what is the implication for staging?

A

“Central” tumor = mainstem bronchus

Makes T2

18
Q

Describe the lymph node staging for lung cancer.

A 
N0 = no lymph nodes
N1 = ipsilateral hilar, peribronchial, intrapleural LNs
N2 = ipsilateral mediastinal, subcarinal
N3 = contralateral mediastinal -or- supraclavicular
19
Q

Describe the metastasis staging for lung cancer

A 
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
20
Q

What values for pre-operative FEV1 are associated with low perioperative mortality risk for pulmonary resection?

A

FEV1 > 2L for pneumomectomy and 1.5L for lobectomy

21
Q

What is the most accurate way of estimating predicted post-operative lung volumes?

A

Perfusion scanning is better than segment counting & quantative CT

22
Q

What is the Post-op Predicted Product, and what is it used for?

A

PPP = DLCO x FEV1.

PPP < 1650 predicts mortality in pulmonary resection

23
Q

What is the general strategy regarding high-tech, low-tech, or no exercise testing based on ppoFEV1 and ppoDLCO?

A

Calculate ppoFEV1 and ppoDLCO based on V/Q.

  • Both >60% => No testing
  • Either/both 30-60% => low-tech testing
  • Either/both <30% => CPET
24
Q

What is a ‘passing’ score for a Shuttle Walk Test?

A

400m

25
Q

What is a ‘passing’ score for Stair Climb Test?

A

22m

26
Q

What are low/moderate/high risk results for VO2 max on CPET?

A

Low-risk: >20, >75% predicted
Moderate-risk: 10-20, 35-75% predicted
High risk: <10, <35% predicted

27
Q

What pre-op assessment is required for peripheral, clinical stage IA tumors with negative PETs?

A

None

28
Q

What is treatment for stage II lung cancer?

A

Surgery + Adjuvant chemotherapy

29
Q

What is treatment for stage IIIA lung cancer?

A

Chemoradiotherapy + adjuvant immunotherapy
-or-
Neoadjuvant chemoradiotherapy, followed by surgery

30
Q

N2 makes lung cancer what clinical stage (minimum)?

A

Stage IIIA

31
Q

What immunotherapy is most common for stage III lung cancer? What does it target?

A

Durvalomab (Ifminzi) blocks PDL1 (Programmed Death Ligand 1)

32
Q

What is treatment for stage IIIB lung cancer?

A

Good performance status - concurrent chemoradiotherapy. Consolidation durvalomab
Poor performance status - XRT only.

33
Q

What is treatment for stage IV lung cancer?

A
  • Platinum-based chemotherapy doublet (any cisplatin combo)
  • Targeted chemotherapy
  • Immunotherapy
34
Q

What is pemetrexed indicated for?

A

Maintenance therapy for non-squamous NSCLC after therapy.

35
Q

Name 9 complications of immunotherapy for lung cancer

A 
Fatigue
Diarreha
Rash
Hypothyrodism
Pneumonitis
Colitis
Hypophysitis
Pancreatitis
Uveitis
36
Q

What is the timeframe for pneumonitis occurring after immunotherapy?

A

2.5 months

37
Q

What is the treatment for pneumonitis occurring after immunotherapy?

A

Drug discontinuation

38
Q

Treatment for extensive small cell lung cancer?

A

Cisplatin + Etoposide

39
Q

Duration of treatment for extensive small cell lung cancer?

A

2 induction cycles, then reassess. Then, another 2-4 cycles for consolidation. No more than 6 cycles.

40
Q

Treatment for limited small cell lung cancer?

A

Etoposide + Cisplatin (same as extensive), plus
radiotherapy.
-PCI (Prophylactic Cranial Radiation) improves survival and QoL.

ABIM Pulmonary (37 decks)

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