Overview Of Lung Cancer

Front 1

Number one cancer killer of men and women.

Back 1

Lung Cancer

Front 2

Number one risk factor accounting for 90% of LC cases

Back 2

smoking

Front 3

Relative risk for LC of a smoker compared to non-smoker.

Back 3

10-30X

Front 4

Smoker exposed to asbestos has ____ higher risk for LC

Back 4

59X

Front 5

Radon is a decay product found in ____. Risk factor for LC.

Back 5

soil, rock, ground water

Front 6

Risk factors for LC besides smoking:

Back 6

asbestos, radon, arsenic, ionizing radiation, halethers, PAH, nickel

history of COPD, head/neck cancer, pulmonary fibrosis

first degree relative w/ LC

Front 7

Pulmonary fibrosis is a RF for which type of LC

Back 7

adenocarcinoma

Front 8

T/F: There is a correlation between dysplastic changes in sputum and LC.

Back 8

False, only 43% of smokers w/ severe dysplasia and 11% w/ moderate dysplasia develop LC

Front 9

Progression of Precancerous Lesions

Back 9

normal -> hyperplasia -> squamous metaplasia -> dysplasia -> carcinoma in situ -> carcinoma

Front 10

T/F: LC tends to follow a stepwise progression in patients w/ COPD or previous primary LC.

Back 10

True

Front 11

T/F: LC formations tends to follow a stepwise progression.

Back 11

False, can have spontaneous remission/regression. Dysplasia does not necessarily mean LC will develop.

Front 12

Metaplasia to Dysplasia takes?

Back 12

3 to 4 years

Front 13

Severe Dysplasia to Carcinoma In Situ takes how long?

Back 13

6 months

Front 14

Carcinoma In Situ to Invasive Cancer takes how long?

Back 14

2 to 10 years

Front 15

T/F: The majority of smokers will develop LC sometime in their lives.

Back 15

False, only 16%.

Front 16

Higher sensitivity from sputum analysis of detecting cancers located where in the lung?

Back 16

central (71%) compared to periphery (49%)

Front 17

Scope put down bronchi and blue light shown to cause abnormal tissues to fluoresce.

Back 17

Autofluorscence Bronchoscopy

Front 18

Problems w/ CT screening for LC.

Back 18

Studies lack results showing screening helps people live longer.
High rate of false positives causing emotional distress, testing, and invasive surgery.

Front 19

T/F: Surgery is not an option for SmCC.

Back 19

True

Front 20

What stages of NSCLC fall under the limited category?

Back 20

Ia, Ib, IIa, IIb

Front 21

What stages of NSCLC fall under the extensive category?

Back 21

IIIa and IIIb

Front 22

What stage of NSLC falls under the metastatic category?

Back 22

IV

Front 23

Difference between T2 and T1 in the NSCLC staging?

Back 23

T2 > 3 cm, invades visceral pleura, invades a main bronchus, atelectasis
T1 < 3 cm, surrouned by lung/visceral pleura, no invasion to lobar bronchus.

Front 24

Difference between T3 and T2 in NSCLC staging?

Back 24

T3 invasion of main bronchus < 2 cm distal to carina, invasion of superior sulcus, chest wall, pericardium, mediastinal pleura; obstructive pneumonitis of ENTIRE lung
T2 invasion of main bronchus > 2 cm distal to carina, obstructive pneumonitis of hilar region

Front 25

Difference between T4 and T3 in NSLC staging?

Back 25

T4 has malignant pleural/pericardial effusion or satelitte tumor nodule w/in same tumor lobe

Front 26

The ____ the tumor is to the carina, the higher likelihodd of surgical care.

Back 26

more distal

Front 27

Atelectasis is a result of ____.

Back 27

tumor obstructing flow

Front 28

Mediastial lymph node involvement is found in over ___ of newly diagnosed LC patients.

Back 28

25%

Front 29

N0 class of NSCLC staging.

Back 29

no nodal involvement

Front 30

N1 class of NSCLC staging

Back 30

ipsilateral peribronchal and/or ipsilateral hilar and INTRApulmonary nodes (w/in the pleural surface)

Front 31

N2 class of NSCLC staging.

Back 31

ipsilateral mediastinal and/or subcarinal node (outside pleura)

Front 32

N3 class of NSCLC staging.

Back 32

contralateral mediastinal or hilar; ipsilateral or contralateral scalene or supraclavicular lymph nodes

Front 33

M0 class of NSCLC staging.

Back 33

no metastases

Front 34

M1 class of NSCLC staging.

Back 34

distant metastases present

Front 35

Median survival time of SCLC w/o treatment.

Back 35

2-4 months

Front 36

Limited SCLC stage.

Back 36

lesion in ipsilateral hemithorax w/in single radiation port (w/in area that can be tolerably radiated)

Front 37

Extensive SCLC stage.

Back 37

extends beyond radiation port (grown beyond area that can be tolerably radiated) w/ worse prognosis

Front 38

Of new presentations of LC the majority are _____.

Back 38

inoperable

Front 39

SCLC is more likely to be ____ compared to NSLC.

Back 39

extensive

Front 40

Symptoms of primary LC related to the tumor.

Back 40

cough, dyspnea, hemoptysis, vague chest discomfort

Front 41

Most common symptom of LC due to tumor?

Back 41

cough, due to post obstructive pneumonia or extrinsic compression due to lymph node enlargement

Front 42

Symtoms of LC related to intrathoracic spread.

Back 42

nerve involvement - recurrent laryngeal nerve (hoarseness), phrenic, brachial plexus, sympathetic nerve trunk
Chest wall and pleura
Vascular involvement- SVC obstruction leading to facial plethora, swollen facies, dilated neck veins, and distended superficial veins on chest
Pericardium, heart, esophagus

Front 43

Symptoms of extrathoracic spread

Back 43

bone - elevated alkaline phosphatase
liver - abnormal LFTs, jaundice
brain/SC-HA, N/V, new onset seizures, confusion, personality changes
Lymph nodes and skin

Front 44

Prognosis is poor w/ metastatic disease related signs such as?

Back 44

anorexia, weight loss, fatigue

Front 45

There are more paraneoplastic syndromes w/ SqCC or SmCC?

Back 45

SqCC

Front 46

Paraneoplastic syndromes seen w/ SqCC?

Back 46

hypertrophic pulmonary osteoarthropathy
hyper calcemia secondary to PTH-related protein -> mental status changes

Front 47

Paraneoplastic sydromes seen w/ SmCC?

Back 47

Lambert-Eaton myasthenic syndrome
Hyponatremia due to ADH secretion by SmCC

Front 48

Get stronger w/ repetitive exercise, associated w/ SmCC.

Back 48

Lambert Eaton myasthenic syndrome

Front 49

NSCLC tools for diagnosis.

Back 49

Transbronchial Biopsy
Endobronchial Biopsy
Transbronchial needle aspiration
Transthoracic needle aspiration
Endoscopic Ultrasound needle aspiration
Mediastinoscopy

Front 50

Fluoroscopy guided, used for peripheral lesions, small risk for pneumothorax.

Back 50

Transbronchial Biopsy

Front 51

Direct visualization of lesion in airway.

Back 51

Endobronchial Biopsy

Front 52

Blind biopsy, however allows for quick processing

Back 52

Transbronchial needle aspiration

Front 53

Good for pleural based and distal peripheral lesions. Higher rate of pneumothorax.

Back 53

Transthoracic needle aspiration

Front 54

Through the esophagus or endobronchially, better resolution w/ increased ability to characterize lymph nodes. Can access a greater number of LN stations.

Back 54

Endoscopic Ultrasound Needle aspiration

Front 55

Superficial incision w/ blind dissection anterior to trachea to access peritracheal LN stations.

Back 55

Mediastinoscopy

Front 56

Noninvasive tools for staging of NSCLC

Back 56

CT, PET (metabolic activity), Endoscopic Ultrasound, MRI (useful or superior sulcal tumors),

Front 57

What is the disadvantage of CT compared to PET or EUS?

Back 57

CT can miss smaller nodal involvement

Front 58

Limited NSCLC treatment

Back 58

surgery

Front 59

Extensive NSCLC treatment

Back 59

chemo +/- radiation

Front 60

Metastatic tumor treatment

Back 60

palliative care - serial thoracocenteis, pleurodesis, stents to open airway

Front 61

Add talc powder to obliterate space btwn pleurae

Back 61

pleurodesis

Front 62

Karnofsky performance scale

Back 62

Best is 100, worst is 0

Front 63

ECOG performance scale

Back 63

0 is good, 4 is bad

Front 64

Inhibition of ___ and ___ pathways is being researched to stop downstream effects of proliferation, differentiation, and angiogenesis.

Back 64

EGFR, tyrosine kinase

Front 65

SCLC treatment

Back 65

platinum based chemo

Front 66

Patients in SCLC remission are offered ____ b/c ____.

Back 66

prophylactic cranial irradiation, SCLC's tendency for metastases to the brain

Front 67

T/F: Surgery has no role in SCLC except in early stages.

Back 67

True