Exam 2, Lung set 4 Flashcards
1
Q
Lung Tumor Facts
A
- 90% are carcinomas
- Biggest cancer killer in USA, only 15% 5-year survival
2
Q
2 major classifications of Lung CA (over 90% of cases)
A
- Small cell lung cancer (SCLC) and Non-SCLC (NSCLC) or mixed.
- SCLCs are worse, but respond much better to chemo
- NSCLCs include Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. *The non-small cell cancers behave & are treated similarly
3
Q
SCLC vs NSCLC
A
SCLC:
- 20-25% of lung cancer
- grows more quickly
- higher risk of METS
- “oat cell” cancer b/c cells are small and look like oats
NSCLC:
- More common ~80% of lung cancers
- slower growing, less risk of metastasis
- 3 types: Adenocarcinoma (30-35%), Squamous cell carcinoma (25-40%), large cell undifferentiated carcinoma (10-15%)
4
Q
Environmental Exposure Risks for lung Cancer
A
SMOKING! Asbestos Chemical fumes (i.e. vinyl chloride) Metallic dusts (Ag & Ni) Radiation exposure (radon)
5
Q
Why is smoking soooo bad?
A
Over 1200 substances in the smoke
- “initiators” and “promoters” (polycyclic aromatic hydrocarbons) (phenol derivatives)
- Radioactive elements (carbon-14)
- Other contaminants (arsenic, nickel, mold, etc)
Damage depends on…
- age when they start
- pack years
- when the quitting happened
6
Q
Bronchiogenic carcinoma
A
Any malignant neoplasm that arises in lung tissue
- *Second most common cancer in the US! (14% of all cancers)
- Leading cause of cancer DEATH in both men & women (28% of all cancer deaths in US, 162,000/year)
- Occurs most often between 40-70 yo
- Usually poor prognosis: 5-year survival ~15%
- Primary risk factor = SMOKING! (whaaaat? Shock!)
- Heavy smokers (+1 pack/day): male -15-25x higher LC mortality, female 2-5x higher LC mortality
7
Q
Sx of Lung Cancer
A
- COUGH! 1st & most common sx : increasing severity of pre-existing cough (like that smokers would have) may suggest neoplasm
- Hemoptysis might be a thing
- Sx of larger tumors: chest pain, loss of appetite, wt loss, DOE
8
Q
Common Locations of Lung Cancer
A
Small cell LC: central, near hilum. “can” be anywhere
Squamous cell Carcinoma: usually central
Adenocarcinoma: usually outer periphery
Large cell undifferentiated carcinoma: anywhere!
9
Q
Adenocarcinoma
A
- Location: periphery of lung just below pleura (asx until late, may show retraction/thickening on x-ray but usually doesn’t show up until cancer has spread)
- *Most frequently dx’d type of LC
- *Most common LC in women & non-smokers
- Associated with scarring
- Frequency increase over past 30 years
- Gross morphology: “3 P’s” Peripheral, Pigmented, Puckered - well circumscribed, possibly central necrotic cores. Usually 2-5cm at time of resection.
- Epithelial tumor with glandular differentiation and mucin production by the tumor cells
10
Q
Squamous Cell Carcinoma
A
- Location: central, arising from bronchi.
- 1/3 of LC’s
- Strongly linked w/Hx of smoking
- Chronic bronchial inflammation can lead to metaplasia of normal ciliated columnar epithelium to squamous epithelium
- Histology: columnar epithelium loses cilia (early), undergoes dysplasia, may penetrate basement membrane (late) becoming invasive carcinoma. *characteristic = keratinization +/or intercellular bridges.
- Gross: Firm, non-encapsulated, sharply circumscribed. Grey/white, granular/dry surface. Large ones outgrow vascular supply -> central hemorrhage, necrosis or cavitation (10%)
- CXR: may see tracheal deviation
- Complications: bronchial obstruction, centri-acinar emphysema & chronic bronchitis, bloody aspiration,
11
Q
Small Cell/Oat Cell Carcinoma
A
- Location: central, near hilum
- Metastasis common (fast growing), bad long term outcome
- Histology: Small, dark-staining epithelial cells, round w/scant cytoplasm, poorly defined borders, granular, absent nucleoli, packed in sheets
- Complications: Produces hormones -> Ectopic ADH (severe hyponatremia), Ectopic ACTH ( cushing’s dz), also PTH (excessive Ca+), Calcitonin (deficient Ca+), Gonadotropins, Serotonin/bradykinin. *These may be the first signs of lung cancer, are common w/small cell LC.
12
Q
Large Cell Carcinoma
A
- Location: Anywhere in lung
- *More resistant to tx than other NSCLC
- Histology: undifferentiated epithelial tumor. Lg polygonal cells w/lg prominent nuclei & moderate cytoplasm.
- Dx by exclusion
13
Q
Bronchial Carcinoid Tumors
A
- *Rare in adults but most common primary LC in children!
- *Not associated w/smoking
- Sx: cough, fever, expectoration, wheezing, hemoptysis, chest pain
- Malignant & metaplastic potential
- Good prognosis, 5-year survival rate ~85%
- Histology: small, round, uniform cells arranged in nests & cords, highly vascular.
- Gross: Submucosal lesion protruding into bronchial cartilage toward lumen. Smooth, cherry red. May obstruct lumen.
- Rarely causes Carcinoid syndrome - only if liver METS, sx are diarrhea, facial flushing & wheezing.
14
Q
Carcinoid tumors (general info)
A
- Derived from neuroendocrine tissue.
- GI is most common location, lungs second (bronchial carcinoid tumors!).
- Produce bio-amines (Epi, NE, serotonin)
15
Q
Hamartomas
A
- *Most common benign tumor of the lung (75%)
- Disorganized tissue growth (fat, epithelium, fibrous tissue, cartilage)
- Usually well circumscribed cartilaginous nests surrounded by CT & fat cells.
16
Q
Complications of Tumor Extension
A
- Hoarseness -> compression of recurrent laryngeal nerve
- Diaphragmatic paresis/paralysis uni/bilaterally -> compression of phrenic n.
- Esophageal obstruction
17
Q
Pancoast Tumor Syndrome
A
- Tumor in lung apex infiltrates brachial plexus!
- Sx: pain, numbness, weakness of affected arm
- May involve adjacent vertebra/ribs
