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70 Cards in this Set
- Front
- Back
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What is the most common type of lung cancer currently? Which subtype is increasing?
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Adenocarcinoma is most common and bronchoalveoloar is increasing.
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Which increases risk of lung cancer more, more cigarrettes per day or greater duration of smoking in years?
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Duration in years.
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How long does it take former smokers to return to the normal risk of lung cancer?
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They never do, but they approach the level of risk of non-smokers after 10-15 years.
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What is the risk of lung cancer in spouses of smokers?
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20-30% increase over spouses of non-smokers.
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Which subtype of NSCLC has the worst stage-for-stage prognosis?
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There is no difference among the subtypes.
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What are the general characteristics of lung adenocarcinoma?
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Peripherally located, frequently metastasizes, associated with scarring.
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Which subtype of NSCLC is most frequently associated with EGFR mutations?
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Bronchoalveolar.
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What are the general characteristics of squamous cell lung cancer?
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Centrally located, tend to cavitate.
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Which two types of lung cancer tend to be centrally located?
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Small cell and squamous cell.
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How do typical and atypical carcinoid lung tumors differ?
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Typical carcinoids are usually treated surgically and have a good prognosis, whereas atypical carcinoids tend to be larger, necrotic and metastatic at presentation.
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What is the main criterion for separating large cell neuroendocrine tumors and small cell lung tumors from atypical carcinoids?
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Higher mitotic count of 11/mm2 in the large cell NEC and SCLC. Average is 70-80 mitoses per mm2.
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Which has the worse prognsis, large cell NEC cancer or atypical carcinoid?
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Large cell NEC.
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How common is EGFR overexpression in NSCLC? What is the significance?
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up to 70% prevalence. EGFR overexpression is an independent negative prognostic factor. This is not the same as specific activating mutations such as exon 19 or 21.
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What is the current role of Avastin in lung cancer?
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Approved for first line treatment of non-squamous NSCLC with carbo-Taxol.
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What is the mechanism of action of Avastin?
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Monoclonal antibody against VEGF.
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Of what potential significance is the protein ERCC1 in lung cancer therapy?
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Increased expression of the protein can lead to DNA repair that makes platin agents ineffective.
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What is the significance of the oncogene EML4-ALK ?
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Tumors that contain the EML4-ALK fusion oncogene or its variants are associated with specific clinical features, including never or light smoking history, younger age, and adenocarcinoma with signet ring or acinar histology. ALK gene arrangements are largely mutually exclusive with EGFR or KRAS mutations [2]. Screening for this fusion gene in NSCLC is important, as "ALK-positive" tumors are highly sensitive to therapy with ALK-targeted inhibitors (crizotinib).
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In what portion of lung cancer patients are adrenal mets present? Liver or bone? Brain?
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Adrenal = 50%
Liver or bone = 20-30% Brain = 10-15% |
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What are the two most common paraneoplastic syndromes in NSCLC?
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hypercalcemia and hypertrophic pulmonary osteoarthropathy.
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Which is the most common cause of hypercalcemia in lung cancer, skeletal mets or humoral?
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Skeletal mets accounts for 85-95% of hypercalcemia.
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Name 4 paraneoplastic syndromes associated with SCLC which affect the nervous system.
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cerebellar degeneration
dementia limbic encephalopathy visual PNS with optic neuritis and retinopathy |
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How common is Lambert-Eaton myasthenia and what type of cancer is it associated with?
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Occurs in less than 1% of SCLC.
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What is the difference between length time bias and lead time bias?
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Length time bias = picking up indolent disease early in the course.
Lead time bias = presumes there is no good treatment, so early detection does not alter the disease course. |
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What was the result of the National Lung Cancer Screening Trial?
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20% mortality reduction in CT-screened group.
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What is the minimum predicted postoperative FVC for a pneumonectomy? Minimum preoperative FVC for a pneumonectomy?
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Postoperative predicted 1 L, preoperative 2 L.
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What is the minimum preoperative FVC for a lobectomy?
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1.5 L
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DLCO less than what percent of predicted value predicts for complications after thoractomy?
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50%
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What test can be used to predict postoperative complications in patients with borderline PFTs?
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Oxygen consumption test. >20 ml/kg, good to go. <10 ml/kg = high risk. Climbing one flight of stairs roughly equates to the 20 ml/kg value.
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What is a T1 lung tumor? T1a? T1b?
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T1 is less than or equal to 3 cm, without invasion more proximal than a lobar brochus. T1a is less than or equal to 2 cm, T1b is between 2-3 cm.
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Describe T2 lung tumors, including a and b descriptors.
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T2 are between 3-7 cm OR involve main bronchus > 2 cm from carina, or invade visceral pleura, or cause atelectasis or pneumonitis. a = 3-5 cm, b = 5-7 cm
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Describe T3 lung tumors.
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Greater than 7 cm or invades chest wall, diaphragm, phrenic nerve, mediastial pleura, pericardium, bronchus < 2cm from carina, whole-lobe atelectasis or pneumonitis, OR separate tumor nodules in the same lobe.
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Describe T4 lung tumors.
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Tumor of any size that invades mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, OR has separate tumor nodules in a different ipsilateral lobe.
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Describe N1 nodes in lung cancer.
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Ipsilateral peribronchial or hilar nodes, intrapulmonary nodes.
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Describe N2 nodes in lung cancer.
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Ipsilateral mediastinal or subcarinal nodes.
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Describe N3 nodes in lung cancer.
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Contralateral mediastinal or hilar nodes; ipsilateral or contralateral scalene, or supraclavicular nodes.
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Describe M1a designation in lung cancer.
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Separate tumor nodules in a contralateral lobe; tumor with pleural nodules or malignant pericardial or pleural effusion.
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Describe M1b designation in lung cancer.
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Distant metastases.
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What is the standard treatment for stages I and II NSCLC.
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Surgery (lobectomy) or radiation if surgery is contraindicated.
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Describe treatment of Pancoast tumor.
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Concurrent chemoradiation followed by resection, as long as it is N0 or N1 disease.
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For which early stage patients should adjuvant chemotherapy for NSCLC be given?
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Consider in stage IB (esp tumors > 4 cm). Adjuvant is appropriate in stages II and IIIA. Platin doublets are standard.
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Which patients should not receive neoadjuvant chemotherapy in early stage NSCLC?
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Those who will require a right pneumonectomy.
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What is the benefit of neoadjuvant chemotherapy for early stage NSCLC, and which patients are most likely to benefit from surgery?
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Patients tend to tolerate neoadjuvant chemo better than adjuvant. Those patients with nodes that clear with neoadjuvant chemo benefit from surgery the most.
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What type of treatment is given for non-bulky stage IIIA NSCLC?
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chemotherapy plus local therapy (surgery or radiation)
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What is the benefit of postoperative radiation therapy in stage II or III NSCLC?
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Decreases local recurrence but does not prolong survival.
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Is it reasonable to substitute carboplatin for cisplatin in adjuvant treatment of NSCLC?
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Most evidence suggests carboplatin has greater efficacy than cisplatin.
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In stage III NSCLC, enlarged nodes are pathologically negative in what percent of patients?
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30%
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What is the survival advantage of giving chemotherapy in metastatic NSCLC?
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20-25% improvement in survival.
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Pemetrexed is approved in what setting in NSCLC?
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First-line treatment of non-sqamous cancers.
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What is the role of erlotinib (Tarceva) in metastatic NSCLC?
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In EGFR mutation - positive patients, used as single-agent initial therapy. Also used in patients refractory to treatment with taxanes and platins.
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What are the overall and complete response rates to chemotherapy in limited stage SCLC? Extensive stage?
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Limited OR = 75-90%, CR = 50%
Extensive OR = 50%, CR = 25% |
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What is the treatment approach for limited stage SCLC?
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Concurrent chemoradiation.
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What is the only drug approved in the second-line setting in SCLC?
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Topotecan.
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How is chemotherapy different for the elderly in SCLC vs NSCLC?
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In SCLC, combination chemo is given, whereas in NSCLC single-agent chemo is often used.
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In SCLC, what is the radiation schedule for limited stage disease when given concurrently with chemotherapy?
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Twice daily (hyperfractionated approach)
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What percentage of patients with limited-stage SCLC treated with radiation and chemotherapy are alive at 3 years?
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About 5%.
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When is PCI given to extensive-stage SCLC patients?
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When they have a good response to chemotherapy.
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What is the survival benefit to PCI in SCLC?
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5% at 3 years.
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What is the difference between thymoma and thymic cancer?
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Both originate in thymic epithelium, but thymomas have admixed lymphocytes and are less aggressive than thymic cancers.
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What paraneoplastic syndromes are associated with thymoma?
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Myasthenia gravis, pure red cell aplasia, vasculitidies, hypogammaglobulinemia.
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What is the usual treatment of thymoma?
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Resection, followed by radiation if there is any invasive component. Chemotherapy is used for unresectable disease (CAP, VIP, cis-etoposide)
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What percent of mesotheliomas are associated with asbestos exposure?
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80%
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Does smoking increase the risk of mesothelioma?
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No
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What are the three types of mesothelioma?
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Epithelial, sarcomatoid, mixed.
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Of what values is PAS stain in the differential diagnosis of mesothelioma?
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Positive in metastatic adenocarcimona, negative in mesothelioma. Leu M1, Mayer mucicarmine and CEA are also usually absent in mesotheliomas but present in adenocarcinoma.
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What is serum mesothelin-related peptide (SMRP)?
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A serum marker that may predict recurrence of mesothelioma.
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Osteopontin is used in what role in the workup of suspected mesothelioma?
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Osteopontin is overexpressed in malignancy.
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What is the standard surgical treatment of mesothelioma?
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Extrapleural pneumonectomy (en bloc resection of parietal pleura, lung pericardium and diaphragm)
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What is the overall approach to therapy in mesothelioma?
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Surgery-chemo-radiation.
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What are the first line chemotherapy drugs in the treatment of mesothelioma?
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Cisplatin and pemetrexed.
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What are the single agent and combination therapy response rates in treatment of unresectable mesothelioma?
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5-20% for single agent (doxorubicin or cisplatin), 15-20% for combination.
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