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55 Cards in this Set

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How is NSCLC further classified?
Squamous cell carcinoma, adenocarcinoma, large cell carcinoma
Which type of lung cancer is most common?
NSCLC - 75%
Which type of lung cancer is more aggressive?
SCLC
Which type of lung cancer is most sensitive to chemotherapy?
SCLC
4 Main Risk Factors for Lung cancer
Smoking, Occupation, Diet, Genetics
How long does it take for a smoker to return to a baseline level of a non-smoker?
15 years
What type of occupational hazards are risk factors for lung cancer?
Asbestos, radon, chloromethyl ether, chromium, nickel, arsenic
What diet deficiencies are risk factors for lung cancer?
Vitamins A, C, E and beta carotene
Is sex a RISK factor for lung cancer?
Nein
Why are there no screening guidelines for lung cancer?
NCI trial in high-risk population did not improve overall mortality.
Clinical presentation of lung cancer
Cough, dyspnea, chest pain, hemoptysis, pneumonitis, dysphagia, wheezing, general weakness, anorexia, fever, anemia
How common are regional metastases with NSCLC?
Less common
How likely are distant metastases developing early with NSCLC?
Not very likely
How common are regional metastases with SCLC?
Common, present with hoarseness/dysphagia, pleural/pericardial effusion, evident tumor at diagnosis common
How common are distant metastases with SCLC?
Common
What systems are affected typically by SCLC distant metastases?
Lung, bones, lymph's, adrenals, brain
Bone pain is common with which form of lung cancer?
SCLC
What is the preferrential site of SCLC distant metastases?
CNS
What are some sign/symptoms of CNS effects of distant metastases of SCLC?
Headache, double vision
What typically can be the first sign of lung cancer?
Paraneoplastic syndromes
Presentation of Paraneoplastic SIADH
Hypoosmolar hyponatremia with normal renal/adrenal function.
Tx of SIADH
Water restriction and demeclocycline, but get the cancer thats causing it!
What are some Paraneoplastic Syndromes?
SIADH, Hypercalcemia, Eaton-Lambert myasthenic syndrome
What is Eaton-Lambert myasthenic syndrome?
A paraneoplastic syndrome caused by antibody production that prevent ACh release... similar to MG
How is Eaton-LAmbert myasthenic syndrome treated?
Physostigmine/AChE inhibitor
What is the method of choice for diagnosing LC?
Bronchoscopy
Describe limited SCLC
Tumor confined to 1 hemithorax and its regional lymph nodes.
Describe Extensive SCLC
Disease that extends beyond limited SCLC and has distant metastases (Bone, liver, bone marrow, CNS, lymph)
What are some factors affecting LC prognosis?
Stage, performance status, gender, age, histological subclaffication, bone marrow/liver metastases, CNS involvement, Blood biochemistry, weigh loss
Treatment of choice for Early stage NSCLC
Surgical resection
When is radiation recommended for limited NSCLC Dz?
If surgery margins are positive for Dz or for patients who refuse surgery (idiots)
When is Chemo recommended for patients with Limited NSCLC?
A Platinum based Tx is warranted whether or not the patient has had radiation if the surgical margins are positive for disease.
When is surgery used for SCLC?
RARELY
When is radiation used for SCLC?
It is used with chemo for limited stage disease, to prevent brain metastases. SHOULD BE USED WITH CHEMO.
When should prophylactic radiation occur?
Cranial irradiation should be used if CR or near CR achieved.
What is the gold standard treatment of lung cancer Chemo wise?
Bevacizumab + Paclitaxel + Carboplatin
For locally advanced disease, if the tumor is resectable, should chemo or radiation be used?
Both should be used... 2 year survival (50-70%) (NEOADJUVIDANT)
For locally advanced LC, if the tumor is unresectable should chemo or radiation be used?
Both should be used.
Which is superior for the treatment of locally advanced LC, Concurrent chemoradiation or sequential?
Concurrent
Who are candidates of the gold standard (Bevacizumab+Paclitaxel+Carboplatin?)
Non-squamous, no anticoag, no hemoptysis and blood in the fucking brain.
4 of em
For limited LC dz, typically regimens for chemo?
Etop + Cisplatin or Etop + Carobplatin
Is advanced stage disease curable?
No
Is disseminated advanced stage disease LC resectable?
No
Why is chemo used in advanced stage LC?
Improve survival to 2-4 months, improves Sx/QOL, improves time to progression.
What element is the cornerstone of chemo for LC?
Platinum based treatments
Relapsed NSCLC, Tx choices?
Erlotinib(Tarceva), Docetaxel OR Pemetrexed
When is Erlotinib/Tarceva used for LC?
Monotherapy following Tx failure.
Is there any benefit to adding Erlotinib/Tarceva to a platinum based therapy?
No
What is the benefit of erlotinib/Tarceva for NSCLC?
Improves cough, pain, dyspnea. Does not improve survival when added to chemo.
Erlotinib/Tarceva side effects
Diarrhea, skin rash, stomatitis, ocular toxicity and infection
Docetaxel, use in NSCLC
Used for relapsed disease, supportive care.
Docetaxel Toxicity
Neutropenia, neutropenic fever, diarrhea, stomatitis, neurosensory side
What factors can help predict response to second-line therapy for SCLC?
Interval between completion and relapse, extent of tumor regression achieved with induction, composition of inductionr regimen
For SCLC relapse <2-3 months, what can you use?
Ifosfamide, Paclitaxel, Docetaxel or Gemcitabine GIPD
For SCLC relapse >2-3 months, what can you use?
Topotecan, irinotecan, CAV, Gemcitabine, Paclitaxel, Docetaxel, Oral etoposide, or vinorelbine.