9.19 Clinical lung cancer

ahmadsadaka's version from 2015-06-04 05:25


Question Answer
types of non-small cell lung cancersAdenocarcinoma, Squamous cell carcinoma, Large cell carcinoma, NSCLC NOS, Sarcomatoid NSCLC
why are screening chest x-rays not done for lung cancernot cost effective, do not affect overall mortality
what might be useful for screening in older smokersCT scans of lungs
are hilar nodes or mediastinal nodes more accurate in chest x-rays at diagnosing hilar
why are CTs more accurate than x-rayID enlarged lymph nodes, adrenal masses, liver metastases
what staging system is used for non-small cell lung cancerTNM
what is T in TNMtumor - size and location, 0-4, A and B
what is N in TNMlymph nodes - 0-3, presence and location
what is M in TNMmetastasis - either present or absent, subcategorized A and B
advantages of chest CTexcellent determination of calcification patterns, provides guide to bronchoscopy and mediastinoscopy
disadvantages of chest CTlarge number of false positives with adrenal masses, large number of false positive lymph nodes
used in patients with clincal stage IB, IIA, and IIB to ensure that there is no spread of tumor that would preclude surgeryPET scan
advantages of PET scanimproved detection of mediastinal involvement, improved detection of distant metastases
disadvantages of PET scanpoor for T staging, poor for brain metastases
what should be done if imaging shows enlarged lymph nodes in mediastinumBIOPSY
what responds to VEGF receptor blockers such as monoclonal antibody bevacizumabadenocarcinomas
what is bevacizumab and what is it used formonoclonal antibody - blocks VEGF receptor - used for adenocarcinomas
why can bevacizumab not be used to treat squamous cell carcinomahigh risk of severe bleeding
what causes severe bleeding in squamous cell carcinomabevacizumab - VEGF receptor blocker
what are gefitnib and erlotinibEGFR tyrosine kinase inhibitors
what do KRAS mutations identifiy tumors that do poorly with tyrosine kinase inhibitors
what predicts response to ALK inhibitor crizotinibpresence of EML-4-ALK translocations
treatment for Stage IaSURGERY --> VATS Lobectomy or Conventional lobectomy or Segmnentectomy or Wedge resection or SBRT or RFA
treatment for Stage IbSURGERY --> Chemotherapy
(Conventional lobectomy or Segmnentectomy or Wedge resection or SBRT or RFA)
treatment for stage IIsurgery + chemotherapy
treatment for stage IIIchemotherapy + radiation therapy with possible late surgery
treatment for stage IVchemotherapy
what is adjuvant chemotherapycisplatin + second drug
EGFR (+) treat withErlotinib or Gefitinib (Tarceva or Iressa)
KRAS (+) treat withcombination chemo
ALK (+) treat withCrizotinib (Xalkori)


Question Answer
if someone has mVO2>20 - surgery or no surgerysurgery
FEV1 should be what before tumor operation>60% predicted
PCO2 should be what before tumor surgery<45
exercise test - maximum oxygen uptake (mVO2) should be what before tumor surgery >20
if someone has mVO2<10 - surgery or no surgerysurgery probably too high risk
if someone has mVO2 10-20 - surgery or no surgerysurgery after pulmonary rehabilitation


Question Answer
what staging system is used for small cell carcinomalimited stage, extensive stage
what stage - 30% patients, average survival 16 months, treatment - radiation plus chemo, cure rate 5-10%limited stage small cell lung cancer
what stage - 70% patients, average survival 9 months, treatment - chemotherapy, no cure rateextensive stage small cell lung cancer
when do you do surgery for small cell lung cancernever - never surgically curable
what stage - confined to hemithorax (essentially TNM stage I)limited stage small cell lung cancer
what stage - any distant metastasis outside hemithorax (essentially TNM stages II, III and IV)extensive stage small cell lung cancer
treatment for limited stage small cell lung cancerchemotherapy (cisplatin / carboplatin + etoposide / irinotecan); radiation therapy = prolong life, cure 25%
treatment for extensive stage small cell lung cancerchemotherapy (cisplatin or carboplatin + second drug) - prolongs life but does not result in cure
benign calcium patternslaminated, diffuse, central or speckled
a lesion unchanged in size for how long is usually benign2 years
PET can give false positives inTB, fungal infections
PET can give false negatives inbronchoalveolar cell carcinoma, carcinoid tumors, hyperglycemia, small cancers


Question Answer
Causes of SVC obstruction60-85% Malignant , 15-40% Benign (thrombosis, fibrosing mediastinitis)
Malignant Causes of SVC obstructionNSCLC (50%) then SCLC (25%) then NHL (10%) - But svc obstruction more commonly occuring in SCLC than NSCLC
Commonest histological type of Pancoast tumourSquamous cell carcinoma --> Adenocarcinoma --> SCLC
Commonest histological type to cause hypercalcemiaSquamous cell carcinoma --> Adenocarcinoma --> SCLC