Test 10_12_12 - Lung Cancer PowerPoint, Review and pics _ cb.txt

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  1. What is the #1 killer in men and women in 2008 in the U.S.
    Lung cancer
  2. With Lung cancer the 5 year survival is
    Low (usually caught at stage 3)
  3. What % of diagnosed lung cancer patients have positive nodes?
  4. Who have slightly higher incidence with lung cancer
  5. What is the average age for onset lung cancer
    Age 60
  6. List the important causative factors for lung cancer:
    • Smoking (#1)
    • Exposure to combustion by-products
    • Asbestos
    • Pollution
    • Chemicals
    • Metals
    • Ionizing radiation
  7. What is the number 1 cause of lung cancer
    • smoking
    • Image Upload 1
  8. List possible symptoms of Lung Cancer:
    • History of smoking
    • Persistent, unproductive cough
    • Hoarseness
    • Hemoptysis
    • Weight loss
    • Dyspnea
    • Unresolved pneumonitis
    • Chest wall pain
    • Apical tumors:¬†weakness in arm, swelling in neck
    • Atelectasis
    • Pleural effusion (sticky fluid)
  9. The 2 major types of Lung Cancer:
    • Small cell lung cancer/oat cell
    • Non-small cell lung cancer
  10. Which type of lung cancer has high mortality; very aggressive,10% of all lung cancers; It tends to be disseminated at time of diagnosis
    small cell lung cancer (SCLC)/oat cell
  11. Which type of lung cancer lesions are central; Most radiosensitive;5 year survival 1%; PCI is sometimes indicated.
    small cell lung cancer (SCLC)/oat cell
  12. List the 4 histological types of Lung Cancer and their frequency
    • Small cell lung carcinoma - frequency 10%
    • Non-small cell lung cancer:
    • Squamous cell - frequency 40%
    • Adenocarcinoma - frequency 40%
    • Large cell - frequency 10%
  13. Which type of lung cancer is 40% of all lung cancers; Central lesion and less likely to metastasize early; Most common in men. Most closely associated with cigarette smoking; 5 year survival 20%?
    NSCLC - Squamous cell
  14. Which type of lung cancer is 40% of all lung cancers; Peripheral lesion and metastasize widely; Most common in females. Less closely linked to smoking. 5 year survival 20%
    NSCLC - Adenocarcinoma
  15. Which type of lung cancer is10% of all lung cancers; Peripheral lesions that tend to metastasize early; 5 year survival 13%
    NSCLC - Large cell
  16. State where lung cancer tends to metastasize
    • Brain (most likely)
    • Liver
    • Bone
    • Image Upload 2
  17. Describe ways in which lung cancer can be detected and diagnosed:
    • Physical exam
    • Chest xray
    • CT thorax and abdomen
    • Pet/CT
    • Pulmonary function test
    • Needle biopsy
    • Sputum cytology
    • Bronchoscopy with biopsy
    • Bone and liver scan to rule out metastasis
    • CT brain if small cell
  18. Describe the 3 various Treatment options for lung cancer:
    • Surgery (for Stage I and II)
    • Radiation Therapy
    • Chemotherapy
  19. State the surgical procedures that may be used for treatment
    • Thoracotomy (removal of lobe)
    • Vat (Video Assisted Thoracotomy)
    • Wedge Resection
    • Image Upload 3
  20. 5 reason that lung cancer can be unresectable (cannot do surgery):
    • Metastatic disease
    • pleural effusion
    • SVC syndrome
    • tracheal wall invasion
    • small cell histology
  21. During treatment when is radiation therapy used
    • definite cured
    • palliative - pallative if obstruction of bronchi, hematypsis, esophageal compression
  22. Which treatment option uses Cisplatin (most common)
  23. Tumors that are present in the apex of the lung and grow by local extension to involve the 8th cervical and 1st thoracic nerve
    Pancoast tumor
  24. What is the radiation dose limit for NSCLC (non-small cell lung cancer)
    • 6000-7500 cGy
    • 180-200 daily
  25. What is the radiation dose limit for SCLC (small cell lung cancer)
    • 4500-6000 cGy
    • 180-200 daily
  26. What is the dose limit for Bronochogenic Carcinomas
    6000-7500 cGy
  27. Boost fields are usually prescribed at what dose
    4000-4500cGy (off cord)
  28. What are the treatment techniques (7)
    • AP/PA (AP for standard upper lobe)
    • oblique
    • Laterals
    • IMRT (Intensity Modulated Radiation Therapy)
    • Vac local (Vaccum-assisted closure therapy)
    • Wing board to support arms
    • Breathing techniques
  29. What is the abbreviation SVC?
    Superior Vena Cava
  30. What syndrome has to have emergency treatment, typically 300-400 cGy per fraction; 3 or 4 fractions and then conventional treatment
    • SVC Syndrome
    • Image Upload 4
  31. What are the dose limit for these critical structures: Normal Lung; Liver
    • Normal Lung - 30% less than 2000 cGy
    • Liver - 3500 cGy
  32. What are the dose limit for these critical structures: Heart; Cord
    • Heart - 4300 cGy
    • Cord - 4500 cGy
  33. What are the dose limit for these critical structures: Esophagus; Skin
    • Esophagus - 5000 cGy
    • Skin - 5500 cGy
  34. What are the dose limit for these critical structures: Brachial Plexus; Bone
    • Brachial Plexus - 6000 cGy
    • Bone - 6500 cGy
  35. The possible side effects of RT (Radiation Therapy) for the lung:
    • Pulmonary Fibrosis (scarring or thickening of lungs)
    • Radiation pneumonitis (inflammation of lungs due to therapy)
    • Dermatitis (itchy rash made of bumps and blisters)
    • Erythema (redness of skin)
    • Esophagitis (inflammation, irritation or swelling of esophagus)
    • Spinal Cord Damage
    • Decreased blood counts
  36. The right lung is composed of three lobes:
    • Upper lobe
    • Middle lobe
    • Lower lobe
    • Image Upload 5
  37. The left lung consist of how many lobes?
    2 lobes
  38. What are the lobes separated by
  39. What consists of the branched airways leading from the trachea to the microscopic air sacs (alveoli)
    • Bronchial tree
    • Image Upload 6
  40. What are the microscopic air sacs of lungs
  41. At what level of the vertebrae the right and left bronchi arise from the trachea
    4th and 5th thoracic vertebrae
  42. The openings of these tubes are separated by a ridge of cartilage called
    • Carina
    • Image Upload 7
  43. The right bronchi are shorter than the left and have a more
    • Vertical slope
    • ( because of this, objects which become stuck and obstructed the airway tend to become lodged in the right bronchi)
  44. *Note*
    • Each bronchus divides into secondary bronchi which turns into finer tubes called Bronchioles
    • Bronchioles continue to divide into very thin tubes called alveolar ducts
  45. What ducts terminate in masses of microscopic air sacs (alveoli)
    Alveolar ducts
  46. What diffuses through the alveolar walls and enter the blood in nearby capillaries
  47. What diffuses from the blood and enters the alveoli
    Carbon dioxide
  48. Each lung occupies most of what space
    • Thoracic space
    • Image Upload 8
  49. This part enter the lung on its medial surface through a region called
  50. What layer of serous membrane is firmly attached to the surface of each lung
    Visceral pleura
  51. The visceral pleura membrane folds back any the hilum to become
    Parietal pleura
  52. What forms part of the mediastinum and lines the inner wall of the thoracic cavity
    Parietal pleura
  53. What does the mediastinum contain (4 parts):
    • Thoracic duct
    • Thymus gland
    • Heart
    • Part of the esophagus
    • Image Upload 9
  54. What 2 membranes are held together by surface tension, normally no actual space in the pleural cavity between them
    • Visceral and parietal pleural membranes
    • Image Upload 10
  55. If the thoracic wall is punctured, atmospheric air may enter the pleural cavity and create a real space between the membranes, this condition is called
    • Pneumothorax - collapsed lung
    • Image Upload 11
  56. Define Atelectasis
    Collapsed lung as a result of pneumothorax
  57. State where gas exchange occurs in the lungs
    • Alveoli
    • Image Upload 12
  58. Differentiate between the visceral pleura and the parietal pleura
    • Visceral pleura lines the surface of the lungs
    • Parietal pleura lines the inner wall of the thoracic cavity
    • Image Upload 13
  59. Define pneumothorax
    • Collapsed lung; the collection of air in the space around the lungs
    • Image Upload 14
  60. Describe the incidence of lung cancer among men and women
    Lung cancer is the #1 killer among men and women
  61. What is the 5 year survival rate for small cell (oat cell)
  62. What is the 5 year survival rate of non-small squamous cell
  63. What is the 5 year survival rate of non-small adenocarcinoma
  64. What is the 5 year survival rate of large cell
  65. State the MOST common symptom of lung cancer
    • Unproductive cough - Most Common
    • Image Upload 15
  66. Describe Horner's syndrome and state the type of lung tumor associated with it
    • Ipsilateral mitosis, ptosis, enopthalmos and anhydrosis
    • Associated with (Apical tumor) Pancoast tumor (syndrome is characterized by shoulder pain, which radiates down the arm, atropthy of hand muscles and bone erosion of the rib and vertebrae
    • Image Upload 16
  67. What is hemoptysis
    Coughing up blood
  68. What does it mean when the lung tumor is central
    • Closer to the hilium
    • Image Upload 17
  69. Describe Small Cell Lung Cancer
    Very aggessive, most radiosensitive
  70. Describe squamous cell cancer
    • central lesion
    • less likely to metastasize early
    • Most common in men
    • closely associated with cigarettes
  71. Describe adenocarcinoma cancer
    • peripheral lesion
    • metastasize widely
    • most common in females
    • less linked to cigarettes
  72. Describe large cell cancer
    Peripheral lesions that metastasize early
  73. Describe the superior vena cava syndrome
    • Compression of the superior vena cava
    • Assocaited with dyspnea; facial, neck, and arm edema; orthopnea (inability to lie flat), and cyanosis ( blue tinge to the lips)
    • Maybe hoarseness
  74. How is SVC syndrome treated
    Chemotherapy & Radiation therapy
  75. What type of lung cancer is best suitable for chemotherapuetic treatment
    Bronchogenic cancers
  76. Lung Diagram
    Image Upload 18
  77. Image Upload 19
    Image Upload 20
  78. RT treament field for upper lobes
    Image Upload 21
  79. RT treatment field for middle lobes
    Image Upload 22

    Image Upload 23
  80. RT treatment field for lower lobes
    Image Upload 24
  81. Lung cancer on X-ray
    Image Upload 25
  82. Lung cancer on CT
    Image Upload 26
  83. Image Upload 27
    • 1st row - CT of lung cancer
    • 2nd row - PET of lung cancer
    • 3rd row - CT/PET of lung cancer merged
  84. Image Upload 28
    • 1. Nasal Cavity
    • 2. Oral Cavity
    • 3. Epiglottis
    • 4. Trachea
    • 5. Bronchial tubes
    • 6. Rib
    • 7. Intercostal muscle
    • 8. Lungs
    • 9. Diaphram
    • 10. Esophagus
    • 11. Bronchioles
    • 12. Capillaries
    • 13. Alveoli
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Test 10_12_12 - Lung Cancer PowerPoint, Review and pics _ cb.txt

Test 10_12_12 - Lung Cancer PowerPoint, Review and pics _ cb
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