[03.18] CMD - Lung Cancer V2.1.pdf

Abnormal mass of tissue

What is the definition of a neoplasm?

Benign

What term describes a non-cancerous neoplasm?

Malignant

What term describes a cancerous neoplasm?

Primary

What type of lung neoplasm forms directly from lung tissue?

Metastatic

What type of lung neoplasm spreads to the lungs from another part of the body?

Non-small cell lung carcinoma

What is the most common primary malignancy of the lung?

SCLC

What is the acronym for small cell lung carcinoma?

NSCLC

What is the acronym for non-small cell lung carcinoma?

Small cell lung carcinoma

What does the abbreviation SCLC stand for?

Non-small cell lung carcinoma

What does the abbreviation NSCLC stand for?

Mesothelioma

Which primary malignant lung neoplasm is mentioned in the source besides SCLC and NSCLC?

Breast cancer, colon cancer, head and neck cancer, and kidney cancer

What are the four common primary cancers that metastasize to the lungs according to the source?

Second

Where does lung cancer rank among the most common types of cancer in the Philippines in 2022?

First

Where does lung cancer rank among cancers in Filipino males in 2022?

Fourth

Where does lung cancer rank among cancers in Filipino females in 2022?

Twelve point six percent

What percentage of all cancer cases in the Philippines in 2022 did lung cancer account for?

Twenty-three thousand seven hundred twenty-eight

What is the absolute number of lung cancer cases in the Philippines in 2022 mentioned in the source?

Second

Where does lung cancer rank in cancer-related mortality in the Philippines in 2022?

Breast cancer

To which cancer is lung cancer second in cancer-related mortality in the Philippines in 2022?

Ten times or greater

By how much does smoking increase the risk of all major types of lung cancer compared to non-smokers?

Smoke quitters

Between smoke quitters and those who continue to smoke, who has a lower risk of developing lung cancer?

Length of time the person has quit

What parameter dictates the size of lung cancer risk reduction in smoke quitters?

Cigarette smoking

What specific exposure is shown to increase the risk of all major types of lung cancer?

Environmental tobacco smoke

What does the acronym ETS stand for in the context of passive tobacco inhalation?

Secondhand smoke

What is another common term for environmental tobacco smoke?

Twenty to thirty percent

By what percentage does exposure to environmental tobacco smoke or secondhand smoke increase lung cancer risk?

Undefined

How is the impact of alternate nicotine delivery devices on the development of lung cancer currently characterized among users?

E-cigarettes and vapes

What are the two examples of alternate nicotine delivery devices mentioned in the source?

Asbestos, arsenic, mustard gas, and polycyclic hydrocarbons

What are the four occupational exposures linked to increased lung cancer risk in the source?

First degree relatives

Which specific family members of patients with lung cancer have an increased susceptibility to developing lung cancer?

Two- to three-fold

By how much is the risk of developing lung cancer increased in first-degree relatives of lung cancer patients?

Specific genes or genetic variants

What does the increased risk of lung cancer in first-degree relatives suggest, especially for non-smoking-related cases?

Ionizing radiation

What physical agent is described as an established lung carcinogen under risk factors?

Chronic bronchitis, emphysema, and pulmonary tuberculosis

What three prior lung diseases have been linked to an increased risk of lung cancer?

PTB

What is the acronym for pulmonary tuberculosis?

Stage at diagnosis

On what factor is the clinical outcome of lung cancer highly related?

Early detection of occult tumors

What specific process is assumed to lead to improved survival in lung cancer patients?

Screening tests, diagnosis, and early treatment

What three components are involved in the process of early detection?

Screening

What term refers to the use of tests across a healthy population to identify individuals with asymptomatic disease?

Target population must be high-risk and effective treatment that reduces mortality must be available

What two criteria must be met for a lung cancer screening program to be successful?

Low-dose, non-contrast, chest CT

What specific imaging modality is an effective tool to screen for lung cancer?

Fifty to seventy-seven years old

What is the eligible age range for lung cancer screening?

Current smoker or has quit in the past fifteen years

What are the smoking status eligibility criteria for lung cancer screening?

Greater than or equal to twenty

How many smoking pack-years are required for a patient to be eligible for lung cancer screening?

Pack-years

What term is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years smoked?

Packs of cigarettes smoked per day multiplied by years smoked

What is the mathematical equation to calculate smoking pack-years?

Over half

What proportion of lung cancer patients present with locally advanced or metastatic disease at the time of diagnosis?

Locally advanced or metastatic disease

In what disease stage do over half of lung cancer patients present at the time of diagnosis?

Primary lesion, local tumor growth, invasion or obstruction of adjacent structures, and growth at distant metastatic sites

What four factors explain the signs, symptoms, or lab abnormalities seen at presentation in lung cancer?

Bones, liver, brain, lymph nodes, and adrenal glands

What are the five most common sites of metastasis for lung cancer?

Persistent cough

What is the most common persistent clinical symptom of lung cancer, often described as on and off for months or years?

On and off cough that has lasted for months or even years

How is the persistent cough in lung cancer patients classically described?

Shortness of breath

Which common symptom may present as exertional dyspnea or easy fatigability?

Exertional dyspnea or easy fatigability

What are two ways shortness of breath may present in lung cancer patients?

Hemoptysis

What is the medical term for coughing up blood?

Persistent cough, shortness of breath, coughing up blood, unexplained weight loss, repeated respiratory infection, and pain

What are the six common symptoms of lung cancer listed in the source?

Shoulder, arm, chest, or back

What are the four locations of pain that a lung cancer patient might present with?

Tissue sampling

What diagnostic process is required and essential to confirm a diagnosis in all patients with suspected lung cancer?

Core needle biopsy

What is the preferred method of tissue biopsy to ensure adequate tissue for analysis in suspected lung cancer?

Core needle biopsy

Which biopsy type is preferred over fine needle aspiration to ensure adequate tissue for analysis in suspected lung cancer?

Bronchial or transbronchial biopsy, fine needle aspiration, and percutaneous biopsy

What are the three methods through which a core needle biopsy of the lung can be performed?

Central lesions

What term describes lesions such as squamous cell carcinomas, small cell carcinomas, or endobronchial lesions?

Squamous cell carcinomas, small cell carcinomas, and endobronchial carcinoid tumors

What are three examples of central lung lesions mentioned in the source?

Bronchoscopic examination

By what procedural diagnostic method are central lung lesions more readily diagnosed?

Peripheral lesions

What term describes lesions such as adenocarcinomas and large cell carcinomas?

Adenocarcinomas and large cell carcinomas

What are the two examples of peripheral lung lesions mentioned in the source?

Transthoracic biopsy

By what procedural diagnostic method are peripheral lung lesions more amenable to diagnosis?

Biopsy of a distant site of disease

In patients with suspected metastatic disease, what location of biopsy is preferred for concurrent tissue and staging confirmation?

Bronchoscopy, percutaneous biopsy of soft tissue/liver, and cell block from malignant pleural effusion

What are the three methods mentioned to obtain a biopsy of a distant metastatic site?

Malignant pleural effusion

From what pleural fluid collection can a cell block be obtained to confirm lung cancer metastasis?

Consider possible curative treatment

What is the clinical management recommendation for lung cancer patients in the absence of distant disease?

Precision-based medicine

What clinical approach is guided by the essential role of biomarker testing in lung cancer care?

Time of initial diagnosis

What is the ideal timing for performing biomarker testing in lung cancer patients?

Advanced stage NSCLC

For what specific group of lung cancer patients is biomarker testing recommended for all individuals?

Biomarker testing

What testing aims to identify specific molecular markers or genetic alterations in the tumor cells?

Next generation sequencing

What genetic diagnostic technique is typically performed on biopsy tissue to identify targetable mutations?

Targetable mutations or driver oncogenes

What specific molecular findings does biomarker testing aim to identify in tumor cells?

Targeted therapy

What clinical treatment approach is guided directly by identifying specific driver oncogenes through molecular profiling?

Determine appropriate treatment in resectable disease and avoid unnecessary procedures in advanced disease

What are the two major reasons why accurate staging of NSCLC is essential?

Surgery

What specific invasive therapeutic procedure is avoided in advanced NSCLC patients by performing accurate staging?

CT scan, PET scan, or preferably PET-CT scan

What three radiographic imaging modalities should all patients with NSCLC undergo initially?

Glucose metabolism

On what physiological process does PET scanning attempt to identify sites of malignancy?

Eighteen-Fluorodeoxyglucose

What radioactive tracer, abbreviated as 18-FDG, is measured during a PET scan?

Eighteen-FDG

What is the chemical abbreviation for 18-Fluorodeoxyglucose?

Hot spot

What visual term describes the appearance of rapidly dividing cells preferentially taking up 18-FDG on a PET scan?

Standardized uptake value

What does the acronym SUV stand for in the context of PET imaging interpretation?

Greater than two point five

What standardized uptake value on a PET scan is highly suspicious for malignancy?

Two point five

What is the numeric SUV threshold above which a lesion on PET is highly suspicious for malignancy?

Diabetes, smaller lesions under eight millimeters, and slow-growing tumors

What are three reasons for false negative results on a PET scan?

Under eight millimeters

Below what size threshold can pulmonary lesions present as false negatives on a PET scan?

Well-differentiated adenocarcinoma and carcinoid tumors

What are the two examples of slow-growing lung tumors that can cause false negatives on PET?

Infections and granulomatous diseases

What are the two broad causes of false positive results on a PET scan?

Pulmonary tuberculosis

What is the specific granulomatous disease mentioned as a cause of false positives on a PET scan?

PTB

What is the acronym for pulmonary tuberculosis mentioned as a PET false positive cause?

Never use PET-CT alone

What is the clinical rule regarding the sole use of PET-CT to diagnose lung cancer, mediastinal involvement, or metastasis?

Tissue biopsy

What confirmatory test is strictly required to validate findings of lung cancer, mediastinal involvement, or metastasis seen on PET-CT?

Large tumors

For what tumor size parameter is lymph node sampling specifically recommended in lung cancer patients?

When metastatic occurrence has been ruled out

In what clinical scenario must lymph node sampling still be done to ensure accurate regional staging?

EBUS-guided mediastinal staging, mediastinoscopy, or throracoscopy

What three procedures can be used to perform lymph node sampling for mediastinal staging?

All patients with enlarged nodes, enlarged tumors, or tumors occupying the inner third of the lung

What three clinical cohorts of patients must undergo lymph node sampling?