Oncology -Non-small cell lung cancer – Flashcards
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What is the number one cause of cancer related deaths for both men and women in the US?
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Lung cancer
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Lung cancer is responsible for more deaths in the US than which cancers *combined*?
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Colorectal Breast Prostate
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What is happening to female rates of lung cancer?
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Increasing -unknown why
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What % of lung cancer are related to tobacco? 30% of all non-smoker lung cancers are related to what?
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90% Environmental smoke
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What are occupational risk factors for lung cancer?
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Asbestos Radon Chromium, nickel, arsenic
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What % of lung cancer is non-small cell lung cancer?
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80%
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What are the types of non-small cell lung cancer?
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Adenocarcinoma (60%) Squamous (25-30%) Large cell (15%)
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Where is adenocarcinoma non-small cell lung cancer located? It is most common in what population?
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Peripheral Nonsmokers -often young
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Where is squamous non-small cell lung cancer located? What are signs of it?
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Central (smokers) Hypercalcemia
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Where is large cell non-small cell lung cancer located?
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Peripheral
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What is the *most common* presentation of non-small cell lung cancer?
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Cough or pneumonia
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What are other presentations of non-small cell lung cancer?
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Hemoptysis Weight loss Chest pain SVC syndrome Vocal cord paralysis Dysphagia Pancoast's syndrome (pain)
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What background setting might non-small cell lung cancer have?
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COPD
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The vast majority of inoperable patients are what?
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Symptomatic
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What are the most common met sites?
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Liver Bone Brain (includes paraneoplastic syndrome) Adrenal
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What are good prognostic factors in non-small cell lung cancer?
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Early stage at dx Good performance status No significant weight loss Female
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What are poor prognostic factors in non-small cell lung cancer?
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553 mutations K-ras oncogene activation
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How do we make the diagnosis of non-small cell lung cancer?
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Bronchoscopy Fine needle aspirate Mediastinoscopy
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What kind of lesions does bronchoscopy establish diagnosis in >90%? When is bronchoscopy helpful?
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Proximal lesions Helpful
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When do we use fine needle aspirates?
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Peripheral lesions
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What is hte most accurate lymph node staging technique? Which lymph nodes?
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Mediastinoscopy Lymph nodes >1cm by CT
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What can be useful in staging mediastinum?
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CT and PET
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Stage 1A (T1AN0M0) lung cancers have what cure rate?
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>70%
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What predicts malignancy?
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Age, smoker, size Border -spiculated vs smooth Calcifications Growth
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LOOK AT SPN ALGORITHM!!!
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Pg. 9
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What are risk factors for lung cancer in never smokers?
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Secondhand smoke Radon Lung disease Genetic factors Estrogens
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What might lung cancer in never smokers respond to?
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Targeted therapy
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?/?? NCCN guidelines?
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...
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KN is a 56 year old former 20 pack year smoker who presents for routine PE. On his history, he notes that he was treated last fall for 'walking pneumonia'. He is doing much better now, but notes that he still has a persistent cough. On reviewing his last CXR from last fall, you note that the radiologist noted that there was a LLL infiltrate with a perihilar suggestion of a spiculated mass. You order a new follow up film, and find that his infiltrate has resolved, but he continues to have a perihilar mass. As the films were done at different locations, no direct comparisons could be made in terms of the size. What should be your next best step?
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A. Have the patient retrieve the previous film so that direct comparisons can be made B. Order a PET scan C. Refer to pulmonologist D. Refer to thoracic surgeon E. Schedule for a percutaneous CT directed biopsy
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Answer...?
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A. Have the patient retrieve the previous film so that direct comparisons can be made -reasonable B. Order a PET scan -reasonable because spiculated
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True or false: The most common presentation of lung cancer is a solitary pulmonary nodule that is often picked up incidentally on routine chest x-rays.
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False -rarely found as SPN
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CJ is a 62 year old smoker who has recently undergone treatment for a Stage II non small cell lung cancer. His surgeon and oncologist are too far away for regular visits, so he wants you to manage his follow up. How often should he be getting his CXR, PET scans and lab work done?
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A. He has completed his therapy. He needs no further testing B. Every 6 months for 2 years, then annually thereafter C. He needs to focus only on stopping smoking at this point D. CXR, blood work and PET scans are not part of routine survivorship care E. A more important issue is reviewing his medications to make sure there are no new drug interactions
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Answer...?
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B. Every 6 months for 2 years, then annually thereafter and C. He needs to stop smoking
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What stages of NSC lung cancer can be operated on?
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IA -II but rarely find this early
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What do we need to do to determine if cancer is resectable or the patient is an operative candidate?
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V/Q scan Need FEV > 3
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Can we operate on stage III and IV NSC?
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NO -treat symptomatically (chemo and other agents) -radiation -may stent bronchus
