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What are the 4 histologic types of lung cancer?
- 1. small cell(oat cell) (10%)
- Non Small Cell Types:
- 2. adenocarcinoma (40%)
- 3. squamous cell (40%)
- 4. large cell (10%)
What is the most aggressive type of lung cancer?
What is the survival rate?
Small cell has a 5 year survival rate of 1%. The lesions are central but it tends to be disseminated at the time of diagnoses(metastasized).It is very radiosensitive.
What is PCI and which kind of lung cancer is it sometimes indicated for?
prophylactic cranial irradiation for small cell lung cancer.
What % of lung ca's are small cell?
What % of lung cancers are squamous cell?
What % of lung cancers are large cell?
What % of lung cancers are adenocarcinoma?
Which histological type of lung cancer is more common in women?
adenocarcinoma 40 % of all lung cancers, peripheral lesion that metastasize widely. LESS closely linked to smoking. 5 yr survival is 2O %
Which kind of lung cancer is most closely associated with smoking?
squamous cell 40 % of all lung cancers, It has central lesion and is less likely to metastasize early. Most common in men. 5 yr survival rate of 20 %
Which is the most common cancer in men?
What are the 5 yr survival rates of the different kinds of lung cancer?
- Small cell: 1%
- Large cell: 13%
- Squamous cell & Adenocarcinoma: 20%
What are the rates of the different kinds of cancers?
- Small cell: 10% of lung cancers(5yr survival 1 %)
- Large cell: 10% of lung cancers (5yr survival 13%)
- Adenocarcinoma & Squamous Cell: each 40% of lung cancers (5 year 20% for each)
Max dose for spinal cord:
4500 cGy (4000 in private practice where lawsuits are a worry)
Daily fraction dose
- 180-200 cGy
- true for all cancers -only higher in exceptional cases like SVC syndrome(300-400 cGy per fraction)
What is SVC and how is it treated?
- Superior Vena Cava syndrome-cuts off oxygen to brain-an emergency
- Typically 3-4 fractions of 300-400 cGy are given before conventional treatment.
What three conditions are considered emergencies in radiation therapy?
- 1. SVC syndrome
- 2. Brain mets
- 3.Spinal cord compression(only have 24-48 hours)
What is the dose for definitive treatment of NSCLC?
What is the dose for definitive treatment for SCLC
4500-6000 cGy (180-2000 cGy)
What is the dose for definitive treatment for bronchogenic carcinoma?
6000-7500 cGy(it's a type of non small cell cancer).
What is the dose for boost fields for lung cancer?
Lymph node doses are always
Differentiate between the visceral and the parietal pleura.
The meaning of the word viscera is:
- The Visceral pleura is the thin serous membrane that covers the lungs. The Parietal pleura is pleura that lines the inner chest walls and covers the diaphragm.
- The PLEURAL CAVITY is between the two layers of pleura
The soft internal organs of the body, especially those contained within the abdominal and thoracic cavities. If I remember viscera means internal organs then I can remember it is the pleura closest to the organ(the lung)
Where does gas exchange occur in the lungs?
in the alveoli
What is a pneumothorax?
a pneumothorax happens when the thoracic wall is punctured and atomospheric air enters the pleural cavity(between the visceral and pleural pleura). It may cause a collapsed lung(atelectasis)
Atelectasis is the collapse of part or (much less commonly) all of a lung.
Describe Horner's syndrome and state the type f lung cancer associated with it.
- Horner's syndrome is associated with pancoast tumors(tumors that present in the apex of the lung and grow by extension to involve the 8th cervical and 1st thoracic nerve)
- 1) ipsilateral miosis(small pupil on same side as tumor)
- 2)ptosis(dropping of the upper eyelid)
- 3) enophthalmos(the impression that the eye is sunk in)
- 4)anhydrosis(decreased sweating on the affected side of the face)
- 5)bone erosion of the rib and vertabrae
- Animals get Horner's too :(
What is the most important causative factor in lung cancer?
What is the dose limit for the lungs?
What is the dose limit for the esophagus?
What is the dose limit for the heart?
What is the dose limit for the brachial plexus?
What is the dose limit for the skin?
What is the dose limit for the liver?
What is the dose limit for bone?
What are the critical structure dose limits?
(for lowest to highest)
- lung-30% <2000cGy
- liver=3500 cGy
- heart-4300 cGy
- cord-4500 cGy
- esophagus-5000 cGy
- skin-5500 cGy
- brachial plexus-6000 cGy
- bone-6500 cGy
Where does lung cancers tend to metastasize ?
the brain(which is the #1 place),liver, and bone
Which kind of lung cancer is the most radiosensitive?
small cell(oat cell)
Which has a slightly higher incidence of lung cancer: men or women?
The #1 killer in men and women in 2008 in the United States is _________.
The average age of onset for lung cancer is: ________ years old..
At diagnoses _____% of patients have positive nodes.
Does quitting smoking make a difference?
Yes, smoking cessation decreases risk over time.
The _____ cigarettes consumed daily increases risk.
*in the book it says over a pack a day is considered to be putting yourself at definite risk for lung cancer.
The overall 5 year survival rate for all kinds of lung cancer is.
- * this is because symptoms do not alert the patient until the cancer is at an advanced staqge
What are the causes of lung cancer?
- 1)Smoking(the most significant factor)
- 2)Exposure to combustion by-products
- 7)Ionizing radiation
What is the most common symptom of lung cancer?
persistent, unproductive cough
A persistent , unproductive cough is the most common symptom of cancer. Wht are other possible symptoms?
- 1)History of Smoking
- 3)hemoptysis(coughing up blood)
- 4)weight loss
- 5)dyspnea(shortness of breath-SOB)
- 6)unresolved pneumonitis
- 7) chest wall pain
- 8) apical tumors(weakness in arm, swelling in neck)
- 9)atelectasis(collapsed lung)
- 10)pleural effusion.
What are ways that lung cancer can be detected and diagnosed?
- 1)bronchoscopy with biopsy
- 2)Chest X-ray
- 4)needle biopsy
- 5)sputum cytology
- 6) bone and liver scan to rule out metastasis
- 7)CT thorax and abdomen(checking for liver mets)
- 8)CT of brain especially small cell (because it tends to metastasize to brain so quickly)
- 9) Pulmonary function tests
- 10)physical exam(weight loss?, swelling in neck? etc)
What type of cancer is best suited for chemotherapy?
What is a Pancoast tumor?
It is tumor that presents in the apex of the lung and grows by extension to involve the eighth cervical and first thoracic nerve. Can cause Horner's syndrome(ipsilateral miosis, ptosis, enophthalmos, and anhydrosis), bone erosion of the rib and vertebrae, shoulder pain which radiates down the arm, and atrophy of the hand muscles
- 1:superior mediastinal
- 3.inferior mediastinal
Surgery is performed on what stages of lung cancer?
Stages I and II
The tumor would be unresectable under the following condtions:
- 1)Metastatic disease
- 2)pleural effusion
- 3)SVC syndrome
- 4)tracheal wall invasion
- 5)small cell histology
Surguries for lung cancer:
- 2)VAT (video assisted thoracotomy)
- 3) wedge resection
What is SVC syndrome?
How is it treated?
- Superior vena cava syndrome (SVCS) refers to a partial blockage of the vein (vena cava) that carries blood from the head, neck, chest, and arms to the heart. IT IS AN EMERGENCY!
- Common symptoms that may indicate SVCS include:
- 1)Rapid or difficulty breathing&difficulty breathing while laying down
- 2)Swelling of the face, neck, upper body, and arms
- 3)Prominence of veins on the front of the chest
- It is treated with 3 or 4 fractions of 300-400 cGy followed by a reduction to 180-200cGy to a total dose of 4500-5000 cGy(300-400cGy per fraction; three or four fractions and then conventional treatment)
What are the various treatments for lung cancer and when each are most likely to be used.
- 1)Surgery- (Thoracotomy, VAT, wedge resection) used in Stage I and II
- 2) Chemo(cisplastin most common) used most often for small cell because of it's propensity to metastasize early, also used in other types when it's metastasized(Stage III, IV)
- 3)Radiation-› Can be used as a Definitive therapy in cancers that have not spread or be used as a Palliative therapy for: 1)Obstruction of bronchi 2) hemoptysis, 3)esophageal compression 4)brain and bome mets
- Radiation therapy also used for SVC syndrome which is an emergency
What are the three conditions considered emergencies in radiation therapy?
- 1)SVC syndrome
- 2) Spinal cord compression
- 3)Brain mets
Radiation therapy treatment techniques:
- 1)AP/PA, obliques, laterals,
- 2)IMRT(intensity-modulated radiation therapy)
- 3)Vac loc(for immobilization)
- 4)wing board to support arms
- 5)Breathing techniques(Gating)
Dose for NSCLC and Bronchogenic carcinoma:
6000-7500 cGy (180-200 daily)
larger dose for non small cell because it is more radioresistant because it doesn't divide as quickly as SCLS
Dose for SCLC:
4500-6000 cGy (180-200 daily)
Boost field doses:
Side effects from radiation therapy:
- 1)Pulmonary Fibrosis
- 2)Radiation pneumonitis
- 5)Esophagitis (most common)
- 6)Sore Throat
- 7)Spinal Cord Damage
- 8)Decreased blood counts
What is the most common side effect to RT for lung ca?
esophagitis which feels like an internal sunburn and usually develops two to three weeks after the initiation of radiation therapy. In addition, the person might feel a sharp, burning pain or food getting stuck in the chest when swallowing.
What is radiation pneumonitis?
is an inflammation of the lungs due to radiation therapy. Symptoms most commonly occur between 1 and 6 months after completing radiation therapy.
- Common symptoms include:Shortness of breath that is usually more notable with exercise, Chest pain, especially that which worsens with breathing. Cough, Low-grade fever
- Treatment is aimed at decreasing the inflammation. Steroids, such as prednisone, are given until the inflammation subsides and then slowly decreased over time.
What is Pulmonary Fibrosis?
scarring throughout the lungs
Critical structure doses:
- lung: 30%< 2000
- liver: 3500
- heart: 4300
- cord: 4500
- esophagus: 5000
- skin: 5500
- brachial plexus: 6000
- bone: 6500
What is the TD5/5 of the cord?
*(lower in private practice ≈ 4000 cGy) true for all values
TD5/5 for the heart:
TD5/5 for the liver:
TD5/5 for the skin:
TD5/5 for the brachial plexus:
TD5/5 for the esophagus?
TD5/5 for the lung:
30%< 2000 cGy