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Pulmonology > 08.26 - Lung Cancer (Nichols) - Questions > Flashcards

08.26 - Lung Cancer (Nichols) - Questions Flashcards

1
Q

What percentage of heavy smokers get lung cancer

A

11%

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2
Q

What percentages of lung cancer do the 3 most common make?

A

Adeno 40%, Squamous 20%, Small Cell 15%

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3
Q

Location of Adeno, Squamous, and Small Cell

A

Peripheral, Central, Central

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4
Q

Which is most commonly associated with paraneoplastic?

A

Small Cell

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5
Q

Which is most associated with post-obstructive pneumonia

A

Squamous

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6
Q

Which is most associated with hypercalcemia

A

Squamous

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7
Q

Median age at presenation for all

A

70

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8
Q

In which types is cough more common

A

Squamous and Small Cell because central

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9
Q

Small Cell is typically treated by

A

Chemotherapy, unless limited to chest and mediastinal lymph nodes (add radiation)

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10
Q

__ for EGFR mutation

A

Erlotinib

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11
Q

Erlotinib

A

EGFR mutation

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12
Q

Crizotinib

A

Translocated ALK

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13
Q

Targets translocated ALK

A

Crizotinib

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14
Q

70% of nonsmokers with lung cancer have

A

Adenocarcinoma

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15
Q

In Adenocarcinoma, often mutations in ___ in never-smokers and ___ in smokers

A

EGFR-dependent pathway in never-smokers, KRAS-dependent pathway in smokers

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16
Q

KRAS mutations confer resistance to

A

Erlotinib

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17
Q

Type most likely to be responsive to targeted therapy

A

Adenocarcinoma

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18
Q

4 Gross Path features of Adeno

A

Peripheral, Solitary, Infiltrate pleura, Spiculated

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19
Q

Most common micro type of Adeno

A

Acinar

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20
Q

Adeno types with poor prognosis

A

Micropapillary, Solid

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21
Q

Adeno types with good prognosis

A

Lepidic

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22
Q

Treatment for Adenocarcinoma

A

Surgery if low stage, Targeted (Erlotinib, Crizotinib), Radiation + Double Chemo if inoperable

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23
Q

Adenocarcinomas are more likely to have ___ mutations and almost never have __ mutations

A

EGFR, KRAS

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24
Q

Adeno in Situ is characterized by

A

Non-destructive growth along intact alveolar septa (lepidic growth)

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25
Q

2 Types of Adeno In Situ and Pathogenesis

A

Non-mucinous from terminal respiratory unit cells (EGFR); Mucinous from Bronchiolar Epithelium (KRAS)

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26
Q

Gross Path of Adeno In Situ

A

Single or Multifocal Nodules, or pneumonia-like consolidation

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27
Q

Micro Path of Adeno In Situ

A

Replaces alveolar lining

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28
Q

Symptoms and Signs of Adeno In Situ

A

majority have none

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29
Q

Tx of Adeno In Situ

A

Surgery; Erlotinib or Crizotinib if applicable; Chemo

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30
Q

Two defining features of Squamous Cell

A

Keratinization and/or Intracellular Bridges

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31
Q

Pathogenesis of Squamous Cell

A

Squamous metaplasia of bronchial mucosa

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32
Q

Hypercalcemia

A

Squamous Cell

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33
Q

Paraneoplastic Syndrome

A

Small Cell

34
Q

Gross Path of Squamous Cell

A

Central, Endobronchial (obstructive), Commonly met to local lymph nodes at presentation

35
Q

Keratin Pearls

A

Squamous Cell

36
Q

4 key features of Squamous Cell

A

Central, Endobronchial, Cavitating, Hemorrhage (Hemoptysis)

37
Q

3 most common mutations in Small Cell

A

RB, RASSF1, Telomerase

38
Q

Most aggressive type of lung cancer

A

Small Cell

39
Q

Gross Path of Small Cells (4 features)

A

Central, Parabronchial, Already mets, Multifocal necrosis

40
Q

1 common sign and symptom of small cell

A

Weight Loss, Edema

41
Q

Tx of Small Cell

A

Chemo with platin + etoposide, usually with radiation

42
Q

3 important concept points about Small Cell

A

Met at presentation, Responsive to chemo, rapidly fatal despite being responsive

43
Q

3 most common primary sites of lung mets

A

Breast, Colon, Stomach

44
Q

__ tend to met to lungs because spread hematogenously

45
Q

Size of mets vs primary in lungs

A

Smaller, rounder, more rapidly growing

46
Q

Location of mets vs primary in lungs

A

Peripheral, less endobronchial, more rapidly growing

47
Q

Lymphangitic Carcinomatosis

A

Mets can fill lymphatics and infiltrate interstitium with mass lesion

48
Q

Micro Path of Mets

A

Adenocarcinoma

49
Q

Treatment of Lung Mets

A

Cytotoxic Chemo, Targeteds

50
Q

Carcinoid tumors are low-grade malignant ___ neoplasms

A

Neuroendocrine epithelial

51
Q

Symptoms of Carcinoid

A

Persistent Cough, Hemoptysis

52
Q

Epidemiology of Carcinoid Tumors

A

Under age 40, up to 40% nonsmokers

53
Q

Gross Path of Carcinoid Tumors

A

Endobronchial polypoid mass or peripheral nodule

54
Q

Pathogenesis of Mesothelioma

A

Deletion of CDKN2A/INK4A

55
Q

Gross path of Mesothelioma

A

Soft, gelatinous, grayish tumor - Large pleural effusion

56
Q

Signs of Mesothelioma

A

Unilateral dullness to percussion at base, decr breath sounds, asymmetric chest wall expansion

57
Q

Chest pain is usually a sign of

A

chest wall involvement. And/or parietal pleura involvement.

58
Q

Cancer most associated with smoking

A

Small Cell

59
Q

Pattern of Adenocarcinoma that makes glands, with desmoplastic reaction

60
Q

Desmoplastic Reaction =

A

Fibrous tissue between glands

61
Q

In clinical scenario of non-resolving pneumonia, think

A

adenocarcinoma in situ (resembles consolidation of pneumonia)

62
Q

2/3 of squamous cell arise from

A

big central bronchi

63
Q

Why does squamous cell cause obstructive symptoms

A

Endobronchial

64
Q

Most likely to cavitate

65
Q

Commonly associated with post-obstructive pneumonia, abscess, bronchiectasis, mucus plugging, and atelectasis

A

Squamous Cell

66
Q

3 things that cavitate

A

Squamous Cell, TB, Wegener’s

67
Q

50% of patients with metastatic lung cancer will have met in

A

adrenal glands

68
Q

Central lesion on radiology =

A

Squamous Cell

69
Q

Peripheral lesion on radiology =

A

Adenocarcinoma

70
Q

Central lesion on radiology, but lesion small compared to adenopathy =

A

Small Cell

71
Q

Cavitation =>

A

Squamous Cell

72
Q

Salt and Pepper Nucleus

A

Small Cell Carcinoma

73
Q

Fastest growing type

A

Small Cell

74
Q

Which stages can be surgically resected

75
Q

What is Stage 3

A

Nodes involved and/or locally really bad

76
Q

Stage 4 means

77
Q

Treatment for Stage 3

A

Combined Chemo + Radiation

78
Q

Structures that look like glands but aren’t

A

Carcinoid Tumor

79
Q

3 sites of mets to lungs per muthiah

A

Breast, Colon, Kidney

80
Q

Soft, gelatinous, grayish

A

Think mesothelioma

Pulmonology (31 decks)

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