Lung Cancer - Clinical Aspects Flashcards
Lung cancer - how lethal is it? How common is it?
#1 cause of cancer death. #2 most common cancer in both women and men (behind breast and prostate cancer)
Does COPD increase the risk for lung cancer, independently of smoking?
Yes. Might be due to PMN-derived free radicals, decreased clearance of carcinogens.
What are some risk factors for lung cancer other than smoking (and COPD)?
Asbestos exposure. Radon. Fine particulate air pollution. 2nd hand smoke. Increased age...
Is lung cancer more common in men than in women?
No. It’s very common in women.
Can asymptomatic lung cancer be cured?
Yes, but it’s hard to screen for.
What’s the prognosis for symptomatic lung cancer?
Poor.
Sentinal lymph nodes for lung cancer?
Mediastinal and supraclavicular nodes
What’s a place to which lung cancer commonly metastasizes that is uncommon in other cancers?
Adrenal glands.
Is COPD associated with clubbing?
No. 20% of patients with lung cancer have clubbing, so if you see it in a patient, look into it. (and definitely don’t write it off as COPD)
What’s the problem with screening for lung cancer?
You can pick up early lung cancer with HRCT - one recent study showed a 20% reduction in lung cancer mortality.
But… 39% of patients had positive findings, 96% of which were false positives. That’s a lot of money, testing, anxiety, radiation, etc. etc. etc.
What’s the definition of a solitary pulmonary nodule (SPN)?
Significance?
A round lesion < 3cm, surrounded by lung.
(lesions < 1cm can be important, but only about 1% will be malignant)
The likelihood of a SPN being cancer depends on the patient population and size.
Usefulness of looking at old chest films when you see a suspicious lesion?
Cancers usually grow.
Which is a reliable sign that an SPN is benign?
a. No growth over 1 month.
b. Patient is a never-smoker.
c. Lesion is only 1cm.
d. None of the above
None of the above.
Thoracic CT can detect mediastinal adenopathy of lung cancer with sensitivity and specificity around 70-80%. What’s an example of a false negative?
Of a false positive?
False negatives: small tumor-bearing nodes.
False positives: enlarged inflammatory nodes.
When is sputum cytology most useful?
When the lesion is central, squamous cell, or something causing hemoptysis.
(stuff near the airways)
(seldom used these days for diagnosis)
Utility of bronchoscopy?
Can directly visualize lesions.
Can sample with washing, brushings, and biopsy.
Can do a transbronchial needle aspiration of mediastinum (which is cool).
When should a transthoracic needle biopsy be done?
or not done?
You don’t need to do it in good surgical candidates with a growing mass.
But in patients unfit for surgery, useful to confirm Dx before doing radiation therapy.
How do you check the body for mets?
PET scan - including liver and adrenals.
MRI with gadolinium for brain.
What does a PET scan light up?
Anything that’s metabolically active - so both tumors, and inflammatory lesions.
At least whole lobe removed = generally better outcomes cancer-wise. What determines how much lung you can take out in surgery? Give 3 categories.
PFTs - specifically FEV1.
FEV1 > 2 liters: can take out whole lung.
FEV1 of 1-2 liters: lobectomy… refine risk with other studies.
FEV1 < 1 liter: segmentectomy… or just radiation therapy.
When would you do invasive mediastinal sampling?
When a patient is a borderline surgical candidate, adenopathy is suggested with imaging, and proof of nodal involvement would change management.
Current utility of chemotherapy in lung cancer?
Limited to use as adjuvant, but not very effective.
Except when the tumor’s driven by EGFR mutation, in which case chemo works better.
(and there are some specific therapies coming out)
What are the characteristics that allow you to call a minimally invasive adenocarcinoma “in situ”?
Pure lepidic growth (along alveolar surface).
No invasion of basement membrane.
What’s the first dichotomy in lung cancer types that an oncologist would care about?
Why?
Small cell vs. non-small cell lung cancer (NSCLC).
This guides treatment - small cell gets chemo, NSCLC gets surgery/radiation.
3 main types of non-small cell lung cancer (NSCLC)?
Adenocarcinoma.
Squamous cell.
Large cell.
Prognosis for small cell vs. NSCLC?
Small cell always has pretty poor prognosis, even if caught early-ish.
NSCLC has better prognosis if caught at Stage 1 or 2… but that’s hard to do.
