Lung Cancer (SCLC, NSCLC) Flashcards
Which of these following substances is the greatest cause of lung cancer?
A. Asbestos
B. Radon
C. Tobacco
D. Ionizing radiation
C. Tobacco
Smoking cessation after 20 min will:
A. Reduce risk of MI by half
B. Risk of MI begins to decrease
C. Blood pressure normalizes
D. Risk of lung cancer death is reduced by half
C. Blood pressure normalized
Smoking cessation after 8 hours will:
A. Decrease risk of MI
B. Normalizes blood pressure
C. Reduces risk of MI by half
D. Reduces risk of lung cancer death by half
A. Decrease risk of MI
Smoking cessation after 1 year will:
A. Normalize blood pressure
B. Begin reducing risk of MI
C. Reduces risk of MI by half
D. Reduces risk of lung cancer death by half
C. Reduces risk of MI by half
Smoking cessation after 10 years will:
A. Reduce risk of lung cancer death by half
B. Reduce risk of Mi by half
C. Normalize BP
D. Begins to reduce risk of MI
A. Reduces risk of lung cancer death by half
Which of the following patients are candidates for an LDCT lung cancer screening? (Select All)
A. TT, Age 53 smokes 2 PPD x 20 years
B. CC, Age 56 smokes 1 PPD x 29 years
C. CT, Age 55 smokes 1 PPD x 35 years
D. AL, Age 71 smokes 2 PPD x 15 years
E. EC, Age 42 smokes 2 PPD x 15 years
C. CT, Age 55 smokes 1 PPD x 35 years
D. AL, Age 71 smokes 2 PPD x 15 years
TL is a 56 yo man who recently stopped smoking last week and has started taking nicorette lozenges. Upon further questioning he reveals that he used to smoke 1 PPD since the age of 21. Is TL a candidate for a LDCT lung cancer screening?
A. Yes
B. No
A. Yes
MJ is a 60 yo woman who has come to the clinic for a general physical. Upon questioning the patient you find that she has a history of alcohol abuse for which she is currently seeking therapy and a extensive history of smoking. She began smoking 1 PPD at the age of 40 and she did so for 10 years. She has been smoking 2 PPD for 5 years and then stopped and has not smoked since then. Is MJ a candidate for LDCT lung cancer screening?
A. Yes
B. No
B. No
She meets other criteria except for her pack year history
1 PPD x 10 years = 10 pack year history
+
2PPD x 5 years= 10 Pack year history
Total = 20 pack year history
Which of these is NOT a pareneoplastic syndrome that presents with lung cancer?
A. SIADH and Anemia
B. Hypercalcemia
C. Cancer-related chachexia
D. Hypocalcemia
E. Acanthosis Nigrans
D. Hypocalcemia
The reason why the cancer can cause Hypercalcemia is because lung cancer can secrete a protein that looks like PTH and PTH increases calcium levels in the body
___ is the most aggressive type of lung cancer
A. Small Cell Lung Cancer (SCLC)
B. Non Small Cell Lung Cancer (NSCLC)
A. Small Cell Lung Cancer (SCLC)
Which of the following is true regarding SCLC? (Select All)
A. Highly sensitive to chemotherapy and radiation
B. More aggressive than NSCLC and is faster growing
C. More associated with Paraneoplastic Sndromes
D. Not clearly correlated to smoking
E. Considered to be slower growing in comparison to NSCLC
A. Highly sensitive to chemotherapy and radiation
B. More aggressive than NSCLC and is faster growing
C. More associated with Paraneoplastic Sndromes
(Short answer)
When staging lung cancer we use TNM system. What does this stand for?
T= Tumor size
N= Nodal involvment (positive or negative)
M= Is the cancer metastatic
Which of the following is a treatment option for Limited SCLC? (Select All)
A. Surgery
B. XRT
C. Chemo
D. Hormonal Therapy
A. Surgery
B. XRT
C. Chemo
Which of the following is a treatment option for Extensive Small Cell Lung Cancer (SCLC)? (Select all)
A. Surgery
B. XRT
C. Chemo
D. Hormone therapy
B. XRT
C. Chemo
When is XRT considered in Extensive SCLC patients?
A. Intent to cure
B. Palliative intent
C. In all extensive SCLC patients
D. When cancer has spread to multiple organs
B. Palliative intent
When do we consider surgery in Limited SCLC? (Select All)
A. Small tumor size
B. T1 and T2 SCLC
C. Extensive nodal involvement
D. Metastatic SCLC
E. No nodal involvement
A. Small tumor size
B. T1 and T2 SCLC
E. No nodal involvement
What is the preferred method of treatment for Limited stage SCLC? (Select all)
A. Surgical resection
B. Chemotherapy only
C. XRT
D. Chemotherapy + XRT
A. Surgical Resection
D. Chemotherapy + XRT
AJ, a 35 yo male was recently diagnosed with SCLC and requires 1st line treatment for Limited stage SCLC. Which of the following is the 1st-line recommended treatment for AJ?
A. Carboplatin + Etoposide
B. Cisplatin + Etoposide + RT
C. Cisplatin + Rituximab
D. Carboplatin + Rituximab
B. Cisplatin + Etoposide + RT
CJ a 42 yo male was recently diagnosed with Limited Stage SCLC. Here PMH includes CKD and her currentl SCr is 1.9. Which of these treatments is a 1st-line recommendation for this patient’s Limited Stage SCLC?
A. Carboplatin + Etoposide + RT
B. Carboplatin + Cisplatin + RT
C. Cisplatin + Etoposide + RT
D. Carboplatin + Rituximab
A. Carboplatin + Etoposide + RT
Cisplatin should not be used in patients with poor renal function and SCr of 1.5 or greater.
What is considered first line treatment for patients with Extensive SCLC?
A. Chemotherapy + RT
B. Combination Chemotherapy alone
C. RT alone
D. Combination Chemotherapy + Rituximab.
B. Combination Chemotherapy alone
In comparison to Limited Stage SCLC when can Carboplatin be used in Extensive Stage SCLC?
A. Carboplatin is considered to be the first line preferred platinum agent in Limited stage SCLC but not in Extensive SCLC
B. Extensive SCLC prefers the use of Carboplatin over CIsplatin while Limited stage SCLC prefers Cisplatin over Carboplatin
C. Extensive SCLC can use either Carboplatin or Cisplatin as the preferred platinum agent while in Limited SCLC carboplatin only used if cisplatin cannot be tolerated
D. Carboplatin can be used in Extensive or Limited SCLC at any time as the preferred platinum agent over cisplatin
C. Extensive SCLC can use either Carboplatin or Cisplatin as the preferred platinum agent while in Limited SCLC carboplatin only used if cisplatin cannot be tolerated
Which of the following combination chemotherapies is possible in Extensive Stage SCLC? (Select All)
A. Cisplatin + Etoposide
B. Carboplatin + Ironotecan
C. Cisplatin + Ironotecan
D. Cisplatin + Carboplatin
E. Carboplatin + Etoposide
A. Cisplatin + Etoposide
B. Carboplatin + Ironotecan
C. Cisplatin + Ironotecan
E. Carboplatin + Etoposide
AJ is a 48 yo male who presents with Extensive Stage SCLC and requires therapy. PMH includes CKD and a SCr of 1.6. Patient has a history of NV and claims that his stomach is very “sensitive” to medications. Which of the following regimens would be a good option for this patient? (Select All)
A. Cisplatin + Etoposide
B. Carboplatin + Etoposide
C. Cisplatin + Ironotecan
D. Carboplatin + Ironotecan
B. Carboplatin + Etoposide
D. Carboplatin + Ironotecan
We would not want to choose cisplatin in this patient because cisplatin is known to have a much higher incidence of NV and should not be used in patients with renal issues.
Which of the following is a dose limiting toxicity of Cisplatin? (Select All)
A. Nausea
B. Ototoxicity
C. Vomiting
D. Hemmorhagic Cystitis
E. Renal dysfunction
A. Nausea
C. Vomiting
E. Renal dysfunction
TC is a 45 yo patient that now has recurrent SCLC and requires therapy. His last chemotherapy regimen was 11 months ago and included the medications Cisplatin + Etoposide. Which of the following chemotherapies is recommended for this patient?
A. Paclitaxel
B. Cisplatin + Ironotecan
C. Cisplatin + Etoposide
D. Carboplatin + Etoposide
C. Cisplatin + Etoposide
Since the patient did not have recurrance of SCLC until at least 6 months later he can receive his previous regimen.
TC is a 45 yo patient that now has recurrent SCLC and requires therapy. His last chemotherapy regimen was 3 months ago and included the medications Cisplatin + Etoposide. Which of the following chemotherapies could be recommended for this patient? (Select all)
A. Paclitaxel
B. Cisplatin
C. Docetaxel
D. Ironotecan
E. Ifosfamide
A. Pacliaxel
C. Docetaxel
D. Ironotecan
E. Ifosfamide
TC is a 45 yo patient that now has recurrent SCLC and requires therapy. His last chemotherapy regimen was 5 months ago and included the medications Cisplatin + Etoposide. Which of the following chemotherapies is recommended for this patient?
A. Carboplatin
B. Gemcitabine
C. Bendamustine
D. Vinorelbene
E. Oral Etoposide
B. Gemcitabine
C. Bendamustine
D. Vinorelbene
oral etoposide is an option however since teh patient was already on etoposide previously and it did not work then it may not be a good agent to give.
TC is a 45 yo patient that now has recurrent SCLC and requires therapy. His last chemotherapy regimen was 7 months ago and included the medications Cisplatin + Etoposide. Which of the following is the BEST treatment option for this patient?
A. Paclitaxel
B. Docetaxel
C. Clinical Trial enrollment
D. Temozolomide
E. Ironotecan
C. Clinical Trial Enrollment
Clinical trial is actually a preferred method of treatment for recurrent patients.
What type of prophylactic radiation is given for SCLC in general?
A. Prophylactic cranial radiation
B. Prophylactic abdominal radiation
C. Prophylactic thoracic radiation
D. Prophylactic distal radiation
A. Prophylactic cranial radiation
C. Prophylactic thoracic radiation
Prophylactic thoracic radiation is recommended in patients with:
A. Limited SCLC
B. Extensive SCLC
B. Extensive SCLC
Prophylactic cranial radiation is used in which SCLC patients?
A. Limited SCLC
B. Extensive SCLC
C. Both Limited and Extensive SCLC
D. Neither
C. Both Limited and Extensive SCLC
Which of the following statments is true regarding prophylactic cranial radiation in patients with Limited SCLC? (Select All)
A. Improves disease free survival
B. Improves overall survival
C. Can be given before adjuvant chemotherapy
D. Given after adjuvant chemotherapy
A. Improves disease free survival
B. Improves overall survival
D. Given after adjuvant chemotherapy
(Short Answer)
Why do we give prophylactic radiation in the cranial and thoracic areas of the body when treating Limited or Extensive SCLC?
SCLC is known to metastasize to the brain and liver so giving prophylactic radiation in these areas will decrease the chances of the cancer spreading to those areas. This radiation will be given after adjuvant radiation has been given.
Pts received Cis+etoposide 16 months ago for limited stage SCLC. Her cancer recurred. What treatment regimen is recommended to be used at this time?
A. Cis+Etoposide
B. Carbo+Paclitaxel
C. Carbo+Etoposide
D. Topotecan
E. Gemcitabine
A. Cis + Etoposide
When comparing Non-Small Cell Lung Cancer (NSCLC) to SCLC which of the following statements is true? (Select all)
A. SCLC has high sensitivity to chemotherapy and radiation
B. NSCLC has moderate sensitivity to chemotherapy but high sensitivity to radiation
C. NSCLC is much slower growing in comparison to SCLC
D. NSCLC has moderate sensitivity to radiation but low sensitivity to chemotherapy
E. NSCLC is not as aggressive as SCLC
A. SCLC has high sensitivity to chemotherapy and radiation
C. NSCLC is much slower growing in comparison to SCLC
D. NSCLC has moderate sensitivity to radiation but low sensitivity to chemotherapy
E. NSCLC is not as aggressive as SCLC
First line treatment for Resectable Lung Cancer in stages 1-3A include: (Select all)
A. Resection of Tumor
B. Chemotherapy only
C. Adjuvant Chemotherapy
D. Possibly Neoadjuvant Chemotherapy
A. Resection of Tumor
C. Adjuvant Chemotherapy
D. Possibly Neoadjuvant Chemotherapy
PT is a 34 yo male with Stage II Resectable NSCLC. Which of the following is a possible treatment option for this patient? (Select All)
A. Surgery + Cisplatin + Etoposide
B. Surgery+ Carboplatin + Etoposide
C. Surgery + Caroplatin + Paclitaxel
D. Surgery + Cisplatin + Vinorelbene
E. Surgery + Cisplatin + Gemcitabine
A. Surgery + Cisplatin + Etoposide
D. Surgery + Cisplatin + Vinorelbene
E. Surgery + Cisplatin + Gemcitabine
Patient CY presents with Curable Resectable NSCLC and requires treatment. Patient has renal dysfunction and a SCr of 1.7. Patient also reports recurrent idiopathic NV. Which of the following is a possible treatment for this patient?
A. Surgery + Cisplatin + Vinorelbene
B. Surgery + Cisplatin + Etoposide
C. Surgery + Cisplatin + Gemcitabine
D. Surgery + Cisplatin + Docetaxel
E. Surgery + Carboplatin + Paclitaxel
E. Surgery + Carboplatin + Paclitaxel
Carboplatin will be preferred in this patient due to his renal dysfunction, SCr of 1.7 and idiopathic NV since cisplatin is known to have a higher incidence of NV in comparison to Carboplatin
T/F
In certain instances of treating Curable Resectable NSCLC it is possible to use Concurrent Radiation/Chemotherapy
True
Patien TY presents with UnResectable stage III NSCLC and requires treatment. Which of the following is NOT considered standard of care for this patient?
A. Neoadjuvant Chemotherapy
B. Chemoradiotherapy
C. Concurrent Radiation + Cispation + Etoposide
D. Adjuvant Chemotherapy
E. Concurrent Radiation + Paclitaxel + Carboplatin
D. Adjuvant Chemotherapy
In Unresectable Lung Cancer we give neoadjuvant chemotherapy NOT adjuvant. The reason for this is because if by chance the neoadjuvant chemotherapy can reduce the size of the tumor then it may be possible to make it resectable
Patient YW presents with Metastatic NSCLC and requires treatment. Performance status: 3 and tumor reveals EGFR+. Which of the following is a possible treatment option for this patient? (Select All)
A. Crizotinib
B. Afatinib
C. Erlotinib
D. Ceritinib
E. Gefitinib
B. Afatinib
C. Erlotinib
E. Gefitinib
Patient YT presents with Metastatic NSCLC and a performance status of 1. Tumor reveals ALK+ gene. Which of the following is a possible treatment option for this patient? (Select All)
A. Crizotinib
B. Ceritinib
C. Erlotinib
D. Ceritinib
E. Pembrolizumab
A. Crizotinib
B. Ceritinib
Patient JJ presents with Metastatic NSCLC and a performance status of 4. Tumor reveals ALK+. Which of the following medications can the patient receive?
A. Crizotinib
B. Ceritinib
C. Erlotinib
D. Afatinib
E. Pembrolizumab
A. Crizotinib
if patients present with a performance status that considers them UNFIT then the only ALK+ medication they can receive is Crizotinib
Patient ZM presents with Metastatic NSCLC and a performance status of 2. Tumor reveals ROS1 mutation. Which of the following is a possible treatment for this patient?
A. Crizotinib
B. Ceritinib
C. Pembrolizumab
D. Gefitinib
E. Erlotinib
B. Ceritinib
Patient TT presents with Metastatic NSCLC and a performance status of 0. Tumor reveals PDL-1 mutation. Which of the following medications is a possible treatment for this patient?
A. Crizotinib
B. Ceritinib
C. Erlotinib
D. Pembrolizumab
E. Gefitinib
D. Pembrolizumab
Patient YW presents with Metastatic NSCLC and a peformance status of 1. Tumor reveals no mutations and is squamous. Which of the following is a potential treatment for this patient?
A. Bevacizumab + Cisplatin/Pemetrexed
B. Cisplatin/Gemcitabine
C. Cisplatin/Pemetrexed
E. Bevacizumab + Erlotinib
B. Cisplatin/ Gemcitabine
Patient TC presents with Metastatic NSCLC and a performance status of 2. Tumor reveals no mutations and is non-squamous. patient has a history of DVT and thromboembolism. Which of these is the BEST recommendation for this patient?
A. Bevacizumab + Cisplatin/Pemetrexed
B. Cisplatin/Gemcitabine
C. Cisplatin/Pemetrexed
D. Erlotinib + Cisplatin
C. Cisplatin/Pemetrexed
Possible treatment options in Non Squamous metastatic NSCLC in FIT patients include Bevacizumab + Cisplatin/Pemetrexed HOWEVER we do not use Bevacizumab in patients with a history of DVT and thromboembolism
Patient TP presents to the clinic after a few months of treatment of his Metastatic non-squamous NSCLC and presents with sypmtoms of the cancer. He was previously on the Continuous maintinence treatment. He is considered recurrent. What is the next option for this patient?
A. Recommend alternative first line treatment for his recurrent metastatic NSCLC
B. Recommend radiation therapy to affected areas of the body
C. Recommend 2nd line options
D. Repeat 1st line therapy previously used in patient.
C. Recommend 2nd line options
Patient TT acheived a response in his Metastatic NSCLC and is now being initiated on a Maintinence regimen using the continuous approach. His cancer is squamous and previous medications include Gemcitabine + Cisplatin. Of the following acceptable continuous medications which is a possible treatment for this patient? (Select All)
A. Gemcitabine
B. Bevacizumab
C. Cetuximab
D. Pemetrexed
A. Gemcitabine
C. Cetuximab
The reason you can only choose these two for this patient is because the patient is continuous AND Squamous. In the squamous regimen for treatment only Cisplatin + Gemcitabine is recommended. Bevacizumab and pemetrexed are involved in the Non-Squamous regimen and are therefore not acceptable for this patient. So the only two options left are Cetuximab and Gemcitabine.
Patient CM acheived a response in his Metastatic NSCLC and is now being initiated on a Maintinence regimen using the continuous approach. His cancer is Non-Squamous and previous medications include Bevacizumab + Cisplatin/Pemetrexed. Of the following acceptable continuous medications which is a possible treatment for this patient? (Select All)
A. Bevacizumab
B. Pemetrexed
C. Cetuximab
D. Gemcitabine
A. Bevacizumab
B. Pemetrexed
Remember that you would not use both of these in the continuous phase. We would only choose one and cancel the others.
Patient TT acheived a response in his Metastatic NSCLC and is now being initiated on a Maintenance regimen using the Switch approach. His cancer is squamous and previous medications include Gemcitabine + Cisplatin. Which of the following acceptable Switch maintenence medications is a possible treatment for this patient? (Select All)
A. Erlotinib
B. Pemetrexed
C. Docetaxel
D. Bevacizumab
E. DC all medication then close follow-up
A. Erlotinib
C. Docetaxel
E. DC all medicaiton then close follow-up
All of the following are toxicities of Bevacizumab EXCEPT:
A. Bleeding
B. HTN
C. Thromboembolism
D. Clotting
E. Renal Toxicity
E. Renal toxicity
It doesn’t make sense but for some reason this medication can actually cause both clotting and/or bleeding
What type of patient cannot receive bevacizumab?
A. Squamous
B. Adenocarcinoma
C. Large Cell carcinoma
A. Squamous
thats why we see it used in non-squamous
It can actually cause life-threatening hemoptysis in squamous patients.
Which of the following is not a side effect of Bevacizumab?
A. Increased bleeding
B. DVT
C. Wound Dehiscence
D. Endometrial Hyperplasia
E. HTN
D. Endometrial Hyperplasia
Which of the following are dose-limiting toxicities of Oxaliplatin?
A. Sensory Neuropathy
B. Myelosuppression
C. Cardiotoxicity
D. Cold-induced neuropathy
A. Sensory Neuropathy
D. Cold-Induced neuropathy
Lung cancer is the __ most leading cause of death in both males and females
A. Number 1
B. Number 2
C. Number 3
D. Number 4
B. Number 2
