25 Lung tumors

Question 0

Other factors causing Bronchogenic carcinoma

Answer 0

Air pollution-

- Radon exposure - indoor and in miners

Question 1

Bronchogenic Carcinoma industrial hazards

Answer 1

Radiation - i.e. atomic bomb survvivors
Uranium miners
Asbestosis

Question 2

Genes associated with Bronchogenic Carcinoma

Answer 2

Oncogenes- Cmyc(small cell carcinoma), (adenocarcinoma) —> Kras, EGFR, EML4-ALK

Tumor Supressor- p5, RB, short arm of chroomosome 3

Question 3

Benzopyrene mech

Answer 3

Causes damager to p53 gene

Question 4

Bronchogenic carcinoma etiology

Answer 4

“Scar cancer” ?? - occurs in vicinity of scarring
usually adenocarcinoma
May actually be that scar is response not cause of tumor

Question 5

Bronchogenic carcinoma epidemiology

Answer 5

• present in 50s y.o.
• 7 months of symptoms usually- cough(70%), weight loss(40%), chest pain(40%), dyspnea (20%)
• increased sputum production (can get some malignant cells in sputum)
• frequently diagnosed 2/2 mets

Question 6

Bronchogenic carrcinoma classifications

Answer 6

Small cell carcinoma
-oat cell- lymphocyte like
-intermediate cells - polygonal
-combined - usually woth squamous
Non small cell carcinoma
-squamous cell- epidermoid carcinoma ***COMMON****
-adenocarcinoma ***COMMON****
    *glandula with mucin, papulllar, solid, bronchioalveolar
-Large cell carcinoma
-Adenosquamous carcinoma

Question 7

Other syndromes assocaited with lung tumors

Answer 7

Pneumonia/abscess/lobar collapes
Lipid pneumonia
Pleural eddusion
hoarsness
dysphagia
rib distruction SVC syndrom/horners - pancoast tumor
***

Question 8

Pancoast tumor

Answer 8

Tumor at apex of lung
- involvement of superior vena cava
- involvement of superior cervical ganglion- horners
Ipsilateral ptosis, myosis, anhydrosis

Question 9

Chemo response in bronchogenic carcinoma

Answer 9

Non small cell carcinoma- surgery may be an option- can remove lower stage tumors

Small cell carcinomas treated with chemo and radiation

Question 10

Bronchogenic carcinoma treatment advances

Answer 10

• Mutation specific: EGFR- treat with tyrosine kinase inhibitor, Kras, and EML4-ALK mutations (ADENOCARCINOMAS
• VEGF antibody- Bevacizumab- not for squamous cell carcinoma (hemmorrhhhage)
• Premetrexed- active in non squamous cell carcinoma

Question 11

Smoking and bronchogenic carcinomas

Answer 11

Smokers 10x greater risk
Heavier smokers 20x
STOPPING FOR 10 YEARS RETURNS TO BASELINE

Question 12

Small cell carcinoma

Answer 12

20-25% bronchogenic carcinomas
100% SMOKERS
WORSTPROGNOSIS
Endobronchial growth with small polyps
neuroendicrine granules
usually already advanced stage
do respond to chemo- but its usually too late

Question 13

Small cell histo

Answer 13

GROWS AROUND BRONCHIOLES

Small round blue cells like lymphocytes
Crush artifact
extensive necrosis

Question 14

Non-Small Cell bronchogenic carcinomas

Answer 14

Squamous
Adeno
-Bronchioloalveolar
Large cell
Adenosquamous

***May be able to treat with surgery if caught early

Question 15

Squamous cell carcinomea

Answer 15

23-40% of bronchogenic carcinoma
Most common in males with cigarette smoking
Cavitary Necrosis
Endobronchial in large bronchi (main or lobar)
Histo- Keratin formation- SQUAMOUS PEARLS intracellular bridges

Question 16

Adenocarcinoma

Answer 16

25-45% bronchogenic carcinomas
Most common in women and nonsmokers
MOST COMMON IN USA
Usually peripheral
Slow growing- asymptomatic, usually metastasize before diagnosis

Question 17

Adenocarcinoma histology

Answer 17

Glandular
-May be glandular with epithelioid lining
Solid
-large sheets of cells - no glands
Papillary
-fingerlike projections into alveoli
BRONCHIOLOALVEOLAR
-follows alvoelar septa "Lepidic"

Question 18

Bronchioloalveolar

Answer 18

1-9% all lung cancers
subset of adenocarcinoma
Goss histology- FOLLOWS ARCHITECTURE OF LUNG
*Nonmucinous(clara cells and type II pneumocytes) 66% of cases
-Nodular (single or multifocal)
-No mucin vacuoles lining epithelium on LM
*Mucinous (tall columnar cells) 33% of cases
-Diffuse infiltrates(pneumonia like and slimy)- AGRESSIVE
- Mucin vacuoles on columnar cells in epithelium

Question 19

Large cell carcinoma

Answer 19

10-15% of bronchogenic carcinoma
pleomorphic large cells with giant cells- some semblance of glandular or squamous
Poor prognosis (6%) 5 year survival

• Giant cell carcinoma
  
  • most malignant
  • peripheral
  • <10 month surival

Question 20

Adenosquamous carcinoma

Answer 20

1-3% of bronchogenic carcinomas

Peripheral scarred tumor with adeno and squamous together

Question 21

Bronchogenic CA spread

Answer 21

Hilar lymph nodes
Adrenals
Liver
Brain
Bone

Question 22

TNM staging

Answer 22

T 1-4,
- 1 no bronchus or pleural,
- 2 involving bronch 2cm from crania
- 3 involves chest walls or other anatomy
- 4 involves mediastinum, heart,other important anatomy may be with malignant PE
N 0-3
- 0 no nodes
- 1 hilar or peribronchial nodes
- 2 mediastinal or subcarinal ipsilateral
- 3 contralateral spread or supraclavicular
M 0-1
- 0 no mets
- 1 mets

Question 23

Cancer class staging

Answer 23

Stage I- no nodes T1 or 2
Stage II - nodes T1or2, no nodes T3
Stage III - T3 with 1 node, or any with nodes 2 or above
Stage IV- Metastatic

Question 24

Paraneoplastic syndromes

Answer 24

Symptom complexes in CA patients not directly due to cancer 1-10% cancer patients

• cushings (ACTH)
• Hyponatremia (ADH)
• Carcinoid (serotonin)
• Hypercalcemia(PTH)
• Myasthenic syndrome

Question 25

Carcinoid tumors

Answer 25

1-5% lung tumors
Younger patients
Usually low grade
usually well circumscribed fleshy mass within bronchus
GOOD PROGNOSIS. 
RARE mets
Surgical excision

Question 26

Carcinoid histology

Answer 26

Salt and pepper chromatin
monomorphic cells
no mitoses
round to ovoid