177: Lung Cancer Flashcards
What kind of lung cancer is this?
How do you know?
Adenocarcinoma
Glandular structures are present
(Simple columnar epithelium)
A biopsy of squamous cell carcinoma will show…
Keratin pearls
True or false:
Lung cancer has the highest annual incidence of cancer among men and women in the United States
False
It is the leading cause of cancer death, but not the leading new diagnosis
What is facial plethora?
What might it indicate?
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)
Where are squamous cell carcinomas usually located?
Centrally
Near the hilum, can create cavitary lesions
Paraneoplastic syndromes are most often associated with what type of lung cancer?
Small cell lung cancer
Pareneoplastic syndrome:
- ectopic production of hormones
- development of antibodies
What is the treatment for small cell carcinoma?
- Limited stage
- Chemotherapy + radiation
- Curative intent
- Extensive stage
- Chemotherapy + immunotherapy
- Palliative intent
What kind of lunc cancer is this?
How do you know?
Small cell lung cancer
Small, densely packed blueish cells with neuroendocrine differentiation
What kinds of lung cancers cause central tumors?
Usually smoking-related tumors
- Squamous cell
- Small cell
- Sometimes adenocarcinoma
What is the goal of treatment for stage I-III lung cancer?
Curative intent
May involve surgery, surgery + chemo, surgery + chemo + other
How do you identify a site for biopsy when working up a patient with suspected lung cancer?
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
What are the most common sites of metastatic lung disease?
- Pleura
- Bone
- Brain/spine
- Liver
- Adrenal glands
What are the 3 mainstays of treatment for stage IV lung cancer?
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
What kinds of lung cancers cause peripheral tumors?
Adenocarcinoma
Large cell carcinoma
Most patients with lung cancer present with state ____ disease
Most patients with lung cancer present with state 4 (metastatic) disease
What is the difference in presentation between tumors that cause SVC syndrome and pancoast tumors?
Tumors that cause SVC syndrome are likely obsructing the superior vena cava
Pancoast tumors are apical, and result in nerve impingement
What is the leading cause of cancer-related deaths in America?
Lung cancer
How is lung cancer diagnosed?
- Tissue sampling is required
- Biopsy a distant site if metastatic disease is suspected
- Usually performed if imaging/other signs are concerning
Where are adenocarcinomas usually located?
May be central or peripheral
What is the goal of treatment for stage IIIC/IV lung cancer?
Palliative (manage symptoms, prolong survival)
Most conducive to personalized therapy based on molecular and PDL1 analysis
What kind of lunc cancer is this?
How do you know?
Squamous cell carcinoma
- Squamous cells present
- Flat-ish, scaly appearance
- Can see keratin pearls
(A subset of NSCLC)
What are the signs of pancoast tumor?
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
_________ lung cancer occurs almost exclusively in smokers
Small cell lung cancer occurs almost exclusively in smokers
What kinds of lung tumors have neuroendocrine differentiation?
Small cell tumors
Carcinoid tumors
What causes Horner’s syndrome?
What are the signs?
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)
What is the most common type of lung cancer seen in never smokers?
Adenocarcinoma
(a subset of NSCLC)
Which pareneoplastic syndrome is associated with squamous cell carcinoma?
Hypercalcemia
What hormone might be produced by carcinoid tumors?
Serotonin
- Causes carcinoid syndrome: flushing and diarrhea
What are the signs of SVC syndrome?
What might this indicate?
- 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
What symptoms of advanced lung disease might give us an indication of the location of the tumor?
- 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
Which type of lung cancer is the most prevalent in the united states?
Non-Small Cell Lung Cancer (NSCLC)
What is a pancoast tumor?
An apical lung tumor that causes nerve impingement
A biopsy of adenocarcinoma lung cancer will show…
Glandular structures
What is the leading risk factor for lung cancer?
Smoking
However, not all lung cancer patients have a smoking history
What information is important to understand when analyzing a lung or tissue biopsy concerning for lung cancer?
-
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?
What is the average 5-year survival for lung cancer?
21%
Hypercalcemia is usually see in which type of lung cancer?
Squamous cell carcinoma
How is small cell lung cancer staged?
- Limited = Within one hemithorax
- Cure possible with radiation
- Extensive = extends beyond one hemithorax
- Cannot be cured
Describe the progression and prognosis of small cell lung cancer
Rapidly growing, aggressive tumors
Prognosis is not good
