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Block 9 Week 3 Meg > Barksy: Pulmonary Neoplasms > Flashcards

Barksy: Pulmonary Neoplasms Flashcards

1
Q

What is the most common cancer found in the lung?

A

metastasis!

**from breast, colorectal, endometrial carcinomas or soft tissue and bone sarcomas and skin melanomas

**the pleura can also be a site of metastasis, especially from breast cancer and ovarian cancer (transcoelomic spread)

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2
Q

Why is it important to distinguish a metastasis from a primary lung cancer?

A

mets are stage 4 vs stages 1-3 in primary lung cancer
dramatic difference in prognosis
dramatic difference in therapy

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3
Q

How do you distinguish a metastasis in the lung from a primary lung cancer?

A

microscopic appearance
multiple vs solitary lesions (a single mass in the lung is most likely primary, multiple masses most likely mets)
presence of precursor lesions (met wouldn’t have a precursor)
organ specific immunocytochemistry (ex: thyroid transcription factor)
molecular profiling

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4
Q

What has happened to the death rates from lung and bronchus cancer in males and females in recent years?

A

Rates of deaths from these cancers began increasing after WWI, then decreased around 1980

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5
Q

Which type of cancer is most common in males? In females? Which type of cancer causes the greatest amount of deaths across both genders?

A

males: prostate
females: breast
both: lung!!!

**5 year survival is really low for lung cancer :(

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6
Q

What are the main causes of human lung cancer?

A

chemical carcinogens

UV/other ionizing radiation

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7
Q

How do chemical carcinogens cause cancer?

A

from DNA adducts which give rise to mutations; if mutations occur in hot spots, spots which change gene expression or protein, mutations can be carcinogenic; if they occur in junk DNA, they can be harmless

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8
Q

What happens to your risk of lung cancer if you stop smoking?

A

your risk will decline, although your risk will still be greater than that of a non-smoker

**whether you stop at age 30, 40, 50, etc there is some benefit in quitting smoking, but there is a greater benefit if you quit when you’re younger

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9
Q

How does UV radiation cause cancer?

A

similar to chemical carcinogens - formation of DNA adducts

differs from chemical carcinogens, because it causes single and double stranded breaks!

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10
Q

Top two leading causes of lung cancer?

A
  1. smoking
  2. radon (in soil)
  • *there are certain hotspots in the US where radon levels are high
  • *radon levels are measured in homes before sales
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11
Q

Two major types of cancer genes

A

oncogenes

tumor suppressor genes

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12
Q

One of the major cancer genes involved in lung cancer

A

HER1 (EGFR)

**over-activation of this pathway causes increased invasion, mets, survival, and decreased apoptosis

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13
Q

Explain how dysfunction in EGFR can lead to cancer growth and invasion

A

In malignancies, you can get overexpression or dysregulation of EGFR, which can increase the signaling response and result in cell cycle progression –> cell proliferation –> decreased apoptotic response –> increased cellular survival –> increased invasiveness and metastasis

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14
Q

One of the most commonly mutated genes seen in virtually all types of human cancers
Multiple complex functions involving antiproliferation and apoptosis

**this gene mutation can’t be targeted as easily in therapy as HER1

A

TP53

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15
Q

What is one important function of TP53?

A

senses DNA damage and arrests cells in G1 to induce repair

**if DNA can’t be repaired, BAX and other apoptosis genes are induced

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16
Q

What are the four anatomical divisions of lung cancer?

A

central
peripheral (near the pleura)
mid-zonal
pancoast (tumor of pulmonary apex, frequently infects the sympathetic ganglion chain - causes Horner’s syndrome)

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17
Q

How would a central lung tumor present?

A

cough, chest pain, hemoptysis, sputum

  • *right next to the mainstem bronchus
  • *can be seen with bronchoscopy
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18
Q

How would a mid-zonal lung tumor present?

A

chest pain

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19
Q

How would a peripheral lung tumor present?

A

silent, picked up accidentally via imaging

**too far to produce cough or hemoptysis

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20
Q

How would a pancoast lung tumor present?

A

Horner’s syndrome

**due to invasions of sympathetic ganglion and chain

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21
Q

What are the two major types of lung cancer?

A
  1. small cell carcinoma

2. non-small cell carcinoma

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22
Q

What are three types of non-small cell lung carcinomas?

A
  1. squamous cell carcinoma
  2. large cell undifferentiated carcinoma
  3. adenocarcinoma (invasive vs noninvasive)
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23
Q

Small cell carcinoma of the lung is also known as (blank) carcinoma

A

oat cell

24
Q

Central and mid-zonal primary lung cancers are often called (blank)

A

bronchogenic carcinoma

**because they occur beside the bronchi

25
Q

At what age do people get bronchogenic cancer? What is the overall 5-year survival? What is the prognosis?

A

age 55-65

**leading cause of cancer death in men and women

overall survival for 5 years only 14%

50% have mets at diagnosis, strongly linked with smoking

26
Q

How do you treat small cell carcinoma?

A

sensitive to chemo w/ or w/o radiation

usu surgery not useful

27
Q

How do you treat non-small cell carcinoma?

A

treat with surgery

doesn’t respond well to chemo

28
Q

14-18% of all primary lung cancer
small “oat” cells
usually central
infiltrate widely and metastasize early (70%)
derived from neuroendocrine stem cells
makes polypeptide hormones- paraneoplastic syndromes

A

small cell carcinoma

29
Q

What area of the lung do small cell carcinomas affect?

A

usu central bronchi

30
Q

What are some paraneoplastic syndromes that can occur along with SMALL CELL cancer due to illegitimate transcription of small molecules?

A

Cushing’s disease
SIADH
neuromuscular syndromes

**These tumors can produce molecules, for example, like ADH, which can lead to SIADH

31
Q

Usu affects central airway with obstruction
Tends to cavitate like TB
Tend to spread to LN’s early but later outside of thorax
More common in men
May be preceded by years of metaplasia-dysplasia-CIS
well differentiated to poorly differentiated

A

squamous cell carcinoma

32
Q

What are two paraneoplastic syndromes that occur along with squamous cell carcinoma?

A 
hypercalcemia (produces a PTH-like hormone)
pulmonary osteoarthropathy (finger clubbing)
33
Q

Enlarged fingertips and loss of normal angle at nail bed

A

finger clubbing

**can be seen in all lung cancers, mechanism unknown

34
Q

10-18% of primary lung cancer
undifferentiated under light microscopy
special studies may reveal some signs of differentiation
poor prognosis and metastasize early

A

large cell carcinoma

35
Q 
grow slowly but metastasize early
K-RAS oncogene mutation in 30%
younger (40’s), women and nonsmokers
generally occurs peripherally
can be associated with scars
pneumonia-like pattern
grow slowly but metastasize early
A

adenocarcinoma

**this is now the most common type of lung cancer

36
Q

Form of adenocarcinoma in situ
Usually arises peripherally & lines the alveolar spaces
Can be multifocal and bilateral
Can be diffuse and mimic pneumonia
Can be associated with pre-existing pulmonary scar
Can be mucinous and non-mucinous

A

Bronchioloalveolar lung cancer

**many pts with this disease are not smokers

37
Q

List 3 differences between bronchioloalveolar lung cancer and adenocarcinoma

A
  1. BAC are a form of adenocarcinoma in situ
  2. adenocarcinoma implies invasion
  3. frequently BACs are adjacent to adenocarcinoma areas
38
Q

What kinds of lung tumors have lepidic spread (like the scales of the butterfly wing)?

A

BAC adenocarcinomas

**no invasion of pulmonary stroma

39
Q

Neuroendocrine tumor
Derived from Kulchitsky cells
neurosecretory granules- carcinoid syndrome rare
most occur in main stem bronchi, removal easier
30% can be either atypical carcinoids or malignant carcinoids and metastasize to hilar lymph nodes and few to distant sites. These atypical or malignant lesions have more mitoses and areas of necrosis

A

carcinoid tumor

**better to have a carcinoid tumor than an adenocarcinoma or any other more malignant cancer

40
Q

Where do carcinoid tumors usually occur?

A

in the main stem bronchi

41
Q

What cells are associated with carcinoid tumors?

A

Kulchitsky cells

42
Q

“Coin lesion” on X-ray and CT scan

A

Bronchial chondromas

**these are benign, many cases that are picked up on imaging, turn out to be bronchial chondromas

43
Q

neoplastic disease of pleura
associated with asbestos exposure (plaques)
not associated with smoking
long latency period
encase the lungs, cause restrictive lung disease
direct pushing invasion of thoracic structures
metastases rare
patterns: sarcomatoid, epithelial and biphasic (both

A

primary malignant mesothelioma

44
Q

Neoplastic disease of the pleura

A

mesothelioma

45
Q

What will you see histologically in mesothelioma?

A

sarcomatoid or epithelial pattern, or both

46
Q

What is the cause of malignant mesothelioma?

A

absestosis from asbestos exposure

iron laden asbestos molecules

47
Q

What is the precursor lesion for mesothelioma?

A

pleural fibrous plaques

**just know that most lung cancers have precursor lesions bc they follow normal cancer progression

48
Q

What is the precursor lesion for carcinoid and small cell carcinoma?

A

Kulchitsky cell hyperplasia

49
Q

What is the precursor lesion for peripheral adenocarcinoma and BAC?

A

can arise from scars

adenomatous hyperplasia and atypical adenomatous hyperplasia

50
Q

List the steps in the progression of a normal lung to BAC (bronchioalveolar lung carcinoma)

A
  1. normal lung w normal type II pneumocytes in alveolus
  2. transformed type II pneumocytes in alveolus
  3. group of transformed cells spread in lipedic manner
  4. differentiated bronchioalveolar lung carcinoma
51
Q

What is staging?

A

Staging: TNM

T: tumor size
N: lymph node involvement of hilar and mediastinal nodes
M: absence or presence of mets

52
Q

T/F: Historically, there has been a lack of personalized medicine in lung cancer. However, an evolving new molecular classification of lung cancer is causing a paradigm shift in individualized therapy.

A

True

53
Q

10% of non-small lung cancer has HER pathway activated pathologically. These cancers are dependent on this pathway being activated. Why is this important?

A

if you can detect mutations in tyrosine kinase domain of EGFR, you can target these tyrosine kinases with medical therapy

54
Q

Two genes that can be rearranged leading to lung cancer; these cancers are sensitive to crizotibin

A

ALK

ROS

55
Q

T/F: Patients with particular lung cancers involving tyrosine kinase alterations, including EGFR mutation/deletion, ALK rearrangement, and ROS rearrangement, can be targeted specifically with tyrosine kinase inhibitors

A

True!

Block 9 Week 3 Meg (10 decks)

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