Lung Cancer PPT

Question 1

What is the most common cancer and the leading cause of cancer-related death in the world.

Answer 1

Lung cancer

Question 2

How common is lung cancer in the US?

Answer 2

Lung cancer is the 2nd most common cancer in the US and the leading cause of cancer-related death.

Question 3

Who is most commonly affected by lung cancer?

Answer 3

Lung cancer is common in people 65 and older and is more common in females.

Question 4

What are the two major types of lung cancer?

Answer 4

The two major types of lung cancer are non-small cell lung cancer and small cell lung cancer.

Question 5

How do the types of lung cancer differ?

Answer 5

Each type grows and spreads in different ways and is treated differently.

Question 6

What accounts for the majority of lung cancer cases?

Answer 6

Tobacco use accounts for 80% of lung cancers.

Question 7

What happens if a person quits tobacco before cancer develops?

Answer 7

If a person quits before cancer develops, the damaged lung tissue gradually improves.

Question 8

What environmental factors increase lung cancer risk?

Answer 8

Occupational or environmental exposure to radon, asbestos, certain metals, radiation, or air pollution increases risk.

Question 9

How does smoking affect the risk from other carcinogens?

Answer 9

If people are exposed to carcinogens and also smoke, their risk is greatly increased.

Question 10

Is lung cancer preventable?

Answer 10

Lung cancer is the most preventable form of cancer.

Question 11

What are the four categories of signs and symptoms of lung cancer?

Answer 11

1. Local disease signs and symptoms
2. Regional disease signs and symptoms
3. Distant metastasis signs and symptoms
4. Nonspecific signs and symptoms

Question 12

What are paraneoplastic syndromes?

Answer 12

Paraneoplastic syndromes are symptoms that occur due to cancer but are not directly related to the local presence of cancer cells.

Question 13

What are the local disease signs and symptoms of lung cancer?

Answer 13

1. Persistent cough
2. Hemoptysis (blood in sputum)
3. Dyspnea
4. Fatigue and weakness (occurs in 1/3 of patients)
5. Weight loss (occurs in ½ of patients)

Question 14

What are the signs and symptoms of regional disease?

Answer 14

Chest pain, nerve entrapment, vascular obstruction, dysphagia, hoarseness, pleural effusion, and SVC syndrome.

Question 15

What is SVC syndrome?

Answer 15

Superior vena cava syndrome is a condition caused by compression of the SVC, leading to blood pooling in the vein.

Question 16

What are the indications of SVC syndrome?

Answer 16

Swelling in the face and arms, distended veins in the upper chest, dyspnea, and orthopnea.

Question 17

What are the signs and symptoms of distant metastasis?

Answer 17

Headaches, visual changes, neurological deficits, and personality changes.

Question 18

What can cause personality changes in distant metastasis?

Answer 18

Brain metastases or pain from a bone metastasis.

Question 19

What is a Pancoast tumor?

Answer 19

A tumor found in the superior sulcus that presents with pain in the shoulder and down the arm, atrophy of the hand muscles, erosion of the ribs and/or vertebrae, or Horner Syndrome.

Horner syndrome is characterized by weakness or dropping of one eyelid, decrease in pupil size of the same eye, and decreased or absent sweating on the same side of the face.

Question 20

What are some paraneoplastic syndromes associated with lung cancer?

Answer 20

Hypercalcemia, hypertrophic osteoarthropathy with clubbing of the fingers, blood clots, gynecomastia, syndrome of inappropriate antidiuretic hormone secretion, and adrenocorticotrophic hormone production syndrome.

Paraneoplastic syndromes are more often present in patients with Small Cell lung cancer (SCLC).

Question 21

What does the American Cancer Society recommend for lung cancer screening?

Answer 21

Low-dose CT for individuals ages 55-74, in otherwise good health, who are current smokers or have quit smoking in the past 15 years, have at least a 30 pack year history, and are willing to attend a smoking cessation program.

Question 22

What is the most common diagnostic imaging for lung tumors?

Answer 22

Chest x ray

Question 23

What lab studies are valuable for lung cancer evaluation?

Answer 23

Evaluation of the blood should include CBC and serum calcium

Question 24

What methods can be used for histologic evaluation?

Answer 24

Histologic evaluation may be obtained through bronchoscopy or surgical interventions such as a mediastinoscopy, and CT-guided fine needle aspiration.

Question 25

How does lung cancer spread?

Answer 25

Lung cancer spreads locally by direct extension, regionally by the lymphatics, and distantly through hematogenous routes.

Question 26

What percentage of lung cancers are localized at the time of diagnosis?

Answer 26

Approximately 15% of lung cancers are localized, 22% have regional spread, and 56% have distant metastasis.

Question 27

What is the order of lymphatic spread in lung cancer?

Answer 27

Lymph spread tends to occur early and follows the divisions of the bronchial tree in the order: intrapulmonary to hilar to mediastinal to supraclavicular.

Question 28

What are the primary lymphatics that drain the lungs?

Answer 28

The primary lymphatics that drain the lungs are the hilar and mediastinal nodes.

Question 29

How does lymph move from the left lung?

Answer 29

Lymph moves from the left lung into the thoracic duct and then into the left subclavian vein.

Question 30

How does lymph move from the right lung?

Answer 30

Lymph moves from the right lung into the right lymphatic duct and then into the right subclavian vein.

Question 31

Where do the pleura drain?

Answer 31

The pleura are rich in lymphatics and drain into the hilum.

Question 32

What are common sites for distant metastasis in lung cancer?

Answer 32

Distance metastasis can occur to the brain, bone, liver, adrenal gland, and contralateral lung.

Question 33

What is the staging system of lung cancer?

Answer 33

AJCC/TNM

Question 34

What are the most significant factors in lung cancer prognosis?

Answer 34

The most significant factors are performance status, stage, and weight loss.

Question 35

How is performance status measured in lung cancer patients?

Answer 35

the Karnofsky Performance Status (KPS) or Eastern Cooperative Oncology Group (ECOG) performance status.

Question 36

What does a high KPS score or low ECOG score indicate?

Answer 36

Patients with a high KPS score or a low ECOG score are predicted to have a better prognosis.

Question 37

What percentage of lung cancers are Non-small cell lung cancers (NSCLC)?

Answer 37

Approximately 80-85% of lung cancers are NSCLC.

Question 38

What are the three subtypes of Non-Small Cell Lung Cancer?

Answer 38

The three subtypes are Adenocarcinomas, Squamous cell carcinomas, and Large cell carcinomas.

Question 39

What percentage of NSCLC do Adenocarcinomas account for?

Answer 39

Adenocarcinomas account for about 40% of all NSCLC.

Question 40

Where do Adenocarcinomas typically arise from?

Answer 40

Adenocarcinomas arise from cells that secrete mucus and are usually found in the periphery of the lung.

Question 41

In which population are Adenocarcinomas more commonly found?

Answer 41

Adenocarcinomas are more common in women and are more likely to occur in younger individuals.

Question 42

What is the growth rate of Adenocarcinomas compared to other NSCLC subtypes?

Answer 42

Adenocarcinomas are the slowest growing of all the other subtypes.

Question 43

What percentage of NSCLC do Squamous Cell Carcinomas account for?

Answer 43

Squamous Cell Carcinomas account for about 30% of all NSCLC.

Question 44

Where do Squamous Cell Carcinomas typically arise from?

Answer 44

They arise from the cells that line the airway and are usually found in the central parts of the lung near the bronchi.

Question 45

In which population are Squamous Cell Carcinomas more commonly found?

Answer 45

Squamous Cell Carcinomas are common in smokers and more common in men.

Question 46

What percentage of NSCLC do Large Cell Carcinomas account for?

Answer 46

Large Cell Carcinomas account for about 20% of all NSCLC.

Question 47

What is another name for Large Cell Carcinomas?

Answer 47

They are sometimes called undifferentiated NSCLC.

Question 48

Where can Large Cell Carcinomas appear in the lung?

Answer 48

They can appear in any part of the lung but may appear in the periphery or central location.

Question 49

What is the growth rate and prognosis of Large Cell Carcinomas?

Answer 49

Large Cell Carcinomas tend to grow quickly and have a high tendency to metastasize, especially to the brain, and have a poor prognosis.

Question 50

What is SCLC?

Answer 50

Small Cell Lung Cancer ## Footnote Also known as 'Oat cell' tumors.

Question 51

Where does SCLC typically occur?

Answer 51

Occurs more centrally in the lung.

Question 52

What is the prognosis of SCLC?

Answer 52

SCLC has the poorest prognosis of all lung tumors.

Question 53

What is the treatment of choice for SCLC?

Answer 53

Chemotherapy.

Question 54

Which chemotherapy drug is most effective for SCLC?

Answer 54

Cisplatin is the single most effective chemotherapy drug in the treatment of SCLC.

Question 55

How is radiation therapy used in SCLC treatment?

Answer 55

Radiation therapy is often given concurrently with chemotherapy.

Question 56

What is the standard practice for chemotherapy and radiation therapy in SCLC?

Answer 56

Standard practice includes the delivery of chemotherapy during accelerated hyperfractionated radiation therapy.

Question 57

What is prophylactic cranial irradiation (PCI) used for in SCLC?

Answer 57

PCI is commonly delivered to prevent brain metastasis.

Question 58

What is the dose of primary treatment as radiation therapy for lung cancer?

Answer 58

60-75 Gy

Question 59

What is the EBRT dose after surgery for lung tumors?

Answer 59

50-65 Gy

Question 60

What is the EBRT dose when there is concurrent chemotherapy for lung tumors?

Answer 60

30-50 Gy

Question 61

What is the dose for palliation or recurrence for lung tumors?

Answer 61

40-50 Gy

Question 62

What are oblique portals used for?

Answer 62

Oblique portals are often used to boost the tumor.

Question 63

What beam energy is commonly used in treatment?

Answer 63

A beam energy of 6-10 MV is commonly used.

Question 64

What does the treatment field design include for upper lobe disease?

Answer 64

The field includes the primary tumor, hila, superior mediastinum, and both supraclavicular areas if there is disease in the upper lobe.

Question 65

What does the treatment field design include for middle lobe disease without mediastinal involvement?

Answer 65

The primary tumor, hila, and superior mediastinum are treated.

Question 66

What does the treatment field design include for lower lobe disease without mediastinal involvement?

Answer 66

The primary tumor and mediastinum are included.

Question 67

What techniques may benefit patients with tumors close to critical structures?

Answer 67

Patients may benefit from IMRT or VMAT.

Question 68

What needs to be considered when placing a treatment field?

Answer 68

The motion of the target and structures needs to be considered.

Question 69

How much can a lung tumor move during a single treatment fraction?

Answer 69

A lung tumor can move more than 1 cm.