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Pulmonary TJ > 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?

24
Q

What is the substance stained red?

25
Identify the various adenocarcinoma patterns
26
What is the new name for bronchioloalveolar adenocarcinoma?
Lepidic-adenocarcinoma
27
What are the two types of lepidic-adenocarcinoma?
Mucinous and non-mucinous
28
What are the genetic mutations associated with some of histologic variants of BAC?
29
What is the 5 year survival prognosis of adenocarcinoma?
15-20%
30
What is the 5 year survival prognosis of lepidic adenocarcinoma?
42%, prognosis is worse for diffuse form
31
What biomarkers is useful in determining whether an adenocarcinoma is a primary tumor or metastatic tumor?
Thyroid-transition factor 1 (TTF-1), presence indicates that is likely of lung origin
32
What are some of the molecular targets in NSCLC?
33
Describe how IHC markers (TTF-1, p63, CK5/6) can be used to determine the type of cancer.
34
What are the four types of neuroendocrine tumors and their differentiation status?
35
What type of neuroendocrine tumor is bronchial carcinoids? Typical age of onset?
Well differentiated neuroendocrine Ca; average age of 45 (with wide range)
36
What is the most common type of bronchial carcinoid?
Central Carcinoid (90%) Less common forms include peripheral and atypical
37
Where do central bronchial carcinoids typically arise? invade?
Typically arise in segmental or larger bronchi as **polypoid exophytic mass projecting into lumen.** Typically invade into bronchial wall.
38
What this be?
Central carcinoid
39
How are atypical bronchial carcinoids different from central bronchial carcinoids?
Increased mitotic activity Tumor necrosis Increased cellularity Moderatelly differentiated High N/C ratio
40
What are some of the general characteristics of small cell carcinoma?
Male:Female ratio of 2:1 Associated with SMOKING Usually Central "oat cell carcinoma"
41
Yo doc, I have this mass in my lungs. Can you tell me what this is?
Small Cell Carcinoma
42
What are those?!?!
Oat Cells (small dots of hyperchromatic nuclei)
43
What type of carcinoma is this?
Smal cell carcinoma (the combined type)
44
Why might small cell carcinoma have such a poor 5 year survival rate?
Generally metastatic by the time a diagnosis is made
45
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.
46
What are some common features of hamartoma?
common benign tumor usually peripheral usually asymptomatic and slow growing "coin lesion" cartilage, bone, fat, muscle, CT
47
What are three things that might lead you to think a tumor is a metastasis?
Multiple nodules, Lymphangitic metastasis, solitary (coin lesion)
48
What are the two phases of malignant mesothelioma?
epithelial-like cells, spindle cells

Pulmonary TJ (38 decks)

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