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Carcinoma Of The Lungs Flashcards

1
Q

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

T/F

A

T

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2
Q

EPIDEMIOLOGY of lung cancer

▪ GEOGRAPHICAL DISTRIBUTION

worldwide

common in ________ countries

A

industrialized

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3
Q

EPIDEMIOLOGY of lung cancer

▪ SEX DISTRIBUTION

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

•difference ___easing

 M: 1 in ______; F: 1 in ____

A

Males; females

decr

16; 17

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4
Q

EPIDEMIOLOGY of lung cancer

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

A

40

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5
Q

Aetiopathogenesis of lung cancer

▪_________ - most important aetiologic factor in both in sexes

A

Cigarette Smoking

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6
Q

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

A

Higher

asbestos

greater

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7
Q

Aetiopathogenesis of lung cancer

▪ Cessation of smoking for ________ is risk to control levels

A

10 years

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8
Q

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

A

Asbestos

Polycyclicaromatic

Chromium

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9
Q

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

A

Pollutants

Pulmonary Fibrosis

Malignant lesions

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10
Q

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

A

terminal bronchiolar epithelium

scars

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11
Q

Carcinomas known to arise adjacent to old granulomas

T/F

A

T

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12
Q

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

A

adenomatous hyperplasia

2

bronchioloalveolar cell adenomas

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13
Q

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

A

papillomatosis

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14
Q

Histologic CLASSIFICATION of lung cancer

_______ carcinoma ____%
_______ Carcinoma ____%

A

Small cell; 15

Non-Small Cell; 85

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15
Q

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

A

Squamous cell

Adeno

Large cell

Adenosquamous

Carcinoid

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16
Q

Major categories

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

Adeno

Squamous

Small cell

Largecell

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17
Q

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

A

many of them show a combination of patterns

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18
Q

Spread & Metastases

▪____________ proximally and distally along _____________.

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

A

Direct extension; bronchus of origin

mediastinum or pleura.

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19
Q

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)

A

chest wall and diaphragm

blood vessels

adeno

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20
Q

Metastasis

Lymph node metastases:
▪ First the _____ region, then

▪_________ and ________(_________) groups

▪ Less commonly in _________ and _________ sites.

A

hilar

Mediastinal and lower cervical ; supraclavicular

axillary and subdiaphragmatic

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21
Q

CLINICAL PRESENTATION of lung cancer

▪ Multi-focal:

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

•______% are incurable due to __________ and ____________

A

head and neck

60; extensive local spread and/or distant metastases.

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22
Q

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.

A

Late

partial or complete bronchial obstruction

primary inflammatory

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23
Q

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

A

Cough

weight loss

Pain ; sputum production

paraneoplastic

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24
Q

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

A

reach a sufficient size

ulcerate into a bronchus

pleural space

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25
Q

Pancoast’s syndrome

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

A

superior pulmonary sulcus

26
Q

Pancoast’s syndrome

Presence of pain in the distribution of the _________

 often accompanied by _______ syndrome secondary to ________________

A

ulnar nerve

Horner’s

involvement of the sympathetic chain.

27
Q

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

A

coin

solitary circumscribed

28
Q

Hormone: syndrome: tumor type

ADH

ACTH

PTH-rp

Serotonin

Calcitonin

Gonadotropins

A

Hyponatremia (SIADH); small cell CA

Cushing syndrome ; small cell CA

Hypercalcemia; squamous cell CA

Carcinoid syndrome; bronchial carcinoids

Hypocalcemia

Gynecomastia

29
Q

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)

A

Poor

no substantial

13; 11

30
Q

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
A

younger than 40 years of ; advanced

Women; men; adenocarcinomatous

superior pulmonary sulcus

31
Q

____________ carcinoma is the most curable form of lung cancer.

_________ carcinoma has a dismal prognosis.

A

Squamous cell

Small cell

32
Q

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

A

Large

Smaller

33
Q

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

A

non- small cell

34
Q

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.

A

Poor

Poor

Worse

35
Q

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.

A

complete surgical excision

pneumon

lob; segmental

36
Q

Lung cancer is the most deadly of the common cancers

T/F

A

T

37
Q

Harmatoma-

Choriostoma-

A

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.

38
Q

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

A

15; fast

Early

Non amenable

Smokers

Poor

39
Q

Non-small cell carcinoma( ____ %)

Can sometimes be resected
(worse or Better ?) prognosis
(Smokers or non-smokers ?)

A

85

Better

Smokers and non-smokers

40
Q

Non-small cell carcinoma Can sometimes be resected

T/F

A

T

41
Q

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

A

Poorly; small

male smokers

Neuroendocrine

Central

Kulchitsky

42
Q

Kulchitsky cells

(Small or Large?) (light or dark?) ____color

_________ cells

______________ nuclei

A

Small; dark; blue

neuroendocrine

Hyperchromatic

43
Q

Small Cell Cancer (3A’s)

Paraneoplastic syndrome
______
______
_________(_____)

A

ADH

ACTH

Antibodies(lambert Eaton syndrom)

44
Q

Squamous Cell Carcinoma

_____ mass arising from ______

_____ production (“_____”) by tumor cells
Intercellular desmosomes (“intercellular bridges”)

A

Hilar; bronchus

Keratin; pearls

45
Q

Squamous Cell Carcinoma

Intercellular desmosomes (“intercellular bridges”)

(Male or female?) ______

Can produce ___________ , leading to _______

A

Male; smokers

Parathyroid Hormone related Protein (PTHrP)

Hypercalcemia

46
Q

Adrenocarcinoma is a Glandular tumor

T/F

A

T

47
Q

Most common lung cancer is ??

A

Adrenocarcinoma

48
Q

Adrenocarcinoma

Predominant in (smokers or nonsmokers?) /(males or females?)

Located (Centrally or Peripherally?)

A

Non smokers

Females ; Peripherally

49
Q

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

A

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

50
Q

______ cells or type 2 pneumocytes

A

Clara cells

51
Q

Large Cell Carcinoma

(Poorly or well?) differentiated

Lacks ____ or ____ differentiation
Lacks _____ cells

(Smokers or Non smokers?) cancer

Central or peripheral

(Poor or Good?) prognosis

A

Poorly

glandular or squamous ; small

Smokers

Poor

52
Q

Mention 2 Neuroendocrine tumors of the lungs

A

Small cell carcinoma

Carcinoid tumors

53
Q

Neuroendocrine tumors are chemogranin negative

T/F

A

F

Positive

54
Q

Complications of lung cancers

Pleural _____

_____ nerve compression: _____ paralysis; ____ test)

_______ nerve compression leading to ____________

A

effusions

Phrenic; Diaphragm; sniff

Recurrent laryngeal

Hoarseness of voice

55
Q

Pancoast tumor

____ edema on the affected side

______ pain radiating toward axilla/scapula

______ ———-, weakness

Can compress _______ nerves and cause _____ syndrome

A

Arm

Shoulder

Arm paresthesias

Sympathetic; Horner’s

56
Q

Horner’s syndrome

_______
________
___________

A

Miosis
Ptosis
Anhidrosis

57
Q

superior sulcus o the king

Groove formed by _______ vessels

A

subclavian

58
Q

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

A

Obstruction of blood flow

Lung; Mediastinal

59
Q

SVC syndrome in pancoast tumor

Characterized by :

_____ swelling or ____ fullness

______ swelling

Can cause increased _____

A

Facial; head

Arm

ICP

60
Q

Metastasis to lung is less common than primary lung tumors

T/F

A

F

Metastasis to lung is More common than primary lung tumors

61
Q

Metastasis to lung

Most commonly from ______ or ____ cancer

Usually (single or multiple?) lesions on imaging

A

breast or colon

Multiple

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