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Alex's First Aid Cards > 609 - 610 - Lung Cancer > Flashcards

609 - 610 - Lung Cancer Flashcards

1
Q

How does lung cancer present?

A
  1. cough
  2. hemoptysis
  3. wheezing
  4. bronchial obstruction
  5. pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT
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2
Q

Are primary neoplasms or metastases more common in the lungs?

A

metastases

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3
Q

What are the common sites of metastasis from lung cancer?

A
  1. Adrenals
  2. Brain
  3. Bone (→ pathologic fracture)
  4. Liver (→ jaundice, hepatomegaly)
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4
Q

What are the complications of lung cancer?

A 
SPHERE of complications:
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)
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5
Q

What is the only type of lung cancer that is not associated with smoking?

A

bronchial carcinoid

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6
Q

Which lung cancers are centrally located?

A

Squamous and Small cell carcinomas are “Sentral”

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7
Q

What is the most common lung cancer in nonsmokers and overall (except for metastases)?

A

Adenocarcinoma

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8
Q

What mutations lead to adenocarcinoma?

A

activating mutations including k-ras, EGFR, adn ALK

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9
Q

What is the fancy medical term for clubbing?

A

hypertrophic osteoarthropathy

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10
Q

What does chest x-ray show in the bornchioloalveolar subtype of adenocarcinoma (adenocarcinoma in situ)?

A

hazy infiltrates similar to pneumonia

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11
Q

What is the prognosis of bronchioloalveolar subtype adenocarcinoma (in situ)?

A

Excellent

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12
Q

How does bronchioloalveolar subtype adenocarcinoma look histologically?

A

grows along alveolar septa → apparent “thickening” of alveolar walls

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13
Q

Is adenocarcinoma central or peripheral?

A

peripheral

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14
Q

How does squamous cell carcinoma present?

A

Central: hilar mass arising from bronchus
Cavitation
hyperCalcemia (produces PTHrP)
Cigarette smokers

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15
Q

What does squamous cell carcinoma look like hisotologically?

A 
Keratin pearls
Intercellular bridges (made of desmosomes connecting the squamous cells)
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16
Q

What is the prognosis of small cell carcinoma?

A

very aggressive (b/c undifferentiated)

17
Q

What type of cells comprise small cell carcinoma?

A

poorly differentiated neuroendocrine cells aka Kluchitsky cells which stain dark blue

18
Q

How does small cell carcinoma look histologically?

A

Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and “salt and pepper” neuroendocrine-type chromatin

19
Q

What are some gene products/amplifications that can be present in small cell carcinoma?

A

ACTH
ADH
Antibodies against Ca2+ channels (LEMS)
Amplification of myc oncogenes common

20
Q

What is the treatment for small cell carcinoma?

A

Chemotherapy – surgery is not an option

21
Q

Describe large cell carcinoma histologically

A

Highly anaplastic undifferentiated tumor with pleomorphic giant cells

22
Q

What is the prognosis and treatment of large cell carcinoma?

A

Poor; less responsive to chemotherapy, remove surgically

23
Q

What is the prognosis and rate of metastasis of bronchial carcinoid tumors?

A

Excellent; rarely metastasizes

24
Q

What causes symptoms of bronchial carcinoid tumors?

A
  1. Symptoms usually due to mass effect

2. Carcinoid syndrome (5-HT secretion → flushing, diarrhea, wheezing) occasionally

25
Q

What does a broncial carcinoid tumor look like histologically?

A

Nests of well differentiated neuroendocrine cells [pathoma: classically form polyp-like mass in bronchus]

26
Q

What stain can be used to identify bronchial carcinoid tumors?

A

chromogranin A

27
Q

What is mesothelioma and what classically causes it?

A

Malignancy of the pleura associated with asbestos

28
Q

What are some complications of mesothelioma?

A

Hemorrhagic pleural effusions

Pleural thickening

29
Q

What histological finding is present in mesothelioma?

A

psammoma bodies

30
Q

What is a pancoast tumor?

A

A carcinoma that occurs in the apex of the lung

31
Q

What syndromes/symptoms are associated with pancoast tumors?

A
  1. Horner syndrome (due to damage of cervical sympathetic plexus)
  2. SVC syndrome
  3. Sensorimotor deficits
  4. Hoarseness
32
Q

What is the superior vena cava syndrome?

A

Obstruction of the SVC → impairs blood drainage from the head (“facial plethora”), neck (JVD), and upper extremities (edema)

33
Q

What is a major cause of SVC syndrome other than malignancy (pancoast tumor)?

A

thrombosis from indwelling catheters

34
Q

What is the medical urgency level in SVC syndrome?

A

Emergency

35
Q

What are the complications of SVC syndrome?

A

↑ intracranial pressure (if obstruction severe) → headaches, dizziness, and ↑ risk of aneurism/rupture of intracranial arteries

Alex's First Aid Cards (20 decks)

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