Onco - Lung ppt Flashcards
true about lung cancer EXCEPT
a. lung cancer is most common cause of cancer death
b. lung cancer is common in young adults, above 20 years
c. the projected lifetime probability of developing lung cancer is 8% among males, and 6% among females
d. NOTA
B; uncommon below age 40, rates increase until age 80; rate tapers off
Projected lifetime probability of developing lung cancer is estimated to be __ among males, and ___ among females
8% and 6% respectively
cigarette smokes have increased risk of developing lung cancer compared to those who have never smoked by how much?
10-fold
one genetic mutation is induced per this number of cigarettes smoked?
15
Former smokers have an increased risk of developing lunch cancer compared to never smokers?
nine-fold
the following statement/s are true
a. Smoking cessation does not reduce the risk of developing lung cancer compared to current smokers
b. Smoking cessation reduce the risk of cancer compared to those who don’t quit and the size of risk reduction is independent with the length of time the person has quit smoking
c. Environmental tobacco smoke and second hand smoking have the same risk of developing lung cancer as active smokers.
d. Exposure to asbestos, aresenic, bischloromethyl ether, hexavalent chromium, mustard gas, nickel and polycyclic aromatic carbons can cause lung cancer.
D
a and b. smoking cessation reduce the risk of developing lung CA and the longer a person has quit, the greater the risk reduction is.
c. Environmental tobacco smoke and second hand smoking has less risk for developing lung CA.
Certain genetic polymorphisms of the ____ enzyme system, specifically ____ and chromosome fragility are associated with the development of lung cancer
P450
CYP1A1
First degree relatives of lung cancer probands have a __ to ___ fold excess risk of lung cancer and other cancers, many of which are not smoking related
two to three
inherited mutations in these genes may develop lung cancer
RB
p53
Rare germline mutation involvng epidermal growth receptor linked to lung cancer susceptibility in never smokers
T790M
A susceptibility locus on this chromosome greatly increases risk of lung cancer among light and never smokers
chromosome6q
4 major cell types of lung cancers (WHO classification)
small cell lung cancer
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
cancer cell type related to heavy tobacco use
l
small cell lung CA
squamous cell carcinoma
packyears to be considered light smoker
<10pack-year history
most common cell type of lung cancer in <10packyear hx, women, <60y.o.
adenocarcinoma
the following statements are true EXCEPT
a. the distinction between squamous and nonsquamous lung cancer is not critical to optimal therapeutic decision
b. daiagnosis of non-small cell carcinoma not otherwise sepcified is no longer considered acceptable
c. TTF-1 or Napsin A are adenocarcinoma immunohistochemistry marker
d. p40 or p63 are squamous markers
A
Four categories for classifying predominant pattern of lung cancer
lepidic predominant
acinar and papillary
solid-predominant
micropapillary
adenocarcinoma markers
a. p40
b. p53
c. p63
d. TTF-1
D
adenocarcinoma markers
a. p40
b. p53
c. RB
d. napsin-A
D
give 2 sqamous markers
p40 and p63
favorable prognosis
a. lepidic
b. acinar
c. papillary
d. solid-predominant
e. micropapillary
(if answer is more than one, give both letters)
A
poor prognosis
a. lepidic
b. acinar
c. papillary
d. solid-predominant
e. micropapillary
(if answer is more than one, give both letters)
D and E
intermediate prognosis favorable prognosis a. lepidic b. acinar c. papillary d. solid-predominant e. micropapillary
(if answer is more than one, give both letters)
B and C
types of squamous cell carcinoma (3)
keratinizing
nonkeratinizing
basaloid
markers to verify neuroendocrine differentiation within a tumor (6)
neuron specific enolase (NSE) CD56 NCAM Synaptophysin chromogranin Leu7
________ is identified in tumors of thyroid and pulmonary origin, is positive in over 70% of pulmonary adenocarcinomas and is a reliable indicator of primary lung cancer, provided a thyroid primary has been excluded.
TTF-1
______ is an aspartic protease that plays an important role in maturation of surfactant B7 and is expressed in cytoplam of type II pneumocytes
Napsin-A
Nap A positive, TTF-1 positive
a. primary lung adenocarcinoma
b. primary lung squamous cell carcinoma
c. primary SCLC
A
Nap A negative TTF-1 positive
a. primary lung adenocarcinoma
b. primary lung squamous cell carcinoma
c. primary SCLC
C
Nap A negative TTF-1 negative
a. primary lung adenocarcinoma
b. primary lung squamous cell carcinoma
c. primary SCLC
B
CK7 negative CK20 negative
a. nonsquamous NSCLC
b. SCLC
c. mesothelioma
d. squamous cell ca
D; the others are CK7 positive, CK20 negative
useful marker for detection of NSCLCs with sqamous differentiation when used in cytologic pulmonary samples
a. p63
b. ROS1
c. KRAS
d. ALK
A
Several markers in the last few years have proven to be more helpful including ____, _____, _____, ` all of which show positivity in mesothelioma.
CK5/6
calretinin
Wilms tumor gene-1
True of MYC
a. one of the earliest sets of oncogenes found to be aberrant
b. most frequently activated via gene point mutation or transcriptional dysregulation in both SCLC and NSCLC
c. Nearly 90% of SCLC harbor mutations in TP63 and RB1
d. AOTA
A
b. amplification instead of point mutation; TP53 instead of TP63
Most common driver mutations in lung carcinoma
KRAS, but most cases are unkown
True about early detection and screening EXCEPT
a. in lung cancer, clinical outcome is related to the stage at diagnosis
b. low dose non contrast, thin slice spiral chest CT has emerged as an effective tool to screen for lung cancer.
c. a patient 45 year old, with history of 25 packyear history of cigarette smoking is a high risk patient
d. former smokers must have quit within the previous 15 years
C; high risk individuals: between 55-74 years, >=30 packyear hx
Describe the prototypical lung CA patient
current or former smoker, either sex, usually in the 7th decade of life
Patient with chronic cough, without hemoptysis, 10 packyears, quit 15 years ago, 60 y.o. with COPD, the ff statements are true
a. should prompt a thorough investigation for lung cancer
b. if CXR is normal, no further tests needed
c. both
d. neither
A; hx of chronic cough with or without hemoptysis in a current or former smoker with COPD age 40 years or older should prompt a thorough investigation for lung cancer even in the face of a normal CXR
A persistent pneumonia without constitutional symptoms merits a thorouguh investigation for underlying course if…
unresponsive to repeated courses of antibiotics
lung cancer arising in a lifetime never smoker is more common in ____ and ____
women and East Asians, younger than their smoking counterparts
_______ is required to confirm a diagnosis in all patients with suspected lung cancer
Tissue sampling
Given greater emphasis placed on molecular testing for NSCLC patients, a ______ is preferred to ensure adequate tissue for analysis
core biopsy
Tumor tissue maybe obtained via minimally invasive techniques such as (6)
bronchial biopsy transbronchial biopsy fiberoptic bronchoscopy FNA percutaneous biopsy EBUS guided biopsy
biopsy is done in patients with
clinically palpable disease such as lymph node or skin metastasis
Percutaneous biopsy is done in patients with suspected metastatic disease. Samples can be taken from
soft tissue mass lytic bone lesion bone marrow pleural lesion liver lesion adequate cell block obtained from a malignant pleural effusion
True of lung cancer staging except
a. lung cancer staging includes determination of location of tumor and metastatic sites and assessment of a patient’s ability to withstand various antitumor treatments
b. most significant dividing line is between those patients who are candidates for surgical resection and those who are inoperable but will benefit from chemotherapy, radiation therapy, or both.
c. both
d. neither
C
give 4 contraindications ot potential curative resection in NSCLC
extrathoracic metastases
superior vena cava syndrome
vocal cord and, in most cases, phrenic nerve paralysis
malignant pleural effusion
cardiac tamponade
tumor within 2 cm of the carina
metastases to the contralateral lung
metastases to supraclavicular lymph nodes
contralateral mediastinal node metastases
involvement of the main pulmonary artery
1s FEV1 of greater than __ L or greater than ___% of predicted can tolerate a pneumonectomy
2L
80%
FEV1 greater than ___ L have adequate reserve for lobectomy
1.5L
VO2 max of ___ mL/kg. min predicts for a higher risk of postoperative complications
<15
in patients with myocardial infarction within the past 3 months is a contraindication to thoracic surgery. What percent of patients will die of reinfarction?
20%
major contraindications for surgery include the ff EXCEPT
a. uncontrolled arrhythmia
b. FEV1 of less than 1L
c. Co2 retention
d. severe pulmonary hypertension
e. resting PCO2 >35mmHg
f. DLCO <40%
E; >45mmHg
true for treatment of lung cancer metastatic disease
a. platinum based chemotherapy for maintenance
b. premetrexed for squamous
c. gemcitabine for nonsquamous
d. AOTA
e. NOTA
A
gemcitabine for squamous
premetrexed for nonsquamous
True of targeted therapy EXCEPT
a. EGFR mutations have been detected in 10-20% of NOrth American patients diagnosed with NSCLC
b. EGFR mutations are associated with younger age
c. EGFR mutations associatied with <10 pack year and nonsmokers
d. EGFR mutations associated with adenocarcinoma
A; 10-15%
Exon deletions associated with EGFR
exon 21
exon 19
L8583
FDA approved oral small molecule TKIs that inhibit EGFR
erlotinib
gefitinib
afatinib
Disease progression occurs usually around how many months?
12months
Approximately what percentage of patients harbor a second site mutation?
50%
T790M mutation occur within exon ___
exon 20
Third gen mutant selective EGFR TKI specific for T790M
Osimertinib
Similar to EGFR, ___ rearrangements are typically but not exclusively associated with younger age, light <10packyear and nonsmokers, and adenocarcinoma histology
ALK
