Neoplasms 2

Question 1

A tissue biopsy is needed for dx of lung cancer.

What are the 3 methods?

Answer 1

• Bronchoscopy w/ fluoroscopy
• CT guided transthoracic needle biopsy
• Thoracotomy

Question 2

What is completed as a pre-op assessment?

Answer 2

Spirometry

Question 3

What are the 4 things you need to know when treating lung cancer?

Answer 3

• Whether it is Non-small or Small
• Stage
• Pts performance status
• Resectability / operability

Question 4

What is the tx for Non-small cell lung cancer in the early stage?

Answer 4

• Pulmonary resection w/ complete MLN evaluation
• Chemotherapy (consult thoracic oncologist)

Question 5

What is the tx for Non-surgical candidates with Non-small cell lung cancer?

Answer 5

• Definitive chemo
• Stereotactic body radiation (single high dose radiation therapy)

Question 6

What % of lung cancers for Small Cell Lung Cancers are limited?

(disease is limited to the unilateral hemithorax including contralateral mediastinal lobes)

Answer 6

30%

Question 7

What % of lung cancers for Small Cell Lung Cancers are extensive?

(tumor extends beyond the hemithorax including pleural effusion)

Answer 7

70%

Question 8

Tx for limited Small Cell Lung Cancer

Answer 8

Chemo & Radiation

Question 9

Tx for extensive Small Cell Lung Cancer

Answer 9

Chemo along as initial tx

Question 10

Which lung cancer has the worst prognosis?

Answer 10

Extensive Small Cell Lung Cancer

Question 11

Post tx surveillance of lung cancers

• A majority of recurrences are at proximal or distal sites?
• How often should pt have H&P and Chest CT?

Answer 11

• Distant sites
• Every 6 months for 2 years and annually thereafter for up to 5 years.

Question 12

• A patient is considered a survivor of cancer if they have not had the diseaes for how many years?
• Past that point, there are no definitive guidelines on continued imaging.
• If any imaging, pt will get what after this amount of time?

Answer 12

• 5 years
• Low dose CT at follow up

Question 13

What is a common “post treatment” complication that you should watch out for in patients w/ lung cancer?

Answer 13

Psychiatric issues

(more common in lung cancer pts than others, bc most of the time they feel blamed for getting cancer from smoking)

Question 14

Pendunculated or sessile growths in central bronchi

Answer 14

Bronchial carcinoid (neuroendocrine) tumors

Question 15

• Bronchial Carcinoid Tumors are derived from what cells?
• Common in what age?
• Male or female predominance?

Answer 15

• Neuroendocrine cells
• Less than 60 yrs
• Equal male : female

Question 16

Which cancer?

• Hemoptysis
• Cough
• Focal wheezing
• Recurrent PNA
• Peripherally located asymptomatic SPNs

Answer 16

Bronchial Carcinoid Tumors

Question 17

Bronchial Carcinoid Tumors

• Fast or slow growing?
• Where do they metastasize to?

Answer 17

• Slow
• GI system. BUT, they rarely metastasize

Question 18

What are 4 common sxs of Carcinoid Syndrome?

Answer 18

• Flushing
• Diarrhea
• Wheezing
• Hypotension

Question 19

What imaging would you order to see if a Bronchial Carcinoid Tumor is central or peripheral?

Answer 19

CXR

Central: Pneumonitis, atelectasis, bronchiectasis, collapse

Peripheral: solitary pulmonary nodule (slightly lobulated)

Question 20

What imaging would you order for Bronchial Carcinoid Tumors to:

• evaluate for endobronchial lesions and metastasis?

Answer 20

CT

Question 21

What imaging would you order for Bronchial Carcinoid Tumors to localize the tumor?

Answer 21

Octreotide Scintigraphy

Question 22

Which cancer is most resistant to radiation and chemo?

Answer 22

Bronchial carcinoid tumors

Question 23

Bronchial Carcinoid Tumors

• Diagnosis is done by:
• Tx is?
• Prognosis?

Answer 23

• Biopsy
• Surgical excision w/ mediastinal lymph node sampling or dissection
• Excellent prognosis after resection

Question 24

Where does the primary tumor of Mesothelioma arise from?

Answer 24

Surface lining of pleura (80%)

Question 25

* If Mesothelioma is diffuse it is \_\_\_\_. * If Mesothelioma is localized it is \_\_\_\_. * Is diffuse or localized more common?

Answer 25

* **Diffuse:** Malignant * **Localized:** Benign * Diffuse (75%)

Question 26

* Mesothelioma is linked to _____ exposure (60 - 80% of pts w/ this report exposure) * Is Mesothelioma more common in men or women?

Answer 26

* **Asbestos** (smoking + asbestos increases chance of getting Mesothelioma by a ton) * **Men** \> Women 3:1

Question 27

Shipyard work Textiles Paints Mining

Answer 27

MESOTHELIOMA

Question 28

**Mesothelioma** * Latent period is ____ years * Median age of onset is __ - __ yrs old

Answer 28

* 20-40 latent period till sxs onset from time of exposure * 72-74 yrs

Question 29

What is needed to dx Mesothelioma?

Answer 29

VATS biopsy

Question 30

Tx of Mesothelioma?

Answer 30

CHEMO!

Question 31

Prognosis of Mesothelioma?

Answer 31

**not great.** * Resp failure * complications of local extension * Median survival from dx is only 7 to 17 months * Fiver yr survival is only 10%

Question 32

**lung cancers in general** * Usually disant or localized? * What are % of each?

Answer 32

* Distant 57% * Localized 16% (5 yr survival rate is higher w/ localized cancers bc they have lower stage)

Question 33

* What decreases lung cancer deaths by 20% in high risk subjects? * What is a grade B recommendation by USPSTF?

Answer 33

* Screening w/ low dose helical CT * Screening w/ low dose CT

Question 34

**USPSTF lung cancer screening recommendations** * Ages __ - \_\_\_ * Current smokers who quit within the past ___ years w/ a ___ pack-year hx or greater * Annual low dose CT screening for at least __ years ( a grade __ recommendation)

Answer 34

* 55-89 * quit past 15 yrs * 30 pack yr hx or greater * at least 3 years * grade B

Question 35

LDCT or CXR screening better at reducing mortality from lung cancer?

Answer 35

LDCT