111714 lung tumors Flashcards
bronchogenic carcinomas account for what percent of lung tumors?
90-95
where bronchogenic carcinomas originate?
bronchial (or bronchiolar) epithelium
causes of bronchogenic carcinoma
tobacco smoke
industrial hazards (radiation, uranium miners, asbestos)
air pollution (radon)
molecular genetics
clinical features of bronchogenic carcinoma
cough weight loss chest pain dyspnea (20%) increased sputum production
if you have tumor obstruction of airway, what clinical features can you see?
pneumonia, abscess, lobar collapse
pancoast tumor
tumor at the extreme apex of lung
involvement of superior cervical sympathetic ganglion, producting Horner’s syndrome (ipsilateral lid lag, miosis, ipsilateral anhydrosis)
classification of bronchogenic carcinomas
small cell carcinoma
non small cell carcinoma (squamous cell carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma, etc)
classified based on response to chemo. small cell carcinoma is treated with chemo, followed possibly by ablation-there is NO role for surgery. non small cell may need surgery.
features of adenocarcinoma
glandular (acinar) with mucin
papillary
solid
lepidic bronchioloalveolar
squamous cell carcinoma
cigarette smoker
CENTRAL CAVITARY NECROSIS
usually arise CENTRALLY (main or lobar bronchi)
usually endobronchial, polypoid growth
diagnostic features of squamous cell carcinoma on histology
intercellular bridges squamous pearls (made of keratin)
what is the most common bronchogenic carcinoma in men?
squamous cell carcinoma
what is the most common bronchogenic carcinoma in women and non-smokers?
adenocarcinoma (however, most pts with adenocarcinoma are smokers)
most common form of lung carcinoma in US
adenocarcinoma
location of adenocarcinoma
usually peripheral with pleural retraction or puckering
growth rate of adenocarcinoma
grows more slowly. metastasizes more frequently than squamous cell carcinoma
histology of adenocarcinoma
glandular (acinar) with mucin
some papillary
some solid
lepidic bronchioloalveolar
bronchioloalveolar carcinoma-define
subset of adenocarcinoma
what gross features of bronchioloalveolar carcinoma are possible?
single peripheral nodule
could have multiple nodules
some diffuse pneumonia-like infiltrate
histology of bronchioloalveolar carcinoma
lepidic spread (tumor cells spread along alveolar septa)
can be mucinous or non mucinous
where are small cell carcinomas located?
central
submucosal infiltration
outcome of small cell carcinoma
highly malignant
median survival is 4 months
small cell carcinoma
extensive necrosis-streaking
paraneoplastic syndrome
excellent response to chemo
large cell carcinoma, undifferentiated
pleomorphic, large cells w/o differentiation
giant cell carcinoma-peripheral
adenosquamous carcinoma
peripheral
sq cell carcinoma and adenocarcinoma in same neoplasm
clinical presentation and behavior similar to adenocarcinoma
