42: Lung Neoplasms - Carnevale

Question 1

you observe a coin lesion on CXR: is it more likely to be malignant or benign?

Answer 1

benign 51-65%
- granulomas (most common), abscess, etc

malignant 35-49%
- metastasis (most common), primary lung cancer

Question 2

most common primary sites for metastatic lung carcinoma

Answer 2

breast
stomach
pancrease
colon

see multiple cannonball lesions on CXR

Question 3

the ONLY benign lung tumor

Answer 3

pulmonary hamartoma

Question 4

most primary lung cancers are classified as..

Answer 4

carcinomas 90-95%

Question 5

common symptoms of lung cancer

Answer 5

cough
weight loss
dyspnea
chest pain

also suspect cancer in a pt greater than 40 with bloody sputum

Question 6

overall survival rate at 5 yr

Answer 6

less than 15%

Question 7

1-10% of lung cancer patient have paraneoplastic syndromes. Which of these syndromes is not like the others?

Answer 7

all are neuroendocrine (cushing, carcinoid, hypocalcemia, etc.)

except for hypercalcemia - PTH, prostaglandin E- which relates to squamous

Question 8

clubbing of fingers aka

Answer 8

hypertrophic pulmonary osteoarthropathy

Question 9

result of local growth of tumor from lung apex directly into brachial plexus

Answer 9

pancoast tumor

usually involves 1st and 2nd thoracic nerves, as well as 8th cervical nerve

–> arm pain, horner;s syndrome

Question 10

what type of tumor is a pancoast tumor usually?

Answer 10

squamous cell carcinoma

Question 11

what is horner syndrome and what is it associated with?

Answer 11

enophthalmos, ptosis
miosis
anhidrosis

associated with pancoast tumors

Question 12

most important factor for lung cancer

Answer 12

smoking

90% of lung CA smoking related

Question 13

precursor lesions to lung cancer

Answer 13

squamous dysplasia and carcinoma in situ

atypical adenomatous hyperplasia

diffuse idiopathic neuroendocrine cell hyperplasia

Question 14

what are the 4 different tumor classifications in the lung?

Answer 14

non-small cell carcinomas: -adenocarcinoma

• squamous cell carcinoma
• large cell carcinoma

small cell carcinoma

Question 15

difference between non-small cell carcinomas and small cell carcinomas

Answer 15

75% non-small cell
25% small cell

surgery is never done with small cell carcinomas!- separation is based on response to treatment

Question 16

most common lung cancer in women, younger patient, non-smokers

Answer 16

adenocarcinomas

Question 17

key histological feature of adenocarcinomas

Answer 17

gland and mucin production

Question 18

lepidic

Answer 18

grows along preexisting alveolar wall, preserves architecture

bronchioloalveolar carcinoma

Question 19

precursor lesion to bronchioloalveolar carcinoma

Answer 19

atypical adenomatous hyperplasia

Question 20

key histological feature is keratin “keratin pearls”

Answer 20

squamous cell carcinoma

Question 21

superior vena cava syndrome = __. what is it associated with?

Answer 21

squamous cell carcinoma

compression results in severe veous and lympahatic congestion of upper body

pancoast tumors are also associated with squamous cell carcinoma

Question 22

is there pleural involvement with squamous cell carcinoma? bronchioloalveolar carcinoma?

Answer 22

YES;

NO

Question 23

precursor lesion to squamous cell carcinoma

Answer 23

carcinomain situ

Question 24

most malignant of all lung cancers

Answer 24

small cell carcinoma

majority are already metastatic at diagnosis

very aggressive and rapid

1 yr survival with treatment

Question 25

can you treat small cell carcinoma with surgery?

Answer 25

nope

chemo is the treatment of choice

Question 26

“oat cell carcinoma” with high N/C ratio

Answer 26

small cell carcinoma

little cytoplasm, round cells

Question 27

undifferentiated cells, diagnosis of exclusion

Answer 27

large cell carcinoma

Question 28

operability is determined by…

Answer 28

staging

absence of metastatic disease

Question 29

lung cancer staging system

Answer 29

TNM

T1-4 tumor size and involvement of other structures

N0-3 lymph node involvement and spread

M0-1 metastasis not present or present

Question 30

which tumor has the highest 5 yr survival rate? lowest?

Answer 30

bronchiolalveolar CA

small cell CA

Question 31

to where do primary lung CA metastasize?

Answer 31

lymph nodes #1
adrenal
liver 
brain 
bone 

in order of %

Question 32

COD for lung CA

Answer 32

pneumonia
lung abscess
bleeding
 fistula
organ metastasis

Question 33

is there a relationship between smoking and carcinoid tumors?

Answer 33

no

young adults too

Question 34

treatment for carcinoid tumors

Answer 34

surgical excision

Question 35

what are tumorlets?

Answer 35

benign small clusters of hyperplastic neuroendocrine cells

diffuse idiopathic pulmonary neuroendocrine cell hyperplasia may be precursor

Question 36

what is carcinoid syndrome? what are the symptoms?

Answer 36

intermittent attacks of diarrhea, flushing, bronchoconstriction and cyanosis; most often associated with serotonin production

produced rarely by carcinoids also produced by small cell carcinomas

Question 37

may be part of continuum of aggressiveness: carcinoid –> atypical carcinoid –>

Answer 37

small cell carcinoma

Question 38

benign primary pleural tumors

Answer 38

pleural fibroma

Question 39

malignant primary pleural tumors

Answer 39

malignant mesothelioma

Question 40

t or f: asbestos workers are more likely to die of primary lung caner than malignant mesothelioma

Answer 40

true

Question 41

what type of pattern is malignant mesothelioma?

Answer 41

severe restrictive pattern - encases lungs