Neoplasm Flashcards
NSCLC Stage 1 treatment
Surgery or if inoperable SBRT
> 1a -> post op targeted therapy if +EGFR
OR
if EGFR- neoadjuvant chemo then surgery
NSCLC Stage 2 treatment
Surgery with
adjuvant chemo
OR
EGFR+/ALK+ then targeted therapy
OR
If EGFR/ALK neg then neoadjuvant chemo + immunotherapy then surgery
NSCLC Stage 3 Treatment
Chemo + radiation + adjuvant immunotherapy or targeted therapy
If EGFR+ then adjuvant osimertinib
Or
High PDL1–> immunotherapy
Or
if EGFR neg then neoadj chemo, immuno then surgeryN
NSCLC Stage 4 or recurrent
Chemo
Targeted therapy (EGFR- erlotinib, ALK alectinib)
Immunotherapy
Supportive Care
Treatment for Pancoast tumor
Induction chemoradiotherapy
- if resectable better if chemo/rad pre op
- If not or N2 then concurrent chem/rad
NSCLC surveillance
CT every 6mo for 2 years
THEN yearly until 5 years
(if eligible for LDCT then yearly)
Treatment for Extensive Small cell
Cisplatin + VP-16 (epoposide)
OR carboplatin + VP-16 (less toxic)
OR cisplatin + irinotecan
2 cycles for induction then:
- 2-4 more for consolidaation
- No benefit to >6 cycles
Can add immunotherapy
NO XRT survival benefit but can be palliative
Treatment for limited small cell
XRT + treatment for extensive
Endobronchial lesion with t(11;19)(q21;p13) chromosomal translocation
Mucoepidermoid salivary gland type carcinoma
Presentation and testing of hypertrophic ostoarthropathy (HOA)
Mass in lung
pain and swelling over long bones
99mTc bone scan
Which diseases cause hypertrophic osteoarthropathy?
Non-small cell lung cancer
(Mesothelioma and benign fibrous tumors of pleura)
pulmonary fibrosis and bronchiectasis, cyanotic CHF, GI tumors, cirrhosis and IBD
Lung cancer with hypercalcemia
Squamous cell carcinoma
PTHrp
When to get mediastinal lymph node sampling ?
If considering resection with curative intent with metastatic dz to only one organ – need to make sure there is not additional spread
Additional testing needed to determine treatment for non-small cell lung cancer
molecular characterization (need enough tissue so likely EBUS)
Genetic alterations- Next gen sequencing
PDL-1 expression (core biopsy)
What value of FEV1 and DLCO would not require additional work up prior to lung resection?
> = 80%
if less then need to get predicted postop (PPO) lung function data
How to assess contribution of lung region to function?
Lung perfusion scintigraphy – pneumonectomy
Segment counting – better for lobectomy (use CT)
How to calculated PPO lung function using perfusion scintigraphy?
PPO FEV1 = preoperative FEV1 x (1 – fraction of total perfusion in the resected lung measured on radionuclide perfusion)
same for DLCO
How to calculate PPO lung function with segment counting?
PPO FEV1 = preoperative FEV1 x (1 – a/b) where “a” is the number of segments to be resected and “b” is the total number of unobstructed segments (total number of segments is 19 [typically 10 on the right and 9 on the left])
Which patients need more work up based on PPO FEV1 and/or DLCO?
<60%
Postoperative predicted FEV1 or DLCO <60 percent but both ≥30 percent, next steps?
need to get stair climb (<22m need CPET) or shuttle walk test (<400 m need CPET)
Postoperative predicted FEV1 and DLCO <30 percent, next steps?
CPET to measure VO2max
lung resection risk based on CPET results
> 20 ml/kg/min (>75% predicted) - low risk
10-20 – moderate risk.
<10 (<35% predicted) – high risk
fibrolymphoplasmacytic infiltrate on path suggestive of …
inflammatory myofibroblastic tumor (IMT)
anaplastic lymphoma kinase translocations associated with what mass
inflammatory myofibroblastic tumor
somatostatin receptors associated with what lung lesion
Carcinoid
Recommended surveillance of NSCLC treated with curative intent
6 mo after completion of therapy and every 6mo for first 2 years then yearly though 5 years
How to tell if two nodules are same cancer or two primary cancers?
Need histological genomic testing.
Features suggestive of separate tumors:
- different appearance on imaging
- different behavior
- absence of regional spread
- presence of different molecular biomarkers
Multiple lung nodules from same cancer staging if in same lobe
T3
Multiple lung nodules from same cancer staging if in different lobes of same lung
T4
Multiple lung nodules from same cancer staging if in different lungs
M1a
