Neoplasms 2 Flashcards
A tissue biopsy is needed for dx of lung cancer.
What are the 3 methods?
- Bronchoscopy w/ fluoroscopy
- CT guided transthoracic needle biopsy
- Thoracotomy
What is completed as a pre-op assessment?
Spirometry
What are the 4 things you need to know when treating lung cancer?
- Whether it is Non-small or Small
- Stage
- Pts performance status
- Resectability / operability
What is the tx for Non-small cell lung cancer in the early stage?
- Pulmonary resection w/ complete MLN evaluation
- Chemotherapy (consult thoracic oncologist)
What is the tx for Non-surgical candidates with Non-small cell lung cancer?
- Definitive chemo
- Stereotactic body radiation (single high dose radiation therapy)
What % of lung cancers for Small Cell Lung Cancers are limited?
(disease is limited to the unilateral hemithorax including contralateral mediastinal lobes)
30%
What % of lung cancers for Small Cell Lung Cancers are extensive?
(tumor extends beyond the hemithorax including pleural effusion)
70%
Tx for limited Small Cell Lung Cancer
Chemo & Radiation
Tx for extensive Small Cell Lung Cancer
Chemo along as initial tx
Which lung cancer has the worst prognosis?
Extensive Small Cell Lung Cancer
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?
- Distant sites
- Every 6 months for 2 years and annually thereafter for up to 5 years.
- 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?
- 5 years
- Low dose CT at follow up
What is a common “post treatment” complication that you should watch out for in patients w/ lung cancer?
Psychiatric issues
(more common in lung cancer pts than others, bc most of the time they feel blamed for getting cancer from smoking)
Pendunculated or sessile growths in central bronchi
Bronchial carcinoid (neuroendocrine) tumors
- Bronchial Carcinoid Tumors are derived from what cells?
- Common in what age?
- Male or female predominance?
- Neuroendocrine cells
- Less than 60 yrs
- Equal male : female
Which cancer?
- Hemoptysis
- Cough
- Focal wheezing
- Recurrent PNA
- Peripherally located asymptomatic SPNs
Bronchial Carcinoid Tumors
Bronchial Carcinoid Tumors
- Fast or slow growing?
- Where do they metastasize to?
- Slow
- GI system. BUT, they rarely metastasize
What are 4 common sxs of Carcinoid Syndrome?
- Flushing
- Diarrhea
- Wheezing
- Hypotension
What imaging would you order to see if a Bronchial Carcinoid Tumor is central or peripheral?
CXR
Central: Pneumonitis, atelectasis, bronchiectasis, collapse
Peripheral: solitary pulmonary nodule (slightly lobulated)
What imaging would you order for Bronchial Carcinoid Tumors to:
- evaluate for endobronchial lesions and metastasis?
CT
What imaging would you order for Bronchial Carcinoid Tumors to localize the tumor?
Octreotide Scintigraphy
Which cancer is most resistant to radiation and chemo?
Bronchial carcinoid tumors
Bronchial Carcinoid Tumors
- Diagnosis is done by:
- Tx is?
- Prognosis?
- Biopsy
- Surgical excision w/ mediastinal lymph node sampling or dissection
- Excellent prognosis after resection
Where does the primary tumor of Mesothelioma arise from?
Surface lining of pleura (80%)
- If Mesothelioma is diffuse it is ____.
- If Mesothelioma is localized it is ____.
- Is diffuse or localized more common?
- Diffuse: Malignant
- Localized: Benign
- Diffuse (75%)
- Mesothelioma is linked to _____ exposure
(60 - 80% of pts w/ this report exposure)
- Is Mesothelioma more common in men or women?
- Asbestos (smoking + asbestos increases chance of getting Mesothelioma by a ton)
- Men > Women 3:1
Shipyard work
Textiles
Paints
Mining
MESOTHELIOMA
Mesothelioma
- Latent period is ____ years
- Median age of onset is __ - __ yrs old
- 20-40 latent period till sxs onset from time of exposure
- 72-74 yrs
What is needed to dx Mesothelioma?
VATS biopsy
Tx of Mesothelioma?
CHEMO!
Prognosis of Mesothelioma?
not great.
- Resp failure
- complications of local extension
- Median survival from dx is only 7 to 17 months
- Fiver yr survival is only 10%
lung cancers in general
- Usually disant or localized?
- What are % of each?
- Distant 57%
- Localized 16%
(5 yr survival rate is higher w/ localized cancers bc they have lower stage)
- What decreases lung cancer deaths by 20% in high risk subjects?
- What is a grade B recommendation by USPSTF?
- Screening w/ low dose helical CT
- Screening w/ low dose CT
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)
- 55-89
- quit past 15 yrs
- 30 pack yr hx or greater
- at least 3 years
- grade B
LDCT or CXR screening better at reducing mortality from lung cancer?
LDCT
