9.8 Lung Cancer Flashcards
What organ is unique site of metastasis for lung cancer?
adrenal gland
Polyp-like mass in the bronchus:
-what to suspect
Carcinoid tumor, classic presentation
lung cancer: where does it rank among cancer deaths
1 cause of cancer death in USA
Lung carcinoma:
divided into what 2 types:
- small cell (15%)–use chemo, no surgery
- non-small cell (85%)–tx with surgery upfront, does not respond well to chemo
most common lung tumor:
- male smokers
- female smokers
- nonsmokers
- squamous cell carcinoma
- adenocarcinoma
- adenocarcinoma
Lung cancer:
-main risk factors (3)
- smoking (85% of lung cancer)
- Radon–radioactive decay of uranium in soil. Accumulates in basements, also seen in uranium miners
- asbestos (remember, in asbestosis more likely to get lung cancer than mesothelioma)
Adenocarcinoma
- histology
- association
- location
- complications, comments
- Glands or mucin
- female smokers, nonsmokers
- peripheral
- no paraneoplastic syndrome
What is characteristic of lung hamartoma composition?
combo of lung tissue and cartilage. often calcified on imaging.
TNM staging of lung cancer:
what are 3 things to consider in the T category
T: Tumor size/local spread
- pleural involvement (more likely in peripheral tumors like adenocarcinoma)
- SVC obstruction
- nerve involvement (recurrent laryngeal–hoarseness, phrenic–breathing paralysis)
lung cancer:
what are 2 most common cancers that metastasize to lung?
- colon
- breast
Non-small cell carcinoma:
-list types (5) by most common
- adenocarcinoma (40%)
- squamous cell carcinoma (30%)
- large cell carcinoma (10%)
- carcinoid tumor (5%)
- bronchioloalveolar carcinoma
Pt presents with distended head/neck veins, edema, blue arms and face.
What’s happening, and how can a lung issue cause this?
SVC syndrome
-lung tumor compresses superior vena cava
what carcinogens to know in cigarettes: (2)
- polycyclic aromatic hydrocarbons
- arsenic–squamous cell carcinoma risk
Pt with coin lesion CXR, calcified.
-think what?
Lung Hamartoma, calcified.
-benign, composed of lung tissue and cartilage, often calcified
Which tumor can present with pneumonia-like consolidation on imaging?
Bronchioloalveolar carcinoma
which lung tumor is most likely to cause pleural involvement? why?
adenocarcinoma (female smokers and nonsmokers) b/c it’s peripheral
Which lung tumors are:
- central
- peripheral
- central or peripheral
(2 each)
- (‘S’) small cell, squamous cell
- adenocarcinoma, bronchioloalveolar
- large cell, carcinoid
Pancoast tumor
-what can it cause, and how does it present (3 symptoms)?
- tumor in apex of lung
- can cause Horner’s syndrome (press on sympathetic chain)
1. ptosis (drooping eyelid)
2. miosis (pinpoint pupil)
3. anhidrosis (no sweating)
Lung cancer:
-typical symptoms (4)
usu nonspecific:
- cough
- weight loss
- hemoptysis
- pneumonia, postobstructive
- neuroendocrine cells: how to identify on staining, and why?
- which lung tumors are neuroendocrine cells?
- chromogranin positive on immunohistochemistry. (neuroendocrine secretory granules)
- 1) small cell carcinoma (poorly differentiated)
2) carcinoid tumor (well differentiated)
small cell carcinoma:
- histology
- association
- location
- complications, comments
- poorly differentiated small cells, mimic lymphocytes
- smokers
- central
- paraneoplastic syndrome can occur (ADH, ACTH, Lambert-Eaton syndrome–Ab against presynaptic Ca channels, muscle weakness that improves with use)
Lung tumor biopsy:
what are you looking for to categorize this tumor?
- Keratin pearls, desmosome interceullar bridges: squamous cell
- glands, mucin: adenocarcinoma
- small cells, mimic lymphocytes: small cell
- none of these, and poorly differentiated: large cell carcinoma
- cartilage present, maybe calcified: hamartoma
- granuloma: infection, or sarcoidosis/berylliosis
How to stage lung cancer
TNM staging:
- Tumor size/local spread (pleura, SVC obstruction, nerve involvement)
- Nodes, lymph. (hilar, mediastinal)
- Metastasis (think adrenal for lung cancer)
carcinoid tumor
- histology
- association
- location
- complications, comments
- well-differentiated neuroendocrine tumor (chromogranin positive)
- not assoc with smoking
- central or peripheral; classic: Polyp-like mass in bronchus
- rarely can cause carcinoid syndrome
Lung cancer:
- what is typically first sign on imaging?
- what are your next steps?
- you usu a solitary nodule (‘coin lesion’)
- compare with old Xrays–if lesion existed before, same size, then more likely benign. If new or growing, maybe malignant
- Do biopsy, necessary for cancer dx
Pt with coin lesion on lung Xray:
-what to consider other than cancer (2)
- 2 main types of benign lesions:
1. granuloma (often TB or fungus–think Histoplasma in Midwest!)
2. hamartoma (composed of lung tissue and cartilage, often calcified)
bronchioloalveolar carcinoma
- histology
- association
- location
- complications, comments
- columnar cells replace squamous cells in air sacs and bronchioles, arise from Clara cells
- not related to smoking
- peripheral
- presents with pneumonia-lika consolidation, excellent prognosis
what accumulates in closed areas like basements that is dangerous to lungs?
Radon–radioactive decay of uranium found in soil.
-2nd leading cause of lung cancer
What lung disorder is more common in Midwest?
Histoplasmosis, leading to benign granulomas in lung.
Look like coin lesions
chromogranin
immunohistochem stain for neuroendocrine cells. (evidence of neurosecretory granules)
-positive in small cell and carcinoid lung tumors
squamous cell carcinoma
- histology
- association
- location
- complications, comments
- keratin pearls, or intercellular bridges (desmosomes, seen only in squamous cells)
- smokers (most common tumor in smokers)
- central
- paraneoplastic syndrome (PTHrP)
“S” mnemonic in lung cancer:
- Small cell carcinoma
- Squamous cell carcinoma
- smokers
- Central
- Syndrome, paraneoplastic
What is the screening method for lung cancer?
No effective lung cancer screening method.
cancers caught late. 15% 5 year survival
