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CPR Exam 1 > Chapter 15: Part 3 (Tumors) > Flashcards

Chapter 15: Part 3 (Tumors) Flashcards

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​
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2
Q

How do we describe tobacco years?

A

Duration and intensity using:

pack-year= (packs smoked per day) * number of years.

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3
Q

What is a pack-year of a patient who smoked 2 packs a day for 30 years?

A

60 pack-years

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4
Q

Large areas of “benign” respiratory mucosa being mutagenized by exposure to carcinogens in tobacco smoke is known as what?

A

“Field effect”

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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%)
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6
Q

Which type of lung cancer shows the strongest association with smoking?

A

Small cell carcinoma

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7
Q

Loss of function mutations in which 2 genes and chromosome are seen with small cell carcinoma of the lung?

A
  1. TP53
  2. RB1
  3. Chr 3p deletions
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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
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9
Q

Amplification of which gene has been associated with squamous cell carcinoma of the lung?

A

FGFR1

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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
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11
Q

Amplification of which gene is associated with small cell carcinoma of the lung?

A

MYC

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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
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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
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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
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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
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16
Q

What stage of adenocarcinoma progression is this?

How big?

A

Adenocarcinoma in situ

  • Dysplastic cells merging (cofluently) along alveoli
  • < 3cm
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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

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18
Q

Do precursor adenocarcinoma lesions all lead to malignancy?

A

NO

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19
Q

What is the most common lung cancer in non-smokers?

A

Pulmonary adenocarcinoma

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20
Q

Majority of adenocarcinomas of the lung express which transcription factor required for normal lung development?

A

Thyroid transcription factor-1

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21
Q

Adenocarcinomas tend to grow ______ than squamous cell carcinomas but metastize _____

A

slower

earlier

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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

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23
Q

What is this?

A

Squamous cell carcinoma with characteristic KERATIN PEARLS

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24
Q

Whatis the progression of squamous cell carcinoma?

A

NL pseutostratf ciliary columnar epi => squamous cells

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25
Q

Squamous cell carcinoma

MCC in M/F

Stronly assx w ______

Where in the lung does it occur?

A

Male

Smoking

Centrally; because precursor cells are located in airways and hilum

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26
Q

How do we recoginize squamous cell carcinoma on CYTOLOGY?

A

Orange cytoplasm is keratin => SQUAMOUS CARCINOMA

Anytime you see ORNG, think squamous carcinoma

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27
Q

What is this?

A

Small cell neuroendocrine carcinoma

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28
Q

Small cell neuroendocrine carinoma

  • lung tumor is almost always ______ at time of presentation, strongly associated with _____ and is best treated with specific chemotherapies/radiation?
A

Metastatic (so fast that on scans, you DO A WHOLE BODY SCAN)

Smoking

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29
Q

What is the most aggressive lung tumor with no known preinvasive phase?

A

Small cell *neuroendocrine* carcinoma

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30
Q

What is the histology of the chromatin, cytoplasm, nucleus, and nucleoli like with small cell carcinoma of the lung?

A
  1. -Tightly packed small blue cells (d/t chromatin)
    • Nuclear molding w nuclei smushed together
    • No nucleoli
    • Necrotically active
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31
Q

How does small cell carcinoma respond to chemo?

A

responds, but recurrence is high

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32
Q

If someone has adenocarcinoma, what tests will you run?

A
  • 1. Test for a EGFR mutation.
    • -Yes=> treat with a EGFR TK-inhibitor.
    1. If no => check for ALK rearrangement
      * - Yes => treat with Crizotinib.
    1. If no, treat with chemotherapy w/or w/o Bevacizumab
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33
Q

What is that MOA of Crizotinib?

A

Inhibits the ALK-EML4 fusion gene.

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34
Q

Tumor immunotherapy attempts to do what?

A

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

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35
Q

What drugs to treat adenocarcinomas target EGFR?

A
  • 1. Erlotinib
  • 2. Gefinitib
36
Q

What drugs to treat adenocarcinomas target PD-1/PD-L1?

A

Pembrolizumab

37
Q

What drugs to treat adenocarcinomas target CTLA-4?

A

Ipilimumab (Yervoy)

38
Q

What drugs to treat squamous cell carcinomas?

A

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
Q

Release of PTHrP leading to paraneoplastic hypercalcemia is associated with what type of lung tumor?

A

Squamous cell carcinoma

40
Q

What paraneoplastic conditions does small cell carcinoma cause?

A
    1. SIADH (secrete too much ADH)
    1. Cushings syndrome (too much ACTH secretion)
41
Q

What is a dermatologic manfiestation that may be associated with lung tumors?

A

Acanthosis nigricans

42
Q

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?

A
  • 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
Q

What are 2 hematologic abnormalities that may be assocaited with lung tumors?

A
  • Leukemoid rxns
  • Trousseau syndrome (DVT and thromboembolism)
44
Q

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?

A

Small cell carcinoma

Adenocarcinoma

45
Q

What are the spectrum of NE tumors?

A

1. DIPNECH

2. Carcinoid tumor

3. Atypical carcinoid tumor

46
Q

What is the main difference between Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) and Carcinoid tumors?

A
  • SIZE!!!
  • DIPNECH = very small, <5mm —> “Tumorlets”
  • Carcinoid tumor = 5mm or larger
47
Q

Why is it important to differentiate DIPNECH from Carcinoid tumors?

A

Carcinoid tumors have ability to metastasize

48
Q

Are carcinoid tumors benign or malignant?

A

MALIGNANT!

They are a grade 1 NE carcinoma.

49
Q

What are features of atypical carcinoid tumors which differ from typical carcinoid tumors (grade 1)?

A
  • 1. Grade 2
  • 2. Increased mitotic activity
    1. NECROSIS (Carcinoids do not undergo necrosis)
  • 4. Disordered growth
    1. Increase rate of metastasis with LOWER survival, but still better than small cell carcinoma.
50
Q

Can all NE tumors produce a carcinoid syndrome?

51
Q

Which cancers are almost always treated w chemotherapy, because they are almost always metastic at presentation?

A

Small cell lung carcinomas

52
Q

Which lung cancer is best known to cause paraneoplastic syndromes?

A

Small cell

53
Q

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?

A

Carcinoid tumor

54
Q

Immunohistochemical stains of carcinoid tumors may be positive for what 4 markers?

A
  • 1. 5HT
  • 2. Neuron specific enolase
  • 3. Calcitonin
  • 4. Bombesin
55
Q

What are the sx’s of Carcinoid Syndrome?

A
  1. - Flushing
  2. - Diarrhea
  3. - Cyanosis
56
Q

What is the prognosis like for typical carcinoid vs. atypical carinoid tumors?

A
  • Typical have 5-year survival of 95%
  • Atypical have 5-year survival of 70%
57
Q

What is a feature that can be seen on CXR and CT indicates a metastatic malignancy?

A

Multiple discrete nodules (cannonball lesions) scattered throughout all lobes

58
Q

What are these?

A

Cannonball lesions (more often located peripherally), meaning this person has a metastatic malignancy

59
Q

What is this

A

Pulmonary harmatoma: BENIGN nodules of CT (often hyalinized cartilage, fat or fibrous tissue) surrounded by clefts of respiratory epithelium

LOOKS LIKE MARBLE and has SMOOTH EDGES

60
Q

Lymphangioleiomyomatosis is a lung disorder occurring almost exclusively in whom?

A

Young women (VERY UNCOMMON in men)

61
Q

Lymphangioleiomyomatosis (LAM) is characterized by proliferation of which cells and what does this create morphologically?

A

Perivascular epithelioid cells –> proliferate and form cysts filled with air.

62
Q

What are 2 complications of LAM?

A
  1. Obstruct lymph vessels
  2. Cysts can pop and cause a sponatneous pneumothorax.
63
Q

What is the mutation seen in LAM?

A

LOF mutation in TSC2, a tumor supressor of mTOR activity

64
Q

Which markers are expressed by Lymphangioleiomyomatosis?

A

PEC cells are modified smooth muscle cells and + for melanoma marker HMB-45

65
Q

The strong tendency for Lymphangioleiomyomatosis to affect young women suggests what hormone contributes to proliferation of perivascular epithelioid cells?

66
Q

What are the 2 types of pleural effusions?

A
  • 1. Exudate (inflammatory) pleural effusion
  • 2. Transudative (non-inflammatory) pleural effision
67
Q

What is this?

A

Pleural effusion

68
Q

What are the major causes of transudate pleural effision?

A

1. HF, d/t increased hydrostatic pressure

2. Decreased plasma oncotic pressure

69
Q

What are the major causes of exudative pleural effision?

A

Inflammation or malignancy

  1. Infection (TB/bacterial pneumonia)
  2. PE
70
Q

What causes pleural effision look like d/t an obstructed duct or in pleural space and most commonly seen in post-surgical CAB.

A

Milky chylous effusion= chylothorax

71
Q

What is empyema?

A

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
Q

What does fluid in empyema look like?

A

Thick, yellow with neutrophils and bacteria

73
Q

what is this

A

empyema; loculations caused by it

74
Q

Bloody effusion: be aware of ______

Clear yellow effusion: be aware of ______

Milky Chylous effusion: be aware of _____

A
  • adenocarcinoma
  • CHF
  • post-surgical CAB or blockage of thoracic duct
75
Q

Pneumothorax is most commonly associated with what 3 conditions?

A

- Emphysema

- Asthma

- Tuberculosis

76
Q

Primary (idiopathic) penumothorax most often occurs in which age group and is due to what?

A
  1. Young patients
  2. Rupture of subpleural blebs
77
Q

What conditions did we learn that cause a pneumothorax?

A
  1. LAM
  2. LCH (langerhan cells histiocytosis)
78
Q

what is this

A

Solitary fibrous tumor: 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
Q

How does the behavior of Solitary Tumor Cells change when they are small vs when they are larger?

A
  • Small: benign
  • Larger: sarcoma
80
Q

what is this?

A

solitary fibrous tumor (well DEFINED/circumscribed)

81
Q

name a malignant pleural tumor

A

mesothelioma

82
Q

what cell we find in mesothelioma

A

ferruginous bodies

83
Q

Pleural cavity pressure > atmospheric = _____ pneumothorax

A

tension pneumo

84
Q

Pleural cavity pressure < atmospheric = _____ pneumothorax

A

primary pneumothorax

85
Q

What stain can we easily see solitary fibrous tumors with, benign tumors of the pleura.

86
Q

how can we get asbestos => causing mesothelioma?

A
  1. insulation
  2. shipyard workers
  3. construction workers

CPR Exam 1 (19 decks)

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