WISEMD Lung Cancer Flashcards
What is the most deadly type of cancer?
Lung cancer, which kills more people than breast cancer, colon cancer, rectal cancer, and prostate cancer combined
What is the problem with diagnosing lung cancer?
It is generally asymptomatic at first and is often metastatic by the time it is detected
How are primary lung cancers classified?
Small cell carcinoma vs. Non-small cell carcinoma (squamous cell carcinoma, adenocarcinoma)
What are Stage I and II cancers treated with and what is the 5 year survival rate? Stage III? Stage IV?
1) Surgery; 60-90%
2) Chemo and radiation;
How can non-small cell carcinoma be treated if it is stage I or II?
Surgery
How does small cell cancer often present?
1) Almost always systemic
2) Multifocal, often metastatic
3) Paraneoplastic syndrome
What is the mainstay treatment of small cell lung cancer? What happens over time with this treatment?
1) Chemotherapy and radiation because it is often advanced
2) Over time, small cell lung cancer becomes resistant to treatment and the outcome is poor
What are important questions to ask in taking a history of a patient with possible lung cancer?
1) Local symptoms: Cough, hemoptysis, chest pain, hoarseness, SOB
2) Symptoms of metastatic disease: lymphadenopathy, brain mets (headaches, balance or vision problems), abdominal symptoms (pain, jaundice, abdominal mass), or general weight loss
3) Cardiopulmonary functional assessment: Implications for surgical candidate, stair climbing (excellent assessment of exercise tolerance - if a patient can go up 3 flights of stairs without stopping, they can tolerate a major pulmonary resection such as pneumonectomy; a patient who can go up 1 flight of stairs without stopping may be able to tolerate a lobectomy), and rule out concomitant CV disease (angina, claudication)
4) Other risk factors: Exposure to toxins (cigarettes, radon, asbestos), infectious etiologies (TB, histoplasmosis)
5) Since most lung cancer are due to metastatic disease elsewhere in the body, you must ask the patient for screening mammography, colonoscopy, and prostate cancer
What are methods of obtaining a lung tissue biopsy?
1) Bronchoscopy
2) CT guided core biopsy
3) Endobronchial ultrasound (EBUS)
4) Endoesophageal ultrasound (EUS)
What tests are used to stage non-invasive lung cancer?
1) CT
2) PET
3) MRI
4) Bone Scan
What tests are used to stage invasive lung cancer?
1) Bronchoscopy
2) EBUS
3) EUS
4) Cervical mediastinoscopy
What are the sizes of tumors for T staging?
1) T1 7cm (Invasion of chest wall, pleura, diaphragm, or main bronchus
4) T4 - Invasion of vital structures (heart, aorta, vertebrae, carina)
What is the gold standard for mediastinal lymph node staging?
Cervical mediastinoscopy
What are some post operative complications after lung cancer removal?
1) Pneumonia/respiratory failure - Most common complication, prophylaxis with PT and pain control
2) Cardiac arrhythmia - Usually atrial, treat with medication
3) Air leaks - Usually self-limited, bronchopleural fistula (potential for infection, may require surgical repair)
4) Bleeding - Monitor chest tube output
