Lung Cancer Epidemiology, Biology, Clinical Presentation and Screening

Question 1

One in __ men is expected to
develop lung cancer during
his lifetime and one in __will
die of it.
• One in ___ women is expected
to develop lung cancer during
her lifetime and one in___ is
expected to die of it.

Answer 1

One in 11 men is expected to
develop lung cancer during
his lifetime and one in 13 will
die of it.
• One in 15 women is expected
to develop lung cancer during
her lifetime and one in 17 is
expected to die of it.

Question 2

trend of cigarette smoking

Answer 2

has been going down. We’ve been seeing drops in lung cancer incidences

Question 3

Composition
– 80% ___, 20% exhaled “___” smoke
– Some [carcinogens] higher in ___

Answer 3

Composition
– 80% sidestream, 20% exhaled “mainstream” smoke
– Some [carcinogens] higher in sidestream

Passive smokers absorb 1-15% of chemicals

• Lung cancer risk of non-smoking wives of
smokers increased 24%(13-36%)

Question 4

20% of lung cancers in non-smokers is due to ___

Answer 4

environmental tobacco smoke

Question 5

lung cancer riskks other than smoking

Answer 5

• Air pollution

• Radon (from mining or indoor
exposure) •

Asbestos
– In setting of asbestosis

– Without asbestosis

– Synergy with smoking
• Other “occupational carcinogens”

Question 6

which vitamin deficiencies are linked to lung cancer

Answer 6

vitamins A, C, E and beta carotene

Question 7

non neoplastic lung disesase

Answer 7

COPD, TB, silicosis, pulmonary fibrosis

Question 8

outline a few genetic abnormalities specific in lung cancer

Answer 8

BRAF

EGFR

Alk fusion

P53 mutation

Question 9

outline the 4 major lung cancer

Answer 9

1. small-cell carcinoma (sclc)
2. non-small cell
   - squamous
   - adenocarcinoma
   - large cell
3. carcinoid
4. others

Question 10

types of non-small cell lung cancers

Answer 10

• squamous
• adenocarcinoma
• large cell

Question 11

most common non-small cell (nsclc)

Answer 11

adenocarcinoma (40%) of lung cancer pathologies

Question 12

person has long-term dyspnea. On CXR, there are large cavitary regions, with a central lesion involving major airway.

• on CT, the large cavity was surrounded by gray white granular tissue.
• this presentation is typical of ___ carcinoma

Answer 12

typical of squamous carcinoma.

Question 13

a person’s ct demonstrates a peripheral nodule or mass. Which pattern is this consistent wiht?

Answer 13

adenocarcinoma

Question 14

which demographics are more at risk for adenocarcinoma

Answer 14

Woman / non-smokers

• Associated with
mutations amenable to
sensitive to molecular
treatment modalities

• this is the most common subtype

Question 15

adenocarcinoma demonstrates a ___ growth pattern. what is this?

Answer 15

a lepidic growth pattern.

• slow growth, airspace fisease that is misdiagnosed as pneumonia since it’s on the periphery as a nodeule or mass.
• can be multifocial, but it preserves lung architecture. might see bronchorrhea.

Question 16

T/f adenocarcinoma preserves lung architecture

Answer 16

ture. it’s usually a peripheral nodule

Question 17

Characteristic symptom of lung adenocarcinoma

Answer 17

bronchorrhea

Question 18

___ ___ carcinoma demonstrates ___ location, ___ growth and has an increased likelihood of ___ into the hilar lymph nodes.

Answer 18

small cell carcinoma: central location, rapid grwoth, and +++ ADENOPATHY.

Question 19

T/F carcinoid tumors ae more likely to be seen in smokers

Answer 19

false. young non-smokers often present with this form of lung cancer.

Question 20

rate of growth in carcinoid tumor. what type of neoplasm does it grow as?

Answer 20

slow growting. presents as lung nodule or endobronchial lesion

Question 21

carcinoid tumors are ___ growing and presents as a lung nodule and ___ lesion

Answer 21

slow growting. presents as lung nodule or endobronchial lesion

Question 22

a ___ ___ nodule is a lung nodule under 3 cm found on routine CXR. usually asymptomatic

Answer 22

solitary pulmonary nodule

Question 23

malignant causes of solitary pulmonary nodule (Lung nodule (<3cm) found on “routine”
CXR, usually asymptomatic)

Answer 23

• bronchogenic carcinoma: adenocarcinoma, squamous cell carcinoma, large cell carcinoma, small cell carcinoma
• metastatic lesions: breast, head and neck, melanoma, colon, kidney, sarcome, germ cell tumor

- pulmonary carcinoid

Question 24

benign causes of solidary pulmonary nodule

Answer 24

• infetious granulma
• abscess/cysts
• benign neoplasms
• vascular
• wegeners granulomatosis

Question 25

"clonal evolution" that causes lung canacer development

Answer 25

1. non -malignant genetic changes that predisposes someone to cancer 3. marker of diffuse tissue injury 4. development of cloncal patches; bunches of cells with more mutations. sartt to grow abnormally, changes in tumor suppressor genes which become less afected. 5. you then get frank malignancy. -- angiogenesis, invasion, and metastasis starts to occur.

Question 26

for solitary pulmonar nodule (SPN), age correlates with probability of malignancy. outline this trend. Outline other risks

Answer 26

50% or higher at age of 60 or above. - risks: smoking, previous cancer

Question 27

SPN often are \<3cm which are less likely to be malignant, but \>3cm has a higher likely hood to be malignant. What characteristics of SPN lesion indicate a benign vs malignant SPN?

Answer 27

**– Benign:** • **Central**, **diffuse**, popcorn or concentric calcification **– Malignant** • **Irregular** or **spiculated**, eccentric calcification

Question 28

SPN type?

Answer 28

benign hamatoma. solitary pulmonary nodule with characteristic popcorn configuration suggestive of a hamartoma

Question 29

SPN type?

Answer 29

– Malignant • Irregular or spiculated, eccentric calcification

Question 30

how is SPN growth characterised?

Answer 30

- based on tumour doubling times of 20-400 days. - benign lesions have doubling \<20 days or \>450 days. - doubling refers to volume -- not diameter.

Question 31

appraoch to SPN

Answer 31

1. always get old XRAYS 2. determine probability of malignancy

Question 32

stability of an SPN leesion for \<2 years suggests a ___ lesion

Answer 32

benign lesion.

Question 33

approach and follow up of solid nodules depending on if the person is high risk or low risk

Answer 33

LOW RISK:if under 6mm with one single nodule, no routine follow up is needed. If larger, consider CT at 6-12 months. if over 8mm, consider CT/PET or tissue sampling at 3 months. HIGH RISK: if under 6mm, optional CT. at 12 months. if 6-8mm, CT at 6-12, then follow up ct at 18 months. if \>8mm, consider CT/PET/CT tissue smapling at 3 month

Question 34

follow up/management for gound class,p art solid, or mulitple opacities (SPN)

Answer 34

the more solid, the faster the follow up

Question 35

symptoms of lung cancer related to the primary lesion

Answer 35

– Cough – Hemoptysis – Chest pain – Dyspnea – Weezing – Weight loss

Question 36

mets of lung cancer

Answer 36

brain mets, bone mets, liver/adrenal mets

Question 37

pancoast's syndrome symptoms and causes

Answer 37

symptoms associated with a superior pulmonary sulcus tumor. sx: - shoulder and arm pain, horner's syndrome, weakness and atrophy of hand muscle caused by: non-small cell lung cancer, other neoplasms, infectious diseases

Question 38

horner's syndrome

Answer 38

assocaited with pancoast's syndome; ipsilateral ptosis, miosis, anhidrosis.

Question 39

nail changes in paraneoplastic syndromes

Answer 39

- clubbing - hypertropic osteoarthropathy.

Question 40

paaneoplastic syndromes

Answer 40

- hypoercalcemia - seen in parathyroid and squamous cell cancers. - SIADH (small cell) - ectopic ACTH production (small cell) - neurological syndromes (small cell)

Question 41

non-Small cell staging vs small cell staging

Answer 41

• Non-Small Cell – Stage I-IV (T N M system) • Small Cell – Limited vs. Extensive stage

Question 42

TNM staging for non-small cell staging.

Answer 42

**T= tumor stages**. T1=\<3cm, T2= \>3cm **N=nodes:** mediastinal lymph nodes identified according to international map. N1= ipsilateral lung, N2 = ipsilateral mediastinum. N3= contralateral mediastinum **M = metastasis**

Question 43

limited vs extensive small cell lung cancer staging

Answer 43

limited= intrathoracic disease. stage IIIB or less. untreated prognosis = 6 month extensive = extrathoracic disease. stage 4. untreated prognosis 6 weeks.

Question 44

current recommendations on screening for lung cancer.

Answer 44

- lung cacner screening for adults age 55-74 years, with at least a 30 pack year smoking history, who smoke or quit smoking less than 15 years ago, with CT every year for up to 3 years.

Question 45

T/f chest radiology with or without sputum cytology can be used to screen for lung cancer

Answer 45

false. only ct and only for adults 77-74 with at least 30 pack year history