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ABTS - Thoracic Surgery Notecards IA > Lung Cancer Overview and Preop Eval > Flashcards

Lung Cancer Overview and Preop Eval Flashcards

1
Q

The overall chance of developing lung ca (men and women)

A

Men: 8%
Women: 6%

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2
Q

At risk patient populations for lung ca

A

Men
African Americans
Low SE class

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3
Q

Most important RF for lung ca

A

Smoking (~85% of cases)

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4
Q

Active smoker has _ fold increase in risk of developing lung ca?

A

16-fold increase

(risk directely correlated to quanitity and duration of smoking)

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5
Q

% reduction in lung cancer mortatity risk with smoking cessation > 10 years

A

30-50% reduction

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6
Q

Enviornmental carcinogens account for _ % of lung cancers

A

10%

(asbestos, radon, tar, soot, arsenic, chromium, nickel)

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7
Q

Inherited lung ca susceptibility may be linked to what chromosome

A

chromosome 6

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8
Q

Genetic markers linked to lung ca

A

k-ras (earlier distant mets and worse NSCLC prognosis)

EGFR ( linked to adenoca)

c-myc (linked to SCLC)

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9
Q

Results of National Lung Screening Trial

A

20% reduction in lung cancer deaths among high-risk patients screened with low-dose helical CT compared to CXR

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10
Q

3 major WHO categories for lung ca

A
  1. NSCLC (most common, ~ 85%)
  2. SCLC
  3. Mixed epithelial lung ca
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11
Q

NSCLC types (3)

A
  1. Adenocarcinoma (MC)
  2. SCC
  3. Large cell ca (10-15%)
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12
Q

Characteristics of lung adenocarcinoma

A
  1. MC histologic type in non-smokers
  2. Peripheral distribution
  3. Cytokeritin 7 and thyroid transcription factor-1 (TTF-1)
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13
Q

What is bronchoalveolar ca

A

indolant, non-invasive, variant of adenocarcinoma

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14
Q

Characteristics of lung SCC

A
  1. Usually arise in major bronchi
  2. Discrete smoking dose-response relationship
  3. Assoc with necrosis and cavitary lesions
  4. Cytokeratin pearls on histology
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15
Q

Characteristics of large cell lung ca

A
  1. 10-15% of lung ca
  2. Large, peripheral mass on CXR
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16
Q

Characteristics of SCLC

A
  1. 15-20% of lung ca
  2. Usually metastatic at time of dx
  3. Poor prognosis
  4. Neuroendocrine type of lung ca
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17
Q

2 neuroendocrine tumor associated lung cancers

A
  1. SCLC
  2. Carcinoid
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18
Q

Most common presenting symptoms of lung ca

A

Weight loss
Fatigue
Cough
Dyspnea
Hemoptysis

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19
Q

Paraneoplastic syndroms MC with what lung cancer types

A

SCLC (SIADH)
SCC (hypercalcemia, PTHRP)

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20
Q

SVC synrome MC with what lung cancer type

A

SCLC (bulky upper lobe tumor)

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21
Q

MC metastatic symproms

A

Neurologic (headache)
Bone pain

22
Q

General approach to cancer management

A

Name
Stage
Treat

23
Q

Approach to diagnosis (Name) of lung ca

A

Histologic confirmation (Name) mandatory:

  1. Sputum cytology
  2. Bronch with bx
  3. EBUS with bx
  4. FNA
  5. CT guided FNA
  6. Surgical bx
24
Q

Lung cancer staging based on

A

TNM classification

25
Q

Lung ca (T-stage)

A

T1: < 3 cm (T1a: < 2cm, T1b 2-3 cm)

  • surrounded by visceral pleura
  • involvment of lobar (not main) bronchus

T2: 3-7cm (T2a: 3-5 cm, T2b: 5-7 cm)

  • involvement of main bronchus (> 2cm from carina)
  • invasion of visceral pleura
  • atelectaiss or obstructive pneumonitis (< entire lung)

T3: > 7 cm

  • invasion of CW, diaphragm, phrenic n, mediastinal pleura, parietal pleura
  • involvement of main bronchus (< 2cm from carina, not involving carina itself)
  • atelectasis or obstructive pneumonitis (entire lung)
  • separate tumor nodules in same lobe

T4:

  • invasion of mediastinum, heart, great vessels, trachea, RLN, esophagus, vertebral body
  • involvement of carina
  • separate tumor nodules in different, ipsilateral lobes
26
Q

Lung ca (N-stage)

A

N1: Ipsilateral peribronchial, hilar, intrapulmonary LN

N2: Ipsilateral mediastinal/subcarinal LN

N3:

  • Contralateral mediastinal/hilar LN
  • Ipsilateral/contraleral scalene or supraclavicluar LN
27
Q

Lung ca (M-stage)

A

M1: Distant mets

M1a:

  • Separate tumor nodule in contralateral lobe
  • Tumor with pleural nodules
  • Malignant pleural or pericardial effusion

M1b: distant mets (liver, bone, brain, adrenal)

28
Q

AJCC lung cancer staging

A

Stage I: T1-T2, N0, M0

Stage II:

  • T1-2 with N1 disease (MO)
  • T2b or T3 alone (NO, MO)

Stage III:

  • N2 or N3 disease
  • T3 with LN (N1-3)
  • T4 alone

Stage IV: M1 disease (M1a or M1b)

29
Q

Staging options for lung ca

A
  1. Mediastinoscopy with LN bx (gold standard for N2 disease)
  2. PET-CT
  3. EBUS and esophageal US-guided bx
  4. MRI brain (brain mets) [T1b (2cm) or greater]
  5. Bone scan (bone mets)
  6. Abdominal CT and LFTs (liver and adrenal mets)
30
Q

MC site for NSCLC distant mets

A

Brain

31
Q

Preoperative risk assessment for lung cancer includes

A

Overall functional status (Zubrod)
Comorbidities
Pulmonary function
Cardiac evaluation

32
Q

Classic spiromety findings used to determine lung cancer resectability

A

Moratlity < 5% when:

FEV1 > 1.5L (lobectomy)
FEV > 2L (pneumonectomy)

33
Q

Postoperative Predicted Pulmonary Function should be determined when

A

Preoperative FEV1 or DLCO < 80% predicted

34
Q

Determination of Postoperative Predicted Pulmonary Function

A
  1. Anatomic calculation
  2. Quantitative CT
  3. Ventilation and/or perfusion scan
35
Q

Patients with Postoperative Predicted FEV1 or DLCO less than _% are at increased risk of perioperative death or cardiopulmonary complicaitons

A

PPFEV1 or PPDLCO < 40%

Should undergo preoperative cardiopulmonary exercise testing (CPET)

36
Q

Most specific predictor of postoperative pulmonary complicatations related to lung resection

A

Maximal oxygen consumption (VO2 max) measurement

VO2 max > 15ml/kg/min >> low risk

FEV1/DLCO < 40% and VO2 max < 15 >> very high risk

37
Q

Alternatives to CPET to evaluate cardiopulmonary reserve preop

A
  1. Shuttle walk test
  2. Stair-climb test
  3. 6-minute walk test
38
Q

Lung cancer screening guidelines 2021

A

Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years:

  • Screen for lung cancer with low-dose computed tomography (CT) every year.
  • Stop screening once a person has not smoked for 15 years or has a health problem that limits life expectancy or the ability to have lung surgery.
39
Q

Fleischner Society pulmonary nodule recommendations:

Single solid nodule <6 mm (<100 mm3)

A
  • low-risk patients: no routine follow-up required
  • high-risk patients: optional CT at 12 months (particularly with suspicious nodule morphology and/or upper lobe location; see “risk assessment” below)
40
Q

Fleischner Society pulmonary nodule recommendations:

Solitary solid nodule 6-8 mm (100-250 mm3)

A
  • low-risk patients: CT at 6-12 months, then consider CT at 18-24 months
  • high-risk patients: CT at 6-12 months, then CT at 18-24 months
41
Q

Fleischner Society pulmonary nodule recommendations:

Solitary solid nodule >8 mm

A

low-risk and high-risk patients: consider CT at 3 months, PET/CT, or tissue sampling.

42
Q

Fleischner Society pulmonary nodule recommendations:

Multiple solid nodules <6 mm

A
  • low-risk patients: no routine follow-up required
  • high-risk patients: optional CT at 12 months
43
Q

Fleischner Society pulmonary nodule recommendations:

Multiple solid nodules >6 mm

A
  • low-risk patients: CT at 3-6 months, then consider CT at 18-24 months
  • high-risk patients: CT at 3-6 months, then CT at 18-24 months

When multiple nodules are present, the most suspicious nodule should guide further individualized management.

44
Q

Fleischner Society pulmonary nodule recommendations:

Single ground glass nodule <6 mm

A

no routine follow-up required

45
Q

Fleischner Society pulmonary nodule recommendations:

Single ground glass nodule ≥6 mm

A

CT at 6-12 months, then if persistent, CT every 2 years until 5 years

46
Q

Fleischner Society pulmonary nodule recommendations:

Single part-solid nodule ≥6 mm

A

CT at 3-6 months, then if persistent and solid component remains <6 mm, annual CT until 5 years

47
Q

Fleischner Society pulmonary nodule recommendations:

Multiple subsolid nodules <6 mm

A

CT at 3-6 months, then if stable consider CT at 2 and 4 years in high-risk patients

48
Q

Fleischner Society pulmonary nodule recommendations:

Multiple subsolid nodules ≥6 mm

A

CT at 3-6 months, then subsequent management based on the most suspicious nodule(s).

49
Q

Fleischner Society pulmonary nodule recommendations:

Guideline Exclusions

A
  • patients aged 35 years or younger
    • considered to have an overall low risk for pulmonary malignancy
    • in this age group, nodules are most likely to be infectious rather than cancer
    • management of incidentally-found pulmonary nodules in this group should be individualized
  • patients with known malignancy
    • an incidentally-detected pulmonary nodule is more likely to be cancer-related than in the general population
  • immunocompromised patients
    • higher risk for opportunistic pulmonary infections
  • lung cancer screening population
    • these patients are on active screening due to a high-risk for lung cancer development, usually current and former smokers, and, therefore, should have their scans reported accordingly to Lung-RADS
50
Q

Fleischner Society pulmonary nodule recommendations:

Risk Assessment

A

The guidelines recommend considering high-risk as an estimated risk of cancer >5%.

Suggested risk factors to consider include older age, heavy smoking, irregular or spiculated margins, and upper lobe location.

51
Q
A

ABTS - Thoracic Surgery Notecards IA (48 decks)

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