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Pulm by Minnie: AH Update > 177: Lung Cancer > Flashcards

177: Lung Cancer Flashcards

1
Q

What kind of lung cancer is this?

How do you know?

A

Adenocarcinoma

Glandular structures are present
(Simple columnar epithelium)

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2
Q

A biopsy of squamous cell carcinoma will show…

A

Keratin pearls

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3
Q

True or false:

Lung cancer has the highest annual incidence of cancer among men and women in the United States

A

False

It is the leading cause of cancer death, but not the leading new diagnosis

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4
Q

What is facial plethora?

What might it indicate?

A

Facial Plethora
A person’s face turns bright red when they raise their arms

Concerning for a tumor in the chest that is compressing the SVC (vessel obstruction)

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5
Q

Where are squamous cell carcinomas usually located?

A

Centrally

Near the hilum, can create cavitary lesions

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6
Q

Paraneoplastic syndromes are most often associated with what type of lung cancer?

A

Small cell lung cancer

Pareneoplastic syndrome:

  • ectopic production of hormones
  • development of antibodies
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7
Q

What is the treatment for small cell carcinoma?

A
  • Limited stage
    • Chemotherapy + radiation
    • Curative intent
  • Extensive stage
    • Chemotherapy + immunotherapy
    • Palliative intent
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8
Q

What kind of lunc cancer is this?

How do you know?

A

Small cell lung cancer

Small, densely packed blueish cells with neuroendocrine differentiation

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9
Q

What kinds of lung cancers cause central tumors?

A

Usually smoking-related tumors

  • Squamous cell
  • Small cell
  • Sometimes adenocarcinoma
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10
Q

What is the goal of treatment for stage I-III lung cancer?

A

Curative intent

May involve surgery, surgery + chemo, surgery + chemo + other

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11
Q

How do you identify a site for biopsy when working up a patient with suspected lung cancer?

A

Use imaging to determine whether there is a chance it has metastasized

If so, biopsy the distant site- can confirm diagnosis and staging with one test

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12
Q

What are the most common sites of metastatic lung disease?

A
  • Pleura
  • Bone
  • Brain/spine
  • Liver
  • Adrenal glands
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13
Q

What are the 3 mainstays of treatment for stage IV lung cancer?

A

In general, therapy is palliative. Make specific as possible to prolong survival and manage symptoms

  • Chemotherapy
  • Targeted therapy: Molecular targets
  • Immunotherapy: Stimulate the immune system to attack cancer cells
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14
Q

What kinds of lung cancers cause peripheral tumors?

A

Adenocarcinoma

Large cell carcinoma

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15
Q

Most patients with lung cancer present with state ____ disease

A

Most patients with lung cancer present with state 4 (metastatic) disease

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16
Q

What is the difference in presentation between tumors that cause SVC syndrome and pancoast tumors?

A

Tumors that cause SVC syndrome are likely obsructing the superior vena cava

Pancoast tumors are apical, and result in nerve impingement

17
Q

What is the leading cause of cancer-related deaths in America?

A

Lung cancer

18
Q

How is lung cancer diagnosed?

A
  • Tissue sampling is required
    • Biopsy a distant site if metastatic disease is suspected
    • Usually performed if imaging/other signs are concerning
19
Q

Where are adenocarcinomas usually located?

A

May be central or peripheral

20
Q

What is the goal of treatment for stage IIIC/IV lung cancer?

A

Palliative (manage symptoms, prolong survival)

Most conducive to personalized therapy based on molecular and PDL1 analysis

21
Q

What kind of lunc cancer is this?

How do you know?

A

Squamous cell carcinoma

  • Squamous cells present
    • Flat-ish, scaly appearance
  • Can see keratin pearls

(A subset of NSCLC)

22
Q

What are the signs of pancoast tumor?

A

Pancoast tumor is an apical tumor that causes nerve impingement

  • Shoulder pain
  • Brachial plexus abnormalities
  • Horner’s syndrome: constricted pupils, drooping eyelids, absence of sweating
  • Hoarseness
    • Due to impingement of laryngeal nerves
23
Q

_________ lung cancer occurs almost exclusively in smokers

A

Small cell lung cancer occurs almost exclusively in smokers

24
Q

What kinds of lung tumors have neuroendocrine differentiation?

A

Small cell tumors

Carcinoid tumors

25
Q

What causes Horner’s syndrome?

What are the signs?

A

Horner’s syndrome is caused by a pancoast tumor that causes nerve impingement

  • Constricted pupil (miosis)
  • Drooping of the upper eyelid (ptosis)
  • Absence of sweating of the face (anhidrosis)
26
Q

What is the most common type of lung cancer seen in never smokers?

A

Adenocarcinoma

(a subset of NSCLC)

27
Q

Which pareneoplastic syndrome is associated with squamous cell carcinoma?

A

Hypercalcemia

28
Q

What hormone might be produced by carcinoid tumors?

A

Serotonin

  • Causes carcinoid syndrome: flushing and diarrhea
29
Q

What are the signs of SVC syndrome?

What might this indicate?

A
  • Signs
    • Facial plethora
    • Dilated collateral veins along the chest
    • Extremity edema
    • Headaches

These signs are caused by obstruction of the superior vena cava, which likely indicates the growth of a tumor

30
Q

What symptoms of advanced lung disease might give us an indication of the location of the tumor?

A
  • Nerve impingement
    • Pancoast tumor
    • Located in the apex of lungs
  • SVC syndrome (Pamberton’s sign)
    • Tumor compresses the SVC
  • Hoarseness
    • Tumor affects laryngeal nerves or larynx
31
Q

Which type of lung cancer is the most prevalent in the united states?

A

Non-Small Cell Lung Cancer (NSCLC)

32
Q

What is a pancoast tumor?

A

An apical lung tumor that causes nerve impingement

33
Q

A biopsy of adenocarcinoma lung cancer will show…

A

Glandular structures

34
Q

What is the leading risk factor for lung cancer?

A

Smoking

However, not all lung cancer patients have a smoking history

35
Q

What information is important to understand when analyzing a lung or tissue biopsy concerning for lung cancer?

A
  • Histology
    • Cell of origin
  • Molecular analysis
    • Mutation driving the tumor
    • Can match with specific drugs
  • PDL1 analysis
    • Interaction of the tumor with the immune system
    • Can we get the immune system to help fight the tumor?
36
Q

What is the average 5-year survival for lung cancer?

A

21%

37
Q

Hypercalcemia is usually see in which type of lung cancer?

A

Squamous cell carcinoma

38
Q

How is small cell lung cancer staged?

A
  • Limited = Within one hemithorax
    • Cure possible with radiation
  • Extensive = extends beyond one hemithorax
    • Cannot be cured
39
Q

Describe the progression and prognosis of small cell lung cancer

A

Rapidly growing, aggressive tumors

Prognosis is not good

Pulm by Minnie: AH Update (34 decks)

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