Lung Carcinoma Flashcards
Early stage (local) disease survival at 5 years
80%
Late stage (distant metastasis) survival at 5 years
Median survival time of patients w/ late stage disease
1 year
Top three cancers for number of new cases per year: men
- prostate:26%
- lung/bronchus: 14 %
- colon/rectum: 8%
Top three cancers for new cases per year: women
- breast: 29%
- lung/bronchus: 13%
- colon/rectum: 8%
Top three cancers for annual deaths: men
- lung/bronchus: 28%
- prostate: 9%
- colon/rectum: 8%
Top three cancers for annual deaths: women
- lung/bronchus: 26%
- breast: 15%
- colon/rectum: 9%
Number of deaths per year from lung cancer
~155,000
Where would lung cancer rank among leading causes of death in the US
3, behind heart disease and other cancers
US lung cancer screen recommendations: age, smoking history, modality
- age: 55-74
- tobacco 33 pack years
- actively smoking or quit w/ in 15 years
- modality: low-dose CT chest
Why is there an age limit on screening recommendations
- with increasing age comes decreasing chance that the lung cancer, if it were to be found, would be treatable
Risk factors for lung cancer
- increasing age, tobacco, radon, occupational, genetic
- men more at risk than women
Tobacco and risk of lung cancer
- both primary, active, and secondary are related to lung cancer
- more you smoke the greater the risk
- appears as though any amount of smoking leads to increased risk
Occupational risk factors for lung cancer: metals
- indoor combustion cook stoves (coal): affects women
- asbestos
- metals: chromium, nickel, zinc, cadmium
- miners, pipe-fitters, welders, metal fabrication
Genetic risk of lung cancer
- 1.51 fold increase in risk after adjustment for smoking in first degree relatives
Women more likely to get what type of lung cancer
adenocarcinoma
Difference b/w smoking and non-smoking lung cancer
- smoking lung cancer more likely squamous cell carcinoma
- non smoking lung cancer more likely adenocarcinoma
Thoracic symptoms of lung cancer
- cough, dyspnea, chest pain, hemoptysis, voice changes, dysphagia
Extra-thoracic symptoms of lung cancer
- bone pain (back pain), headache, seizures, neurologic deficits, abdominal swelling, shoulder pain
Common sites of lung cancer metastasis
- bone, brain, adrenal glands, liver, pleura
Systemic symptoms of lung cancer (paraneoplastic symptoms)
- anorexia, weight loss, clubbing of nails
Most popular staging at diagnosis & survival rate
> 50% are distant: which has the worst 5 year survival rate (~5%)
Systems focused on when doing a physical exam of patient w/ suspected lung cancer
- weight & weight history
- pulmonary, heart/vascular, lymph nodes, neurologic
Lab tests for patients w/ suspected lung cancer & what they indicate
- blood count, electrolytes, liver function, serum proteins
- indicate nutritional status, metastatic disease
Radiographs for patient w/ suspected lung cancer and their importance
- CT chest w/ contrast: categorize primary lesion & lymph nodes
- positron emission tomography (PET): search for metastasis (staging)
Functional status assessment for patients with lung cancer & purpose
- assess ability of patient to withstand and benefit from treatment
- rate global functional status
- measure pulmonary functional status
Pulmonary functional status assessment tests
- exercise capacity formal: measure VO2
- exercise capacity informal: walk 2 flights of stairs
- measure total lung capacity: FVC, FEV1
Global functional status assessment test & meaning
- Karnofsky Scale
- 0-100: with 100 being best
- high number means can use treatment
- lower number means palliative care
Diagnosing lung cancer
- all suspected lung cancers require biopsy for confirmation of diagnosis
Types of biopsy used in lung cancer
- CT-guided FNA
- ultrasound tip bronchoscope
- thoracentesis
Thoracentesis use in lung cancer
- used for pleural effusion
- fluid can be examined for malignant cells
- malignant pleural effusion is assigned M1 status in TNM system, which translates into Stage IV*
Surgical options for removal of lung masses
- wedge resection
- segmentectomy
- lobectomy
- pneumonectomy
TMN staging general meaning
- T factor: size based; tells you if you can get it out w/ surgery (T1-T4)
- N factor: lymph node involvement; ipsilateral, mediastinum, contralateral (N0-N3)
- M factor: metastasis; yes or no (M0 & M1)
Stage IV & TMN stagin
Stage IV = and T, any N, with M1
Treatment-Stage approach
- early stage (no metastasis): surgery
- advance stage (limited to chest): chemo + radiation w/ curative intent
- advanced stage w/ metastasis: palliative care (may include chemo & radiation)
Role of palliative care in lung cancer
- for patients with distant disease, focusing on early palliative care improves both survival and quality of life
Overall survival of patients diagnosed with lung cancer at 5 years
14%
