Lung Cancer 2006

Front 1

How is NSCLC further classified?

Back 1

Squamous cell carcinoma, adenocarcinoma, large cell carcinoma

Front 2

Which type of lung cancer is most common?

Back 2

NSCLC - 75%

Front 3

Which type of lung cancer is more aggressive?

Back 3

SCLC

Front 4

Which type of lung cancer is most sensitive to chemotherapy?

Back 4

SCLC

Front 5

4 Main Risk Factors for Lung cancer

Back 5

Smoking, Occupation, Diet, Genetics

Front 6

How long does it take for a smoker to return to a baseline level of a non-smoker?

Back 6

15 years

Front 7

What type of occupational hazards are risk factors for lung cancer?

Back 7

Asbestos, radon, chloromethyl ether, chromium, nickel, arsenic

Front 8

What diet deficiencies are risk factors for lung cancer?

Back 8

Vitamins A, C, E and beta carotene

Front 9

Is sex a RISK factor for lung cancer?

Back 9

Nein

Front 10

Why are there no screening guidelines for lung cancer?

Back 10

NCI trial in high-risk population did not improve overall mortality.

Front 11

Clinical presentation of lung cancer

Back 11

Cough, dyspnea, chest pain, hemoptysis, pneumonitis, dysphagia, wheezing, general weakness, anorexia, fever, anemia

Front 12

How common are regional metastases with NSCLC?

Back 12

Less common

Front 13

How likely are distant metastases developing early with NSCLC?

Back 13

Not very likely

Front 14

How common are regional metastases with SCLC?

Back 14

Common, present with hoarseness/dysphagia, pleural/pericardial effusion, evident tumor at diagnosis common

Front 15

How common are distant metastases with SCLC?

Back 15

Common

Front 16

What systems are affected typically by SCLC distant metastases?

Back 16

Lung, bones, lymph's, adrenals, brain

Front 17

Bone pain is common with which form of lung cancer?

Back 17

SCLC

Front 18

What is the preferrential site of SCLC distant metastases?

Back 18

CNS

Front 19

What are some sign/symptoms of CNS effects of distant metastases of SCLC?

Back 19

Headache, double vision

Front 20

What typically can be the first sign of lung cancer?

Back 20

Paraneoplastic syndromes

Front 21

Presentation of Paraneoplastic SIADH

Back 21

Hypoosmolar hyponatremia with normal renal/adrenal function.

Front 22

Tx of SIADH

Back 22

Water restriction and demeclocycline, but get the cancer thats causing it!

Front 23

What are some Paraneoplastic Syndromes?

Back 23

SIADH, Hypercalcemia, Eaton-Lambert myasthenic syndrome

Front 24

What is Eaton-Lambert myasthenic syndrome?

Back 24

A paraneoplastic syndrome caused by antibody production that prevent ACh release... similar to MG

Front 25

How is Eaton-LAmbert myasthenic syndrome treated?

Back 25

Physostigmine/AChE inhibitor

Front 26

What is the method of choice for diagnosing LC?

Back 26

Bronchoscopy

Front 27

Describe limited SCLC

Back 27

Tumor confined to 1 hemithorax and its regional lymph nodes.

Front 28

Describe Extensive SCLC

Back 28

Disease that extends beyond limited SCLC and has distant metastases (Bone, liver, bone marrow, CNS, lymph)

Front 29

What are some factors affecting LC prognosis?

Back 29

Stage, performance status, gender, age, histological subclaffication, bone marrow/liver metastases, CNS involvement, Blood biochemistry, weigh loss

Front 30

Treatment of choice for Early stage NSCLC

Back 30

Surgical resection

Front 31

When is radiation recommended for limited NSCLC Dz?

Back 31

If surgery margins are positive for Dz or for patients who refuse surgery (idiots)

Front 32

When is Chemo recommended for patients with Limited NSCLC?

Back 32

A Platinum based Tx is warranted whether or not the patient has had radiation if the surgical margins are positive for disease.

Front 33

When is surgery used for SCLC?

Back 33

RARELY

Front 34

When is radiation used for SCLC?

Back 34

It is used with chemo for limited stage disease, to prevent brain metastases. SHOULD BE USED WITH CHEMO.

Front 35

When should prophylactic radiation occur?

Back 35

Cranial irradiation should be used if CR or near CR achieved.

Front 36

What is the gold standard treatment of lung cancer Chemo wise?

Back 36

Bevacizumab + Paclitaxel + Carboplatin

Front 37

For locally advanced disease, if the tumor is resectable, should chemo or radiation be used?

Back 37

Both should be used... 2 year survival (50-70%) (NEOADJUVIDANT)

Front 38

For locally advanced LC, if the tumor is unresectable should chemo or radiation be used?

Back 38

Both should be used.

Front 39

Which is superior for the treatment of locally advanced LC, Concurrent chemoradiation or sequential?

Back 39

Concurrent

Front 40

Who are candidates of the gold standard (Bevacizumab+Paclitaxel+Carboplatin?)

Back 40

Non-squamous, no anticoag, no hemoptysis and blood in the fucking brain.

Hint 40

4 of em

Front 41

For limited LC dz, typically regimens for chemo?

Back 41

Etop + Cisplatin or Etop + Carobplatin

Front 42

Is advanced stage disease curable?

Back 42

No

Front 43

Is disseminated advanced stage disease LC resectable?

Back 43

No

Front 44

Why is chemo used in advanced stage LC?

Back 44

Improve survival to 2-4 months, improves Sx/QOL, improves time to progression.

Front 45

What element is the cornerstone of chemo for LC?

Back 45

Platinum based treatments

Front 46

Relapsed NSCLC, Tx choices?

Back 46

Erlotinib(Tarceva), Docetaxel OR Pemetrexed

Front 47

When is Erlotinib/Tarceva used for LC?

Back 47

Monotherapy following Tx failure.

Front 48

Is there any benefit to adding Erlotinib/Tarceva to a platinum based therapy?

Back 48

No

Front 49

What is the benefit of erlotinib/Tarceva for NSCLC?

Back 49

Improves cough, pain, dyspnea. Does not improve survival when added to chemo.

Front 50

Erlotinib/Tarceva side effects

Back 50

Diarrhea, skin rash, stomatitis, ocular toxicity and infection

Front 51

Docetaxel, use in NSCLC

Back 51

Used for relapsed disease, supportive care.

Front 52

Docetaxel Toxicity

Back 52

Neutropenia, neutropenic fever, diarrhea, stomatitis, neurosensory side

Front 53

What factors can help predict response to second-line therapy for SCLC?

Back 53

Interval between completion and relapse, extent of tumor regression achieved with induction, composition of inductionr regimen

Front 54

For SCLC relapse <2-3 months, what can you use?

Back 54

Ifosfamide, Paclitaxel, Docetaxel or Gemcitabine GIPD

Front 55

For SCLC relapse >2-3 months, what can you use?

Back 55

Topotecan, irinotecan, CAV, Gemcitabine, Paclitaxel, Docetaxel, Oral etoposide, or vinorelbine.