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67 Cards in this Set

  • Front
  • Back
Number one cancer killer of men and women.
Lung Cancer
Number one risk factor accounting for 90% of LC cases
Relative risk for LC of a smoker compared to non-smoker.
Smoker exposed to asbestos has ____ higher risk for LC
Radon is a decay product found in ____. Risk factor for LC.
soil, rock, ground water
Risk factors for LC besides smoking:
asbestos, radon, arsenic, ionizing radiation, halethers, PAH, nickel

history of COPD, head/neck cancer, pulmonary fibrosis

first degree relative w/ LC
Pulmonary fibrosis is a RF for which type of LC
T/F: There is a correlation between dysplastic changes in sputum and LC.
False, only 43% of smokers w/ severe dysplasia and 11% w/ moderate dysplasia develop LC
Progression of Precancerous Lesions
normal -> hyperplasia -> squamous metaplasia -> dysplasia -> carcinoma in situ -> carcinoma
T/F: LC tends to follow a stepwise progression in patients w/ COPD or previous primary LC.
T/F: LC formations tends to follow a stepwise progression.
False, can have spontaneous remission/regression. Dysplasia does not necessarily mean LC will develop.
Metaplasia to Dysplasia takes?
3 to 4 years
Severe Dysplasia to Carcinoma In Situ takes how long?
6 months
Carcinoma In Situ to Invasive Cancer takes how long?
2 to 10 years
T/F: The majority of smokers will develop LC sometime in their lives.
False, only 16%.
Higher sensitivity from sputum analysis of detecting cancers located where in the lung?
central (71%) compared to periphery (49%)
Scope put down bronchi and blue light shown to cause abnormal tissues to fluoresce.
Autofluorscence Bronchoscopy
Problems w/ CT screening for LC.
Studies lack results showing screening helps people live longer.
High rate of false positives causing emotional distress, testing, and invasive surgery.
T/F: Surgery is not an option for SmCC.
What stages of NSCLC fall under the limited category?
Ia, Ib, IIa, IIb
What stages of NSCLC fall under the extensive category?
IIIa and IIIb
What stage of NSLC falls under the metastatic category?
Difference between T2 and T1 in the NSCLC staging?
T2 > 3 cm, invades visceral pleura, invades a main bronchus, atelectasis
T1 < 3 cm, surrouned by lung/visceral pleura, no invasion to lobar bronchus.
Difference between T3 and T2 in NSCLC staging?
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
Difference between T4 and T3 in NSLC staging?
T4 has malignant pleural/pericardial effusion or satelitte tumor nodule w/in same tumor lobe
The ____ the tumor is to the carina, the higher likelihodd of surgical care.
more distal
Atelectasis is a result of ____.
tumor obstructing flow
Mediastial lymph node involvement is found in over ___ of newly diagnosed LC patients.
N0 class of NSCLC staging.
no nodal involvement
N1 class of NSCLC staging
ipsilateral peribronchal and/or ipsilateral hilar and INTRApulmonary nodes (w/in the pleural surface)
N2 class of NSCLC staging.
ipsilateral mediastinal and/or subcarinal node (outside pleura)
N3 class of NSCLC staging.
contralateral mediastinal or hilar; ipsilateral or contralateral scalene or supraclavicular lymph nodes
M0 class of NSCLC staging.
no metastases
M1 class of NSCLC staging.
distant metastases present
Median survival time of SCLC w/o treatment.
2-4 months
Limited SCLC stage.
lesion in ipsilateral hemithorax w/in single radiation port (w/in area that can be tolerably radiated)
Extensive SCLC stage.
extends beyond radiation port (grown beyond area that can be tolerably radiated) w/ worse prognosis
Of new presentations of LC the majority are _____.
SCLC is more likely to be ____ compared to NSLC.
Symptoms of primary LC related to the tumor.
cough, dyspnea, hemoptysis, vague chest discomfort
Most common symptom of LC due to tumor?
cough, due to post obstructive pneumonia or extrinsic compression due to lymph node enlargement
Symtoms of LC related to intrathoracic spread.
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
Symptoms of extrathoracic spread
bone - elevated alkaline phosphatase
liver - abnormal LFTs, jaundice
brain/SC-HA, N/V, new onset seizures, confusion, personality changes
Lymph nodes and skin
Prognosis is poor w/ metastatic disease related signs such as?
anorexia, weight loss, fatigue
There are more paraneoplastic syndromes w/ SqCC or SmCC?
Paraneoplastic syndromes seen w/ SqCC?
hypertrophic pulmonary osteoarthropathy
hyper calcemia secondary to PTH-related protein -> mental status changes
Paraneoplastic sydromes seen w/ SmCC?
Lambert-Eaton myasthenic syndrome
Hyponatremia due to ADH secretion by SmCC
Get stronger w/ repetitive exercise, associated w/ SmCC.
Lambert Eaton myasthenic syndrome
NSCLC tools for diagnosis.
Transbronchial Biopsy
Endobronchial Biopsy
Transbronchial needle aspiration
Transthoracic needle aspiration
Endoscopic Ultrasound needle aspiration
Fluoroscopy guided, used for peripheral lesions, small risk for pneumothorax.
Transbronchial Biopsy
Direct visualization of lesion in airway.
Endobronchial Biopsy
Blind biopsy, however allows for quick processing
Transbronchial needle aspiration
Good for pleural based and distal peripheral lesions. Higher rate of pneumothorax.
Transthoracic needle aspiration
Through the esophagus or endobronchially, better resolution w/ increased ability to characterize lymph nodes. Can access a greater number of LN stations.
Endoscopic Ultrasound Needle aspiration
Superficial incision w/ blind dissection anterior to trachea to access peritracheal LN stations.
Noninvasive tools for staging of NSCLC
CT, PET (metabolic activity), Endoscopic Ultrasound, MRI (useful or superior sulcal tumors),
What is the disadvantage of CT compared to PET or EUS?
CT can miss smaller nodal involvement
Limited NSCLC treatment
Extensive NSCLC treatment
chemo +/- radiation
Metastatic tumor treatment
palliative care - serial thoracocenteis, pleurodesis, stents to open airway
Add talc powder to obliterate space btwn pleurae
Karnofsky performance scale
Best is 100, worst is 0
ECOG performance scale
0 is good, 4 is bad
Inhibition of ___ and ___ pathways is being researched to stop downstream effects of proliferation, differentiation, and angiogenesis.
EGFR, tyrosine kinase
SCLC treatment
platinum based chemo
Patients in SCLC remission are offered ____ b/c ____.
prophylactic cranial irradiation, SCLC's tendency for metastases to the brain
T/F: Surgery has no role in SCLC except in early stages.