Lung Cancer - clinical approach

Question 1

smoking + asbestos leads to which lung cancer?

Answer 1

bronchogenic

(small cell or non-small cell)

Question 2

lung cancer in _____ degree relative increases lung cancer risk?

Answer 2

first

Question 3

Does diet prevent lung cancer?

Answer 3

higher intake of fruits/veggies may; unsure

B-carotene or vit E non conclusive

Question 4

only definitive prevention of lung cancer

Answer 4

smoking cessation

NEVER too late to benefit from smoking cessation

Question 5

lung cancer screening

Answer 5

LDCT (low dose helical CT)

(sputum and plain CT not effective)

medicare approved

Question 6

lung cancer screening

Answer 6

LDCT (low dose helical CT)

(sputum and CT does not effective)

medicare approved if asymptomatic + risk factors and over 55 yo

Question 7

tabacco smoking history that increases lung cancer risk

pack/day x years smoking hx

Answer 7

20 pack years

85% risk;

Question 8

when do you hear stidor

Answer 8

inspiration

wheezing is exhalation

Question 9

sx of lung cancer (5)

Answer 9

1. cough; new or changed
2. hemoptisys
3. stridor or wheezing
4. anorexia
5. weight loss
6. asthenia (loss of energy/strength)

Question 10

What imaging abdormalities are seen in lung cancer?

Answer 10

1. enlarging nodule or mass
2. persistent atelectasis, opacity or pleural effusion

must compare to previous imaging (changes in 2 years)

Question 11

Define “nodule”

Answer 11

<3mm round opacity

if > 3 mm = mass

Question 12

Describe a benign nodule

on CXR or CT

Answer 12

calcification that is diffuse, central or laminar

Question 13

3 CT features suspicious for malignancy of lung

Answer 13

1. spiculated edges
2. irregular margins
3. lymphadenopathy

Question 14

When do you get a CT scan of suspected lung cancer?

Answer 14

nodule > 4mm or no previous films

if stable < 4 mm = no f/u needed

Question 15

when do you consider biopsy of suspected lung cancer?

Answer 15

nodule 8 mm & high risk

Question 16

When do you consider PET/CT of suspected lung cancer?

Answer 16

> 8mm & low risk

Question 17

S/sx of regional spread (5)

Answer 17

1. tracheal obstruction
2. hoarseness
3. dysphagia
4. pleural effusion
5. CP

Question 18

s/sx bone metastasis from lung (2)

Answer 18

1. cytopenia
2. leukoerythroblastosis

Question 19

s/sx liver metastasis from lung (3)

Answer 19

1. fever
2. anorexia
3. weight loss

Question 20

Deifine paraneoplastic syndrome

Answer 20

syndrome due to substances produced by tumor

Ab produced and cross-react with healthy tissue

Question 21

hypercalcemia of malignancy (2 sx)

paraneoplastic syndrom

Answer 21

1. polyuria
2. polydipsia

lethargy, N/V

Question 22

cause of hypercalcemia of malignancy

(paraneoplastic syndrome)

Answer 22

1. PTH-related peptide secreatted –> osteolytic metastases
2. ectopic parathyroid hormon production

Question 23

Hypercalcemia malignancy management

Answer 23

1. hydration
2. meds: bisphosphonates, denusomab
3. dialysis

Question 24

What are the 6. paraneoplastic syndromes associated w/lung cancer?

Answer 24

1. hyponatremia
2. cushings
3. acromegaly
4. dermatomyositis/polymyositis
5. LEMS
6. osteoarthropathy (clubbing)

Question 25

what is the most accessible site (method) with the least invasive method of evaluating lung cancer?

Answer 25

biopsy

Question 26

Which 5 labs would you order for lung cancer work-up?

Answer 26

1. blood count 1. calcium 1. liver test 1. electrolytes 1. creatinine

Question 27

Staging is done with which tests?

Answer 27

1. US: bronco, thoraco, mediastinum 1. CT 1. PET

Question 28

Which lung cancers are removed w/surgery?

Answer 28

1. non-small cell cancer 1. mesothelioma

Question 29

6 Treatments for non-small cell lung cancer?

Answer 29

1. surgery 1. radiation 1. cytotoxic therapy 1. target chemo against driver mutation (EGFR or ALK) 1. immunotherapy 1. ***smoking cessation***

Question 30

4 Sx of mesothelioma

Answer 30

1. SOB 1. non-pleuritic CP 1. diminished breath sound 1. dullness to percussion

Question 31

Dx of mesothelioma (2)

Answer 31

1. CT: pleural effusion or pleural plaques 1. biopsy

Question 32

tx of mesothelioma (2)

Answer 32

1. chemo 1. surgery + radiatiton

Question 33

Presentation of pancoast tumor

Answer 33

1. horner syndrome 1. CP 1. shoulder pain/ hand atrophy 1. neuropathy in ulnar n. distribution

Question 34

cause of hypercalcemia of malignancy | (paraneoplastic syndrome)

Answer 34

1. PTH-related peptide secreatted --> osteolytic metastases 1. ectopic parathyroid hormon production