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CC March 2017 Lung cancer in never-smokers

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echoecho's version from 2017-04-09 19:57

Section

Question Answer
What is the leadaing cause of cancer death worldwide with very little change in prevalence over the last several years?lung cancer
There are about ____ million new lung cancer diagnoses each year worldwide and about ____ million deaths?1.8 million; 1.6 million
In the US, a new dx of lung CA will be made in ______ patients annually with ____ deaths?225,000; 160,000
It is unequivocally clear the _____ ______ accounts for 80-90% of lung cancer?cigarette smoking
The risk increases with the ____ and ____ of smoking?amount; duration
If an individual has a > ____ pack year smoking hx, the risk of lung CA is ____ to ___ times higher tha a never-smoker?30; 20-25 times
Long-term smoking of only _________ to ___ cigarettes/day creates a ___ fold increased risk of lung CA compared to never-smokers?1; 10; 9
Men and women who smoke can significantly decrease their risk of lung CA by simply _____?stopping
Unfortunately, tobacco smoking is highly ______, making abstinence difficult?addictive
If a smoker with a 30 pack year history stops smoking, their risk of developing lung cancer will drop ___-___% over the next 15 years compared to individuals who continue to smoke?80; 90
Does the risk ever reach the very low risk level that never-smokers enjoy?no
Define a "never-smoker" patient?smoked < 100 cigarettes in their lifetime
It is estimated that about ___ to ___% of women and ___% of men who develop lung CA in the US are classified as a "never-smoker"?15-20; 10
These estimates are lower than in most of the world, especially in Japan, and the Asian Pacific islands where women with lung cancer are never smokers in ___ to _________% of the cases?60-75
The lung cancer cell type among never-smokers is predominately ______ (70%), a higher proportion than in smoking-related lung cancers?adenocarcinoma
____-cell lung cancer is virtually never seen in never-smokers?small
What 2 lung cancers are found in a minority of patients?1) squamous cell 2) large cell
Generally, the clinical presentation, treatment and the prognosis for never-smokers with lung cancer is very similar to smoking-related cancer with a median survival of ___ to ___ months in stage 3 and 4 patients?10; 14
Never-smokers who have acquired one of several recognized driver ______ are treated differently and have better outcomes?mutations
Along with direct tobacco smoking, the International Agency for Cancer Research ha classified what 3 "known human carcinogens". The greatest association is with _____ cancer?1) secondhand smoke 2) radon gas 3) outdoor air pollution 4) lung
What are the two most common causes of lung cancer in never-smokers?1) second hand smoke 2) radon gas
*** Studies have shown that ___ to ___% of lung cancer among never-smokers is due to second smoke (especially with exposure before the age of ___ years)?1) 15; 13 2) 25
*** Exposure from multiple sources, such as at ______ and the _____, increases cancer risk?1) home; 2) workplace
*** Never smoking women are more likely to have what exposure as the cause of lung cancer; how about never-smoking men?1) secondhand smoke exposure 2) occupational hazards
What is radon?it is a gaseous decay product of uranium and radium that damages the respiratory epithelium through the emission of alpha particles
The danger of radon exposure was first seen by the increased risk of lung cancer in _____ workers?uranium
Radon is present in what 3 places and can accumulate in homes?1) soil 2) rock 3) ground water
It is estimated that _____ to ____ lung cancers in never smokers in the US occur each year related to radon exposure (it likely causes more lung cancer deaths among never-smokers than secondhand smoke exposure)?3000; 4000
Exposure to both radon and second hand smoke produces a higher risk than either of the factors alone, true or false?true
Testing for radon in the home is readily available, and ______ techniques can lower levels to a safe range?mitigation
List the environmental and occupational exposures related to lung cancer in never-smokers?1) asbestos 2) chromium 3) heavy metals 4) indoor and outdoor air pollutants (burning coal, fumes from cooking oil, diesel exhaust)
What are remediable sources of outdoor air pollution linked to lung cancer?smog and high-levels of diesel exhaust
*** Radiation therapy to the _______ (most commonly used in Hodgkin lymphoma) increases the relative risk of developing lung cancer by 3-5 fold with the risk extending 20-25 years after treatment?mediastinum
*** Women who receive chest wall radiation for breast cancer also have a ____ fold increased risk for lung cancer, which is even higher if they are smokers?3
Inflammatory lung disease, infections such as TB and COPD are associated with an increased risk of lung cancer thought to be related to ongoing ______ injury?inflammatory
Patients with diffuse pulmonary _____ have a 8-14 fold increased risk of lung cancer regardless of smoking hx?fibrosis
_____ genetic factors are also felt to play a role in lung cancer in never-smokers?Germline
There are reports of several families of multiple family members who develop lung cancer at _____ age, unrelated to smoking?young
A family hx of ____ cancer is a useful clinical marker for increased risk, even when no smoking exposure is present?lung
There are negative or inconclusive data linking lung cancer with what factors?1) obesity 2) lack of exercise 3) diets high in red meat or lacking in fruits/vegetables 4) excess alcohol intake 5) viral exposures 6) estrogen use 7) cocaine intake
Limited data are available showing a causal relationship between heavy ______ smoking and lung cancer; most studies do NOT show an associated or are confounded by concurrent tobacco smoking?marijuana
One of the most exciting advances in the management of lung cancer has come from the discovery of _____, _____ _____ ____ ____, that stimulate proliferation, invasion of bodering normal tissues and the spread of metastatic disease through the lymphatics and vascular structures?acquired, targetable oncogene drive mutations
The above mutations are found most commonly in never-smoking younger women of ____ extraction?Asian
The above lung cancers are mostly what type of cancers (although mutations have occasionally been found in squamous cell lung cancers)?adenocarcinoma
Smokers occasionally do have an active mutation and most oncologists will screen all lung cancers for these mutations, true or false?true
Initial therapy for these tumors uses what instead of chemotherapy?TKIs (tyrosine kinase inhibitors)
*** These lung cancers respond to TKIs (give examples) and have a high response rate (___% to ___%) with median duration of disease control being 10-2 months?1) erlotinib, Gefitinib, Afatinib) 2) 80; 90
*** SUMMARY = The incidence of lung cancer in never-smokers is about ___% of all cases worldwide?25
*** SUMMARY = The International Agency for Cancer Research has classified what 3 factors as known human carcinogens; the greatest association is with lung cancer?1) secondhand smoke 2) radon gas 3) outdoor air pollution
*** SUMMARY = List the other causes linked with lung cancer in never-smokers?1) radiation therapy to the chest 2) COPD 3) pulmonary inflammatory disease 4) heavy metal exposure 5) other indoor/occupational pollutants 6) family hx of lung cancer
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