Carcinoma Of The Lungs Flashcards by Iseoluwa Ojo

Carcinoma of the lung has become increasingly frequent over the past 50 years.

T/F

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EPIDEMIOLOGY of lung cancer

▪ GEOGRAPHICAL DISTRIBUTION

worldwide

common in ________ countries

industrialized

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EPIDEMIOLOGY of lung cancer

▪ SEX DISTRIBUTION

•More common in (males or females?) than (males or females?)

•difference ___easing

 M: 1 in ______; F: 1 in ____

Males; females

decr

16; 17

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EPIDEMIOLOGY of lung cancer

AGE DISTRIBUTION
 >90% are over _____ years at time of the diagnosis.

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Aetiopathogenesis of lung cancer

▪_________ - most important aetiologic factor in both in sexes

Cigarette Smoking

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Aetiopathogenesis of lung cancer

▪ Cigarette Smoking
EVIDENCE

▪ Smokers in urban areas - (lower or higher?) risk
▪ Air pollution and _____ increase the carcinogenic effect of tobacco
▪ The greater the degree of cigarette consumption the ______ the severity of the changes

Higher

asbestos

greater

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Aetiopathogenesis of lung cancer

▪ Cessation of smoking for ________ is risk to control levels

10 years

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Other Causes of Ca Lung - Environmental Pollutants

▪________ - thought to be responsible for about 5% of all lung carcinoma deaths.
▪ ______________hydrocarbons
▪ Arsenic
▪ Nickel
▪ ________ compounds
▪ Vinylchloride
▪ Radiation (uranium workers, people with high radon concentration in their houses)
▪ Otheroccupationalagents

Asbestos

Polycyclicaromatic

Chromium

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Other Causes of Ca Lung - environmental ______, _________, pre-__________

Pollutants

Pulmonary Fibrosis

Malignant lesions

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Other Causes of Ca Lung - Pulmonary Fibrosis
▪ Another factor thought to be related to the development of carcinoma.
▪ May be preceded by atypical proliferation of the ____________
▪ Malignant tumors arise at site of ______ resulting from bullets or other foreign bodies

terminal bronchiolar epithelium

scars

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Carcinomas known to arise adjacent to old granulomas

T/F

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Other Causes of Ca Lung - Premalignant Lesions
▪ Atypical _____________ of type _____ alveolar cells or __________________________ as a precursor of adenocarcinoma?

adenomatous hyperplasia

bronchioloalveolar cell adenomas

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Other Causes of Ca Lung - Premalignant Lesions

▪ A few cases of malignant transformation of ______ of the respiratory tract, 20 to HPV infection, have been found

papillomatosis

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Histologic CLASSIFICATION of lung cancer

_______ carcinoma ____%
_______ Carcinoma ____%

Small cell; 15

Non-Small Cell; 85

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Histologic CLASSIFICATION of lung cancer

Non-Small Cell Carcinoma 85%
i._________ carcinoma (25-40%)
ii. _____ carcinoma (25-40%)
iii. _______ carcinoma
iv. ________ carcinoma
v. Carcinomas with pleomorphic or sarcomatoid elements
vi. ________ tumour
vii. Carcinomasofsalivaryglandtype
viii. Unclassified carcinoma

Squamous cell

Adeno

Large cell

Adenosquamous

Carcinoid

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Major categories

_______ carcinoma (M37%, F47%)
________ cell carcinoma (M32%, F25%)
3._________ carcinoma (M14%, F18%)
__________ carcinoma(M18%,F10%)

Adeno

Squamous

Small cell

Largecell

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Part of the difficulty in sharply separating lung carcinomas into the previously described categories stems from the fact that ________________

many of them show a combination of patterns

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Spread & Metastases

▪____________ proximally and distally along _____________.

▪ Grows into the lung parenchyma- may reach the _______ or ______

Direct extension; bronchus of origin

mediastinum or pleura.

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Spread & Metastases

▪ Seeding pleura and extension into the __________ and _________

▪ Invasion of ————- (>80% of cases); may lead to extensive tumor emboli  cor pulmonale, (seen more commonly with ______carcinoma)

chest wall and diaphragm

blood vessels

adeno

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Metastasis

Lymph node metastases:
▪ First the _____ region, then

▪_________ and ________(_________) groups

▪ Less commonly in _________ and _________ sites.

hilar

Mediastinal and lower cervical ; supraclavicular

axillary and subdiaphragmatic

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CLINICAL PRESENTATION of lung cancer

▪ Multi-focal:

•Associated with cancer of the _______ region in about 20% of the cases.

•______% are incurable due to __________ and ____________

head and neck

60; extensive local spread and/or distant metastases.

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CLINICAL PRESENTATION of lung cancer

▪ Symptoms and signs develop relatively (early or late?) in the course of the disease

▪ Usually related to ___________ or _______ ————, and may lead to confusion with a __________
process.

Late

partial or complete bronchial obstruction

primary inflammatory

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The most common symptoms of lung cancer
In decreasing order of frequency, are
▪ ________
▪ _________
▪ _____
▪ increased _____________
▪ hemoptysis
▪ malaise
▪ fever
▪ Those resulting from _________ manifestations.

Cough

weight loss

Pain ; sputum production

paraneoplastic

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Peripherally located lesions of lung cancer are clinically silent until they ___________ to _________ or to involve the _________.

reach a sufficient size

ulcerate into a bronchus

pleural space

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Pancoast's syndrome ▪ Carcinomas in the ____________ result in a clinical picture known as Pancoast's syndrome.

superior pulmonary sulcus

Pancoast's syndrome Presence of pain in the distribution of the _________  often accompanied by _______ syndrome secondary to ________________

ulnar nerve Horner's involvement of the sympathetic chain.

Sometimes cancer of the lung presents as a "_____ lesion" (a ________________ mass) on the chest x-ray film of an asymptomatic individual.

coin solitary circumscribed

Hormone: syndrome: tumor type ADH ACTH PTH-rp Serotonin Calcitonin Gonadotropins

Hyponatremia (SIADH); small cell CA Cushing syndrome ; small cell CA Hypercalcemia; squamous cell CA Carcinoid syndrome; bronchial carcinoids Hypocalcemia Gynecomastia

PROGNOSIS The long-term ▪( poor or good?) ▪ _________ improvement in recent years in long-term survival rates. ▪ Statistics show a ___% 5-year survival for whites and ___% for blacks for all stages of lung carcinoma (National Cancer Institute)

Poor no substantial 13; 11

Prognosis 1. Age. Patients who are ____________ age have a very poor prognosis, probably because most have _______ disease at presentation. 2. Sex. _______ have a worse survival rate than ______; (have a higher incidence of advanced lesions and tumors with an ___________ pattern) 3. Location. It has been claimed that tumors of the ______________ have a better prognosis than the others

younger than 40 years of ; advanced Women; men; adenocarcinomatous superior pulmonary sulcus

____________ carcinoma is the most curable form of lung cancer. _________ carcinoma has a dismal prognosis.

Squamous cell Small cell

(Small or Large?) tumors have a worse prognosis than (smaller or larger ?) neoplasms of the same histologic type.

Large Smaller

A direct relationship is evident between clinical stage and survival rates, particularly for ______________ carcinoma

non- small cell

Prognostic factors Blood vessel invasion. This feature has (poor or good?) prognostic connotations. Pleural effusion. This feature carries a (poor or good ?) prognostic connotation. Presence of a scar. It has been claimed that peripheral adenocarcinomas or undifferentiated large cell carcinomas associated with a well-defined fibrotic area (scar) have a (better or worse?) prognosis than tumors lacking this feature.

Poor Poor Worse

TREATMENT The standard therapy for operable carcinoma of the lung is ____________ through thoracotomy. In the form of ➢_______ectomy ➢_____ectomy, or ➢________ resection(very rarely) depending on the location and type of the tumor.

complete surgical excision pneumon lob; segmental

Lung cancer is the most deadly of the common cancers T/F

Harmatoma- Choriostoma-

hamartoma is a local malformation made up of an abnormal mixture of cells and tissue. a histologically normal tissue proliferation or nodule of a soft tissue type not normally found in the anatomic site of proliferation.

Small cell carcinoma (____%) (Slow or Fast?) growing (Early or late?) metastasis (Amenable or Non amenable ?) to surgical resection (Smokers or non-smokers?) Treated with chemo (Poor or Good?) prognosis

15; fast Early Non amenable Smokers Poor

Non-small cell carcinoma( ____ %) Can sometimes be resected (worse or Better ?) prognosis (Smokers or non-smokers ?)

85 Better Smokers and non-smokers

Non-small cell carcinoma Can sometimes be resected T/F

Small Cell Cancer (Poorly or Well?) differentiated (small or large?) cells Classic in _______ _________ tumor Found in the ____ aspect of the lung High number of mitotic figures _________ cells

Poorly; small male smokers Neuroendocrine Central Kulchitsky

Kulchitsky cells (Small or Large?) (light or dark?) ____color _________ cells ______________ nuclei

Small; dark; blue neuroendocrine Hyperchromatic

Small Cell Cancer (*3A’s*) Paraneoplastic syndrome ______ ______ _________(_____)

ADH ACTH Antibodies(lambert Eaton syndrom)

Squamous Cell Carcinoma _____ mass arising from ______ _____ production (“_____”) by tumor cells Intercellular desmosomes ("intercellular bridges")

Hilar; bronchus Keratin; pearls

Squamous Cell Carcinoma Intercellular desmosomes ("intercellular bridges") (Male or female?) ______ Can produce ___________ , leading to _______

Male; smokers Parathyroid Hormone related Protein (PTHrP) Hypercalcemia

Adrenocarcinoma is a Glandular tumor T/F

Most common lung cancer is ??

Adrenocarcinoma

Adrenocarcinoma Predominant in (smokers or nonsmokers?) /(males or females?) Located (Centrally or Peripherally?)

Non smokers Females ; Peripherally

which grows slower and which metastasizes wider and earlier between Adrenocarcinoma and squamous cell carcinomas

Adrenocarcinomas grow more slowly than squamous cell carcinomas but metastasize widely and earlier.

______ cells or type 2 pneumocytes

Clara cells

Large Cell Carcinoma (Poorly or well?) differentiated Lacks ____ or ____ differentiation Lacks _____ cells (Smokers or Non smokers?) cancer Central or peripheral (Poor or Good?) prognosis

Poorly glandular or squamous ; small Smokers Poor

Mention 2 Neuroendocrine tumors of the lungs

Small cell carcinoma Carcinoid tumors

Neuroendocrine tumors are chemogranin negative T/F

F Positive

Complications of lung cancers Pleural _____ _____ nerve compression: _____ paralysis; ____ test) _______ nerve compression leading to ____________

effusions Phrenic; Diaphragm; sniff Recurrent laryngeal Hoarseness of voice

Pancoast tumor ____ edema on the affected side ______ pain radiating toward axilla/scapula ______ ———-, weakness Can compress _______ nerves and cause _____ syndrome

Arm Shoulder Arm paresthesias Sympathetic; Horner's

Horner's syndrome _______ ________ ___________

Miosis Ptosis Anhidrosis

superior sulcus o the king Groove formed by _______ vessels

subclavian

SVC syndrome in pancoast tumor _____ of ______ through SVC Can be caused by compression from tumor _____ Masses: NSCLC, SCLC _______ Masses: Lymphoma Other causes include thrombosis Indwelling catheters, pacemaker wires

Obstruction of blood flow Lung; Mediastinal

SVC syndrome in pancoast tumor Characterized by : _____ swelling or ____ fullness ______ swelling Can cause increased _____

Facial; head Arm ICP

Metastasis to lung is less common than primary lung tumors T/F

F Metastasis to lung is More common than primary lung tumors

Metastasis to lung Most commonly from ______ or ____ cancer Usually (single or multiple?) lesions on imaging

breast or colon Multiple

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Carcinoma Of The Lungs Flashcards

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