Term
| what is the leading cause of CA death in north america and europe? |
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Definition
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Term
| what are the trends in lung CA? |
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Definition
| black males have the highest rate, white females have the lowest rate - but all demographics have been rising since the push for cigarette advertising in WWII. lung CA incidence has finally started to drop more recently due to anti smoking efforts |
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Term
| what kinds of lung CA does smoking increase the risk of? |
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Definition
| squamous, small cell, large undifferentiated, adenocarcinoma. |
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Term
| what is the risk increase for lung CA in secondhand smoke? |
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Definition
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Term
| what are other risk factors besides smoking that contribute to lung CA? |
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Definition
| air pollution, radiation exposure (radon), nutrition (need green-yellow veggies, but beta-carotene supplements may INCREASE risk), asbestos (increases risk of all lung CA types, mesothelioma and synergistic w/tobacco smoke), silica, and adenocarcinomas associated w/scar tissue |
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Term
| what are the risk increases/decreases in cigarette smoking according to the american CA society? |
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Definition
| >20 fold increase of lung cancer development in smokers, 5 fold excess in asbestos exposure, and down to 9 fold excess in former smokers |
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Term
| is it still helpful if stage 4 lung CA pts stop smoking? |
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Definition
| not in terms of stopping the CA, but chemo/radiation will be more effective |
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Term
| what are good prognostic factors for lung CA pts? |
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Definition
| *weight stable, early stage, good KPS (karnofsky’s performance status - 100 is highest), female gender, no K-ras mutation |
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Term
| how does expression of EGFR (epidermal growth factor receptor) affect lung CA prognosis? |
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Definition
| lung CA in pts w/mutations in EGFR leads to constitutive activation of EGFR, making it more aggressive - however these pts will respond better to EGFR-TKIs. pt w/o this mutation will still respond better to chemo. |
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Term
| should pts with the ERCC1 gene receive cisplatin chemotherapy (CDDP)? what is their overall prognosis? |
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Definition
| probably not, pts with the ERCC1 (5' endonuclease of the nucleotide excision repair complex) gene have a *poor response to CDDP, but do have a higher base prognosis w/lung CA |
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Term
| is a high RRMI1 (regulatory unit of ribonuclease reductase) good or bad for lung CA pts generally? do they respond differently to specific chemotherapy agents? |
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Definition
| a high RRMI1 level in lung CA pts is consistent with a better prognosis, however these pts will also have a *worse response to gemcitabine/carboplatin |
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Term
| what is K-ras, and how do its mutation/levels affect lung CA prognosis in pts? is this mutation associated with smoking? |
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Definition
| a mutation in K-ras in lung CA pts will increase resistance to cisplatin/navelbine/EGFR-TKI and decrease median survival. mutations in K-ras are associated with cigarette smoking. |
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Term
| what % of lung CA pts have symptoms at time of dx? what are these symptoms due to? how does presence of these symptoms inform the prognosis? |
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Definition
| 90% of lung CA pts have symptoms at time of dx, 30% of which are due to the primary tumor (*cough, hemoptysis, dull chest pain, hoarseness, dysphagia, diaphragmatic paralysis w/phrenic nerve involvement) and 60% are general (anorexia, *weight loss, fatigue). *presence of these symptoms indicates a poorer prognosis |
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Term
| is superior vena cava syndrome associated with lung CA? how does this syndrome present? is this an emergency? |
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Definition
| yes, and more specifically SVC syndrome is associated with small cell lung CA. pts w/SVC syndrome present with headache, SOB, full ruddy face and dilation of veins. this is considered a radiation oncology emergency. |
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Term
| can lung CA cause dysrhythmias? |
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Definition
| yes, lung CA can become involved with the pericardium and cause irritation |
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Term
| how common is pleural effusion with lung CA? can this be malignant? what is tx for this? |
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Definition
| extremely common, and it can be malignant - so if you see this, get the fluid tested after draining. once drained, pleurodesis can be performed (glue the pleura together to prevent further fluid accumulation) |
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Term
| what characterizes possible chest wall invasion by lung CA? are there differences in instances of this among the different kinds of lung CA? |
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Definition
| tumors can grow out into the ribs, chest wall etc - *squamous cell lung CA seems to cause more rib erosion, though this is indicative of more advanced lung CA |
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Term
| what is horner's syndrome? |
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Definition
| horner syndrome is *miosis, ptosis, and anhydrosis can can result from sympathetic chain involvement by lung CA |
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Term
| when does lung CA become most lethal? |
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Definition
| localized lung CA is easy to treat however metastatic lung CA is what kills people ("game over") |
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Term
| what are the rates of prevalence with lung CA metastasis to different parts of the body? |
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Definition
| liver:35%, bone:30%, CNS: 10% (but 50% of small cell lung CA, so now prophylactic cranial irradiation is standard of care), adrenal:25-35% (usually bilateral, clinically silent), some skin metastasis |
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Term
| if lung CA metastasizes to only one location, what is the tx? |
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Definition
| if lung CA metastasizes to only one site, that site can be sx resected and generally be ok (as opposed to chemo etc for pts w/multiple mets) |
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Term
| what is a paraneoplastic syndrome commonly associated w/small cell lung CA? how do pts w/this present? |
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Definition
| SiADH (syndrome of inappropriate antidiuretic hormone) @ 75%. pts with SiADH cannot secrete free water into urine, diluting serum and causing Na+ levels to drop - hypoatremic (mental status changes/seizure/anorexia/vomiting). SiADH pts have hypo-osmolar serum and hyper-osmolar urine and their symptoms are much worse if the Na+ drop happens quickly |
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Term
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Definition
| the tumor needs to be treated, democlocycline (antibx) has been shown to positively affect the balance of free water handling. people w/this also need to be on fluid restriction (1 L total daily) |
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Term
| can lung CA result in ectopic ACTH? tx? |
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Definition
| yes, though this paraneoplastic syndrome is asymptomatic most of the time, it is a bad prognostic indicator. symptoms include: hyperpigmentation, edema, hypokalemic alkalosis, hyperglycemia, peripheral muscle weakness, and lack of immunity (WBC dysfunction due to cortisol). tx: get rid of tumor, aminoglutethamide, and metyrapone |
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Term
| what is hypercalcemia in lung CA usually due to? what are symptoms? tx? |
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Definition
| bone metastasis from squamous cell lung CA due to secretion of a PTH like hormone. symptoms include: nausea, anorexia, malaise, wt loss, *dehydration* (acts as diuretic - *tx w/HYDRATION* only diurese if pt is euvolemic), abdominal pain, constipation, thirst, polyuria, and confusion. tx: *bisphosphonates*, calcitonin (quick on, quick off), gallium nitrate, & tumor tx |
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Term
| what is eaton-lambert syndrome? (*possible test question*) |
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Definition
| a paraneoplastic syndrome associated with *small cell lung CA caused by an antibody blocking the Ca++ channel of peripheral cholinergic nerve terminals. dx: test for anti-hu/anti-yo/anti-ri antibodies. symptoms: proximal muscle weakness, dry mouth, hyporeflexia, and dysphagia. |
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Term
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Definition
| a paraneoplastic syndrome associated w/lung CA featuring an abnormal angle of the nail bed which is seen more w/squamous and adenocarcinomas (actually seen in any chronic lung disease) |
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Term
| what needs to happen with CXRs of suspected or diagnosed lung CA pts? |
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Definition
| *new CXRs need to be compared to old ones* |
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Term
| is a CT scan better diagnostically when looking for lung CA? |
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Definition
| yes - if you think something small is going on |
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Term
| are bronchoscopies used to dx lung CA? |
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Definition
| yes bxs can be obtained w/them |
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Term
| what is a transthoracic needle bx? |
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Definition
| a bx technique good for peripheral lung CA out of reach via bronchoscope. this can be used in conjunction w/PET scan |
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Term
| what is pleural bx w/VATs? |
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Definition
| video assisted thorascopy - fancier way to bx |
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Term
| how specific is sputum cytology? |
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Definition
| sputum cytology has a low specificity. pt coughs up sputum, put it in a cup, do for 3 consecutive days and send to the lab for cytology - if you see malignant cells = dx |
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Term
| when is a mediastinoscopy appropriate? |
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Definition
| mediastinoscopies are appropriate for checking lymph nodes associated T3 lesions regardless of CT/PET and peripheral T2/central T1,T2s should have a mediastinoscopy |
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Term
| does a PET scan still require confirmation before aggressive therapy? |
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Definition
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Term
| does sx improve stage I lung CA? chemo? |
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Definition
| sx improves stage I, chemo only helps after stage I/>4 cm |
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Term
| what kinds of sx are performed on lung CA pts? |
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Definition
| lung sparing sleeve resections (lobectomy) and segmentectomy/wedge resection (controversial). the jury is out on lymph node resection. resection of solitary brain met can provide OS (overal survival) benefit, though this procedure in other areas is not proven |
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Term
| what is the american lung CA drug combo? |
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Definition
| paclitaxel/CDDP and there is no data supporting whether any other combination is more effective |
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Term
| how does bevacizumab help with lung CA pts? |
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Definition
| *bevacizumab (anti-VEGF)* helps keep CA maintained along with and after chemo (paclitaxel/CDDP) - though does not work with small cell/brain mets |
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Term
| can addition of erbitux to chemo w/EGFR pts help? |
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Definition
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Term
| if pt lung CA pt has a high grade tumor does a combination of both chemo and radiation help? |
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Definition
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