Chapter 15: Part 3 (Tumors) Flashcards
(87 cards)
1
Q
Lung and bronchus cancer is the ____ most common cancer in M and W.
What cancer causes the most deaths?
A
- Lung and bronchus
- Lung and bronchus
2
Q
How do we describe tobacco years?
A
Duration and intensity using:
pack-year= (packs smoked per day) * number of years.
3
Q
What is a pack-year of a patient who smoked 2 packs a day for 30 years?
A
60 pack-years
4
Q
Large areas of “benign” respiratory mucosa being mutagenized by exposure to carcinogens in tobacco smoke is known as what?
A
“Field effect”
5
Q
What are the 3 most common lung tumors in order?
A
- 1. Adenocarcinoma (38%)
- 2. Squamous cell carcinoma (20%)
- 3. Small cells neuroendocrine carcinoma (14%)
6
Q
Which type of lung cancer shows the strongest association with smoking?
A
Small cell carcinoma
7
Q
Loss of function mutations in which 2 genes and chromosome are seen with small cell carcinoma of the lung?
A
- TP53
- RB1
- Chr 3p deletions
8
Q
Deletions of which 3 chromosomal loci and 3 genes are seen as early events in the squamous cell carcinoma of the lung
A
- 3p and 9p on CDKN2A gene
- 17p (on of TP53 gene)
- Loss of RB tumor suppressor
9
Q
Amplification of which gene has been associated with squamous cell carcinoma of the lung?
A
FGFR1
10
Q
Loss of function mutations in which 2 genes and chromosome are seen with small cell carcinoma of the lung?
A
- TP53
- RB
- Chr 3p deletions
11
Q
Amplification of which gene is associated with small cell carcinoma of the lung?
A
MYC
12
Q
What mutations cause Adenocarcinomas?
A
GOF mutations in growth factor receptor pathways, including r
- RTK mutation = EGFR + ALK + ROS + MET and RET
- Non-RTK = KRAS
13
Q
Which type of lung cancer occurs in the peripheral lung and which in the central/hilar lung?
A
- Peripheral: adenocarcinoma ; thus most cancers occur peripherally
- Central/hilar: squamous cell carcinoma
14
Q
What are the 4 stages of lung adenocarcinoma progression?
A
- 1. Normal
- 2. AAH (atypical adenomatous hyperplasia)
- 3. AIP (adenocarcinoma in-situ)
- 4. Adenocarcinoma
15
Q
What stage of adenocarcinoma progression is this?
How big?
A
AAH (atypical adenomatous hyperplasia)
- Dysplastic pneumocytes that line alveoli with with some intersitial fibrosis.
- 5mm or less
16
Q
What stage of adenocarcinoma progression is this?
How big?
A
Adenocarcinoma in situ
- Dysplastic cells merging (cofluently) along alveoli
- < 3cm
17
Q
What stage of adenocarcinoma progression is this?
A
Invasive pulmonary adenocarcinoma
Malignant glands are invading lung tissue (all glands look different).
Can arise from precursors or new
18
Q
Do precursor adenocarcinoma lesions all lead to malignancy?
A
NO
19
Q
What is the most common lung cancer in non-smokers?
A
Pulmonary adenocarcinoma
20
Q
Majority of adenocarcinomas of the lung express which transcription factor required for normal lung development?
A
Thyroid transcription factor-1
21
Q
Adenocarcinomas tend to grow ______ than squamous cell carcinomas but metastize _____
A
slower
earlier
22
Q
Which tumor of the lung tends to spread by air, forming satellite tumors on alveoli and may consolidate an entire lobe mimicking lobar pneumonia?
A
Mucinous ADENOCARCINOMA
23
Q
What is this?
A
Squamous cell carcinoma with characteristic KERATIN PEARLS
24
Q
Whatis the progression of squamous cell carcinoma?
A
NL pseutostratf ciliary columnar epi => squamous cells
25
**_Squamous cell carcinoma_**
MCC in M/F
Stronly assx w \_\_\_\_\_\_
Where in the lung does it occur?
**Male**
**Smoking**
**Centrally; because precursor cells are located in airways and hilum**
26
How do we recoginize **squamous cell carcinoma** on CYTOLOGY?
**_Orange cytoplasm_** is keratin =\> SQUAMOUS CARCINOMA
Anytime you see ORNG, think squamous carcinoma
27
What is this?
**Small cell neuroendocrine carcinoma**
28
**_Small cell neuroendocrine carinoma_**
* lung tumor is almost always ______ at time of presentation, strongly associated with _____ and is best treated with **specific** chemotherapies/radiation?
**Metastatic** (so fast that on scans, you DO A WHOLE BODY SCAN)
**Smoking**
29
What is the most aggressive lung tumor with no known preinvasive phase?
**Small cell \*neuroendocrine\* carcinoma**
30
What is the histology of the chromatin, cytoplasm, nucleus, and nucleoli like with **small cell carcinoma** of the lung?
1. -Tightly packed small blue cells (d/t chromatin)
2. - N**uclear molding w nuclei smushed together**
3. - No nucleoli
4. - Necrotically active
31
How does small cell carcinoma respond to chemo?
responds, but recurrence is high
32
If someone has **adenocarcinoma**, what tests will you run?
* **1. Test for a EGFR mutation.**
* -Yes=\> treat with a **EGFR TK-inhibitor.**
* 2. If no =\> **check for ALK rearrangement**
* - Yes =\> treat with **Crizotinib**.
* 3. If no, treat with **chemotherapy w/or w/o Bevacizumab**
33
What is that MOA of **Crizotinib**?
**Inhibits** the **ALK-EML4 fusion** gene.
34
**Tumor immunotherapy** attempts to do what?
**Block PD-1 or CTLA-4** signaling.
Tumor can acquire PD-1 ligand/CTLA4, bind to T-cell of DC and prevent them from attacking it. Tumor immunotherapy attempts to prevent this interaction so we can kill tumor cells
35
What drugs to treat **adenocarcinomas** target **EGFR**?
* **1. Erlotinib**
* **2. Gefinitib**
36
What drugs to treat adenocarcinomas target **PD-1/PD-L1?**
**Pembrolizumab**
37
What drugs to treat **adenocarcinomas** target **CTLA-4?**
**Ipilimumab (Yervoy)**
38
What drugs to treat s**quamous cell carcinomas?**
You need to **be** **cautious** on what drugs to use (VEGF inhibitors) **because these occur centrally** and we are still seeing what to use bc they are so close to BV.
39
Release of **PTHrP** leading to **paraneoplastic hypercalcemia** is associated with what type of lung tumor?
**Squamous cell carcinoma**
40
What paraneoplastic conditions does **small cell carcinoma** cause?
* 1. **SIADH** (secrete too much ADH)
* 2. **Cushings syndrome** (too much ACTH secretion)
41
What is a dermatologic manfiestation that may be associated with lung tumors?
**Acanthosis nigricans**
42
**Apical** lung cancers (**pancoast tumors**) in the **superior pulmonary sulcus** tend to invade which neural structures around the **trachea** and produce what signs/sx's?
- Invade **cervical sympathetic plexus**
- Severe pain in the distribution of the **ulnar nerve**
- **_Horner syndrome_** --\> _enophthalmos_ (sunken eyeball) + _ptosis_ (eyelid droop) + _miosis_ (small pupil) + _anhidrosis_ (no sweating on that side of face).
43
What are 2 hematologic abnormalities that may be assocaited with l**ung tumors?**
- **Leukemoid rxns**
- **Trousseau syndrome** (DVT and thromboembolism)
44
***Lambert-Eaton Syndrome*** is most often associated with what tumor of the lung?
***Trousseau sign (migratory thrombophlebitis)*** is most often associated with what type of lung tumor?
**Small cell carcinoma**
**Adenocarcinoma**
45
What are the spectrum of **NE tumors?**
**1. DIPNECH**
**2. Carcinoid tumor**
**3. Atypical carcinoid tumor**
46
What is the main difference between **Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH)** and **Carcinoid tumors?**
- **SIZE**!!!
- **DIPNECH = very small, \<5mm** ---\> "Tumorlets"
- **Carcinoid tumor = 5mm or larger**
47
Why is it important to differentiate DIPNECH from Carcinoid tumors?
Carcinoid tumors have ability to **_metastasize_**
48
Are **carcinoid tumors** benign or malignant?
**_MALIGNANT_**!
They are a **grade 1 NE carcinoma.**
49
What are features of **atypical carcinoid tumors** which differ from typical carcinoid tumors (grade 1)?
* **1. Grade 2**
* **2. Increased mitotic activity**
* 3. **NECROSIS** (Carcinoids do not undergo necrosis)
* **4. Disordered growth**
* 5. **Increase** rate of **metastasis** with **LOWER survival, but still better than small cell carcinoma.**
50
Can all NE tumors produce a **carcinoid _syndrome_?**
**Yes**
51
Which cancers are almost always treated w **chemotherapy**, because they are almost always metastic at presentation?
**Small cell lung carcinomas**
52
Which lung cancer is best known to cause paraneoplastic syndromes?
**_Small cell_**
53
Which tumor of the lungs grows as **fingerlike** or **spherical polypoid masses** that commonly project into the lumen of the bronchus and may produce so-called **collar-button lesions**?
**Carcinoid tumor**
54
Immunohistochemical stains of **carcinoid tumors** may be positive for what 4 markers?
* **1. 5HT**
* **2. Neuron specific enolase**
* **3. Calcitonin**
* **4. Bombesin**
55
What are the sx's of **Carcinoid Syndrome?**
1. **- Flushing**
2. **- Diarrhea**
3. **- Cyanosis**
56
What is the prognosis like for **typical carcinoid** vs. **atypical carinoid tumors?**
- **Typical** have 5-year survival of **95%**
- **Atypical** have 5-year survival of **70%**
57
What is a feature that can be seen on **CXR** and **CT** indicates a **metastatic malignancy?**
Multiple discrete nodules (**cannonball lesions)** scattered throughout all lobes
58
**What are these?**
Cannonball lesions (more often located peripherally), meaning this person has a **metastatic malignancy**
59
**What is this**
**Pulmonary harmatoma: _BENIGN_** **nodules** of **CT** (often *_hyalinized_* cartilage, fat or fibrous tissue) surrounded by **clefts of respiratory epithelium**
## Footnote
*LOOKS LIKE MARBLE and has SMOOTH EDGES*
60
**Lymphangioleiomyomatosis** is a lung disorder occurring almost exclusively in whom?
**_Young women_** (VERY UNCOMMON in men)
61
**Lymphangioleiomyomatosis (LAM)** is characterized by proliferation of which cells and what does this create morphologically?
**Perivascular epithelioid cells** --\> proliferate and form cysts filled with air.
62
What are 2 complications of **LAM**?
1. **Obstruct lymph vessels**
2. **Cysts** can **pop** and cause a **sponatneous pneumothorax.**
63
What is the **mutation** seen in **LAM**?
**_LOF mutation in TSC2,_** a tumor supressor of mTOR activity
64
Which markers are expressed by **Lymphangioleiomyomatosis**?
PEC cells are *_modified smooth muscle cells_* and + for m**elanoma marker HMB-45**
65
The strong tendency for **Lymphangioleiomyomatosis** to affect young women suggests what hormone contributes to proliferation of perivascular epithelioid cells?
**Estrogen**
66
What are the 2 types of **pleural effusions?**
* **1. Exudate (inflammatory) pleural effusion**
* **2. Transudative (non-inflammatory) pleural effision**
67
What is this?
**Pleural effusion**
68
What are the major causes of **transudate pleural effision?**
**1. HF, d/t increased hydrostatic pressure**
**2. Decreased plasma oncotic pressure**
69
What are the major causes of **exudative pleural effision?**
**Inflammation** or **malignancy**
1. **Infection (TB/bacterial pneumonia)**
2. **PE**
70
What causes pleural effision look like d/t an obstructed duct or in pleural space and most commonly seen in **_post-surgical CAB._**
Milky chylous effusion= chylothorax
71
What is empyema?
Inflammatory exudate where pus accumulates in the pleural space, often d/t a bacterial infection. It creates web-like traps for fluid, making it hard to remove by draingage
72
What does fluid in **empyema** look like?
**Thick, yellow** with **neutrophils** and **bacteria**
73
what is this
empyema; loculations caused by it
74
Bloody effusion: be aware of \_\_\_\_\_\_
Clear yellow effusion: be aware of \_\_\_\_\_\_
Milky Chylous effusion: be aware of \_\_\_\_\_
* **adenocarcinoma**
* **CHF**
* **post-surgical CAB or blockage of thoracic duct**
75
**Pneumothorax** is most commonly associated with what 3 conditions?
**- Emphysema**
**- Asthma**
**- Tuberculosis**
76
**Primary (idiopathic) penumothorax** most often occurs in which age group and is due to what?
1. **Young patients**
2. **Rupture of subpleural blebs**
77
What conditions did we learn that cause a pneumothorax?
1. LAM
2. LCH (langerhan cells histiocytosis)
78
**what is this**
**Solitary fibrous tumo**r: benign soft-tissue tumor in the pleura that is attached to the lung by a pedicle.
Whorls of [**reticulin**], [**collagen** fibers] with **spindle cells** that look like **fibroblasts**
79
How does the behavior of **Solitary Tumor Cells** change when they are small vs when they are larger?
* **Small: _benign_**
* **Larger: _sarcoma_**
80
**_what is this?_**
**_solitary fibrous tumor_** (**well DEFINED**/circumscribed)
81
name a malignant pleural tumor
**mesothelioma**
82
what cell we find in **mesothelioma**
**_ferruginous bodies_**
83
Pleural cavity pressure \> atmospheric = _____ pneumothorax
**tension pneumo**
84
Pleural cavity pressure \< atmospheric = _____ pneumothorax
**primary pneumothorax**
85
What stain can we easily see **solitary fibrous tumors** with, benign tumors of the pleura.
**_CD34_**
86
how can we get asbestos =\> causing mesothelioma?
1. **insulation**
2. **shipyard workers**
3. **construction workers**
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