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Pulmonary - Matt > 2.1.2 Lung Cancer > Flashcards

2.1.2 Lung Cancer Flashcards

1
Q

When is the peak incidence of lung cancer? What is gender ratio?

A

6th and 7th decade of life

2:1 Males to females, possibly due to the greater number of male smokers

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2
Q

What are some risk factors for lung cancer?

A

SMOKING!!

Asbestos exposure

Radiation

Aromatic hydrocarbons

Metals: beryllium, nickel, arsenic

Hx of lung cancer

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3
Q

Tobacco usage accounts for what percentage of cancers globally?

A

20% (up to 30% in certain high income countries)

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4
Q

How many people does tobacco kill annually?

A

6 million

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5
Q

What are some genetic mutations/abnormal expressions associated with lung cancer?

A

EGFR mutation (AdCa)

K-ras mutation, cigarrette smoking (non-small cell Ca)

Myc overexpression (small cell Ca)

P53, Rb mutations (small cell Ca, non-small cell Ca)

Bcl-2 expression (SCC- adenoCa)

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6
Q

What are some of the possible local clinical features of lung cancer?

A
  • Cough, dyspnea, hemoptysis, pain, pneumonia, pleural effusion
  • Pancoast tumor (apex of lung)
  • Coin lesion
  • Pancoast syndrome (cervical sympathetic nerve paralysis)
  • Horner’s syndrome (endophthalmos, ptosis, meiosis, anhidrosis)
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7
Q

What is a possible medistinal clinical feature of lung cancer?

A

Superior Vena Cava Syndrome

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8
Q

Name 6 common paraneoplastic syndromes.

A
  1. Cushing syndrome -due to production of ACTH. It’s primarily associated with small cell carcinoma; also carcinoid tumors and other carcinomas such as large cell carcinoma.
  2. Inappropriate ADH secretion – – causing hyponatremia and greater osmolality of urine than blood. This is mainly associated with small cell carcinoma; occasionally adenocarcinoma.
  3. Carcinoid syndrome
  4. Hypercalcemia – – in the absence of skeletal metastasis is due to ectopic secretion of a PTH-like substance. This is associated predominantly with squamous cell carcinoma.
  5. Gynecomastia (Gonadotropin)
  6. Acromegaly (GH)
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9
Q

What are the five most common sites of lung cancer metastases?

A

Regional lymph nodes (most cases)

Liver, 30%

Adrenal glands, 50%

Bone, 15-20%

Brain, 20%

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10
Q

What are the four most frequent causes of death in patients with lung cancer?

A

Pneumonia, Lung abcesses, Bleeding, Effects of metastasis on other organs

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11
Q

Describe the 5-year survival rate of various types of lung cancer. Which is worst?

A

Small cell carcinoma is the worst

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12
Q

What are the two gross classifications of lung cancer?

A

Central (neoplasms in major bronchi, segmental bronchi, or greater than 1 mm in diameter)

Peripheral (lung parenchyma where bronchioles are less than 1 mm in diameter)

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13
Q

What are some of the benign epithelial lung cancers? malignant epithelial lung cancers?

A

Benign: adenomas, papillomas

Malignant: squamous cell carcinoma, small cell carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma, neuroendocrine tumors

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14
Q

Other than epithelial lung cancers, what are some possible types of lung cancer?

A
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15
Q

Name the top 4 most common lung cancers.

A

Squamous Cell Carcinoma (25-40%)

Adenocarcinoma (25-40%)

Small Cell Carcinoma (20-25%)

Large Cell Carcinoma (10-15%)

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16
Q

What are some clinical features of squamous cell carcinoma?

A
  • Hemoptysis, cough
  • Symptoms due to obstruction: recurrent pneumonia, atelectasis
  • Superior vena cava syndrome (severe venous and lymphatic congestion of the upper body due to compression or invasion of the superior vena cava. Results in dusky cyanosis & marked dilation of veins of head, neck, & arms)
  • Pancoast tumor/syndrome
  • Horner syndrome
  • Hypercalcemia (sec of PTH-like substance)
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17
Q

What are some of the factors that increased the likelihood of squamous cell carcinoma?

A

SMOKING, more frequent in males, centrally located

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18
Q

What are two key histologic features of squamous cell carcinoma?

A

Keratin pearl and desmoplastic (fibrous) stroma of tumor

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19
Q

What two markers can be useful in immunostains to help identify/accurately diagnose squamous cell carcinoma?

A

p63/p40

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20
Q

What is the most important prognostic factor in squamous cell carcinoma? What is the 5 year survival?

A

Clinical stage; 15%

21
Q

What is the common location of adenocarcinoma? Which gender is commonly affected?

A

Peripherally located (75%), most common type in women

22
Q

What are some the various forms/presentations of adenocarcinomas? (6)

A
  1. Acinar adenocarcinoma
  2. Solid carcinoma with mucous formation (formerly large cell carcinoma)
  3. Papillary adenocarcinoma - finger-like projections
  4. Micropapillary adenocarcinoma - small finger-like projections
  5. Inv mucinous adenocarcinoma
  6. Lepidic-pattern adenocarcinoma
23
Q

What type of adenocarcinoma?

A

Acinar

24
Q

What is the substance stained red?

A

Mucin

25
Q

Identify the various adenocarcinoma patterns

A
26
Q

What is the new name for bronchioloalveolar adenocarcinoma?

A

Lepidic-adenocarcinoma

27
Q

What are the two types of lepidic-adenocarcinoma?

A

Mucinous and non-mucinous

28
Q

What are the genetic mutations associated with some of histologic variants of BAC?

A
29
Q

What is the 5 year survival prognosis of adenocarcinoma?

A

15-20%

30
Q

What is the 5 year survival prognosis of lepidic adenocarcinoma?

A

42%, prognosis is worse for diffuse form

31
Q

What biomarkers is useful in determining whether an adenocarcinoma is a primary tumor or metastatic tumor?

A

Thyroid-transition factor 1 (TTF-1), presence indicates that is likely of lung origin

32
Q

What are some of the molecular targets in NSCLC?

A
33
Q

Describe how IHC markers (TTF-1, p63, CK5/6) can be used to determine the type of cancer.

A
34
Q

What are the four types of neuroendocrine tumors and their differentiation status?

A
35
Q

What type of neuroendocrine tumor is bronchial carcinoids? Typical age of onset?

A

Well differentiated neuroendocrine Ca; average age of 45 (with wide range)

36
Q

What is the most common type of bronchial carcinoid?

A

Central Carcinoid (90%)

Less common forms include peripheral and atypical

37
Q

Where do central bronchial carcinoids typically arise? invade?

A

Typically arise in segmental or larger bronchi as polypoid exophytic mass projecting into lumen. Typically invade into bronchial wall.

38
Q

What this be?

A

Central carcinoid

39
Q

How are atypical bronchial carcinoids different from central bronchial carcinoids?

A

Increased mitotic activity

Tumor necrosis

Increased cellularity

Moderatelly differentiated

High N/C ratio

40
Q

What are some of the general characteristics of small cell carcinoma?

A

Male:Female ratio of 2:1

Associated with SMOKING

Usually Central

“oat cell carcinoma”

41
Q

Yo doc, I have this mass in my lungs. Can you tell me what this is?

A

Small Cell Carcinoma

42
Q

What are those?!?!

A

Oat Cells (small dots of hyperchromatic nuclei)

43
Q

What type of carcinoma is this?

A

Smal cell carcinoma (the combined type)

44
Q

Why might small cell carcinoma have such a poor 5 year survival rate?

A

Generally metastatic by the time a diagnosis is made

45
Q

Use TTF-1, Neuroendocrine markers (chromo, synaptophysin, CD56), and Ki67 to differentiate b/t typical carcinoid, atypical carcinoid, large cell neuroendocrine Ca, small cell Ca.

A
46
Q

What are some common features of hamartoma?

A

common benign tumor

usually peripheral

usually asymptomatic and slow growing

“coin lesion”

cartilage, bone, fat, muscle, CT

47
Q

What are three things that might lead you to think a tumor is a metastasis?

A

Multiple nodules, Lymphangitic metastasis, solitary (coin lesion)

48
Q

What are the two phases of malignant mesothelioma?

A

epithelial-like cells, spindle cells

Pulmonary - Matt (47 decks)

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