275 - Lung Cancer Flashcards
Lung tumors can cause hoarseness by compressing which structure?
Laryngeal nerve
Describe the following for Adenocarcinoma of the lung
- Location:
- Biopsy finding:
- Smoking Hx:
- Location: Anywhere (Central or peripheral)
- Biopsy finding: glandular structures
- seen in smokers and non-smokers
- Most common histology in never-smokers
Type of Non small cell lung cancer
What is the leading cause of cancer death in America?
Lung cancer
What stages of lung cancer can be treated with curative intent?
I - III
Late stage III and stage IV shoudl be treated with palliative intent
At what stage of lung cancer do patients often present?
Late stages (IV)
Early stages are often asymptomatic
In general, how do PDL1-inhibitors work?
Tumors that produce PDL1 turn off T-cells, which prevents them from fighting the tumor
PDL1 inhibitors block the tumor’s signaling, allowing T-cells to become activated against the tumor
What exposure is associated with mesothelioma?
Asbestos
Disease of the pleura
What kind of lung cancer is this?
Adenocarcinoma
Most common histology of NSCLC
A for Adeno - A lot (most common), Anyone (smokers and non-smokers), and Anywhere (central or peripheral)
In lung cancer, most paraneoplastic syndromes are associated with small cell lung cancer
What is one hormone NOT produced by SCLC? Which tumor produces it?
PTHrp
Squamous cell lung cancer (A type of NSCLC) produces PTHrp
Results in hypercalcemia without lytic bone lesions
Which type of lung cancer is most prevalent in the USA?
Non-small cell lung cancer
List 3 possible symptoms of a Pancoast tumor
- Shoulder pain
- Brachial plexopathy
- Horner syndrome –> Ptosis, miosis, absence of facial sweating
Caused by nerve impingement
- Note: Pancoast tumor refers to location in the apex of the lung, not a specific histological subtype*
- Compare to SVC syndrome, which will have more signs of vascular compression: dilated collateral veins, facial plethora, extremity edema, headaches*
Wha is the most common type of lung cancer seen in never smokers?
Adenocarinoma
- A type of NSCLC
- Bronchioalviolar carcinoma is a subtype of adenocarcinoma
List 3 types of non-small cell lung cancer
- Adenocarcinoma
- Bronchioalviolar is a subtype of adenocarcinoma
- Squamous cell
- Large cell
List 5 common sites of metastases from lung cancer
- Pleura
- Bone
- Brain/spine
- Adrenals
- Liver
List 3 substances that may be ectopically produced by SCLC
Paraneoplastic Syndromes:
- ADH -> hyponatremia
- ACTH -> Cushing syndrome (high cortisol)
- Antibodies against pre-synpatic Ca2+ channel
- > Lambert Eaton
- Proximal muscle weakness, improves with stimulation
What is the difference between limited and extensive stage?
Limited = 1 hemithorax, all disease encompassed in a single radiation port
Extensive = larger than this
Describe the following for Squamous cell lung cancer
- Location:
- Biopsy finding:
- Smoking Hx:
- Location: Central
- Biopsy finding: Keratin pearls
- Smoking Hx: Smokers (Rare in never-smokers)
**Associated with hypercalcemia - May secrete PTHrp**
Type of NSCLC
Which type of lung cancer is most often associated with paraneoplastic syndromes?
Small cell lung cancer
What kind of lung cancer is this?
Squamous cell carcinoma
C for Squamous cell - (bc the curve of the q looks like a c)
“Central, Cavitary, Calcium, Keratin”
Describe the following for Small cell lung cancer
- Location:
- Biopsy finding:
- Smoking Hx:
- Location: Central
- Biopsy finding: Small blue cells
- Smoking Hx: Smokers (rare in never smokers)
**Associated with paraneoplastic syndromes**
What kind of lung cancer is this?
Small cell lung cancer
S for Small cell - smokers, central, small blue cells, syndromes, agressive
Neuroendocrine cells are small and blue
When working up a patient with suspected lung cancer, what is the most appropriate site to biopsy?
First, firgure out if there might be distant/metastatic disease
If so, biopsy that site
A biopsy from a metastatic site allows you to both diagnose and stage lung cancer
List 4 symptoms of SVC syndrome
- Facial plethora
- Dilated collateral veins along the chest
- Extremity edema
- Headaches due to vascular congestion
Vs. Pancoast tumor, caused by nerve impingement, will likely have shoulder pain, nerve symptoms, and possible Horner syndrome
What locations of the body are affected by mesothelioma?
Sites of pleura:
- Peritoneal cavity
- Tunica vaginalis
- Pericardium
Associated with asbestos exposure
If a patient presents with hypercalcemia without bone metastases, which ligand is most likely responsible?
PTRrp (Parathyroid hormone related peptide)
Produced by squamous cell lung cancer
What are paraneoplastic syndromes?
Paraneoplastic syndromes can occur due to:
- ectopic production of hormone (ADH, ACTH)
- Development of antibodies (immune system producing antibodies against the tumor, but can attack healthy self tissue)
- Ex) Lambert Eaton
