KEY wk 6 lec 1

Question 1

most common type of lung cancer

Answer 1

adenocarcinoma (non-small cell)

Question 2

3 subtypes of non-small cell lung cancer

Answer 2

1. adenocarcinoma
2. squamous cell carcinoma
3. large cell carcinoma

Question 3

where are pan coast tumors located and in what type of cancer

Answer 3

apex of lung in squamous cell carcinoma (non-small cell)

Question 4

which cancer is common in nonsmokers?

Answer 4

adenocarcinoma

Question 5

location and tissue involvement in adenocarcinoma

Answer 5

peripheral and bronchial mucosal glands

Question 6

location and histology of squamous cell carcinoma

Answer 6

central and keratin pearls

Question 7

which lung cancer has hypercalcemia

Answer 7

squamous cell

Question 8

large cell carcinoma

location

ddx of

histology

Answer 8

large peripheral masses

diagnosis of exclusion (see focal necrosis and keratin and gland formation so exclude squamous cell c. (keratin) and adenocarcinoma (gland)

Question 9

small cell lung cancer

location

cells involved

Answer 9

centrally or hilum

neuroendocrine

Question 10

spread of non-small cell vs small cell

Answer 10

small cell grow and spread more quickly

Question 11

TNM acryonym for tumor stages in lung carcinoma

Answer 11

T: TUMOR size and spread locally?

N: spread to lymph NODES?

M: distant METASTASES or pleural fluid involvement?

Question 12

4 stages of tumors/ cancer

Answer 12

stage 1: small tumor and no lymph involvement or metastases

stage 2 and 3: regional lymph involvement

stage 4: distant metastasis

Question 13

lung cancer most of metastasizes to:

Answer 13

-region lymph nodes- hilar and mediastinal nodes

-brain

-bone

-liver

-adrenal glands

Question 14

most common sx of lung cancer

Answer 14

cough

Question 15

sx and signs in central vs peripheral tumors

Answer 15

central: cough, hemoptysis, dyspnea, wheezing, atelectasis, post obstructive pneumonia

peripheral: severe pain (from infiltration of parietal pleura and chest wall), pleural effusion, dyspnea, cough

Question 16

common effects from pancoast tumor

Answer 16

shoulder and upper back pain bc effect ribs and spine

Question 17

horners syndrome

which nerve involved and sx

Answer 17

tumor impinges sympathetic nerve plexus –> effects ipsilateral side

ptosis: upper eyelid droop

miosis: pupil constriction

anhidrosis: no sweating

Question 18

pancoast syndrome

which nerve involved and sx

Answer 18

C8, T1, T2 nerves

severe arm and shoulder pain and paresthesia, radiate down arm in ulnar distribution

atrophy of hand muscles

Horner’s syndrome (ptosis, miosis, anhidrosis)

Question 19

superior vena cava syndrome sx

Answer 19

Dyspnea, cough, edema of the face and/or upper extremity, venous distension, dysphagia, headache, all due to obstruction of the superior vena cava

Question 20

sx of loco regional spread of lung cancer

Answer 20

-superior vena cava syndrome (dysnpena, cough, face edema, dysphagia, headache)

-hoarseness (paralyzed laryngeal nerve)

-hemidiapgram and dyspnea (phrenic nerve palsy)

-horner syndrome (brachial nerve root)

-dysphagia (esophageal compression)

-pericardial effusion

Question 21

general symptoms of distant metastasis

Answer 21

weight loss, cachexia (muscle mass loss)

Question 22

bone metastases sx

Answer 22

bone pain

spinal cord impingement (cramping muscles, constipation, erectile, paralysis)

Question 23

brain metastases sx

Answer 23

headache
mental status
seizure
ataxia
N/V

Question 24

liver metastases sx

Answer 24

hepatomegaly
anorexia
confusion
jaundice
nausea

Question 25

paraneoplastic syndromes

Answer 25

nonmetastatic systemic effects from substances made by cancer or cancer itself impair organs i.e. endocrine, dermatologic, rheymatologic....

Question 26

2 causes of paraneoplastic syndrome

Answer 26

from physiologically active substances made by cancer: hormones, hormone precursors, enzymes, cytokines altered immune response (body makes antibodies which cross react with normal tissue)

Question 27

small or non-small lung cancers have paraneoplastic syndromes more commonly?

Answer 27

small

Question 28

examples of paraneoplastic syndromes

Answer 28

hypercalcemia (ectopic production of parathyroid hormone - squamous cell carcinoma) syndrome of inappropriate antidiuretic hormone (small cell lung cancer) digital clubbing and hypertrophic pulmonary osteoatropathy and trousseau syndrome of hyper coagulability (adenocarcinoma) cushing syndrome (ectopic ACTH production - small cell)

Question 29

endocrine symptoms from paraneoplastic syndromes and sx

Answer 29

hypercalcermia (hyperparathyroid --> thirst, muscle weakness, loss of appetite, confusion, ab pain, depression) Syndrome of inappropriate antidiuretic hormone (SIADH) (hyponatremia --> thirst, muscle weakness, loss of appetite, confusion, abdominal pain, and depression) cushing- high ACTH (hypokalemia --> increased serum and urine cortisol concentrations)

Question 30

Cushing syndrome Syndrome of inappropriate antidiuretic hormone (SIADH) secretion Hypercalcemia ---------- match with the answer-------- hyperparathyroid hyponatremia hypokalemia

Answer 30

Cushing- hypokalemia SIADH - hyponatremia hyperparathyroid - hypercalcemia

Question 31

primary lung cancers are mainly (90%) from

Answer 31

tobacco smoke

Question 32

carcinogens causing lung cancer

Answer 32

tobacco smoke asbestos radon air pollution

Question 33

what does tobacco do to cause lung cancer

Answer 33

* Polyaromatic hydrocarbons and nicotine-derived nitrosamine ketone are known to cause DNA damage by forming DNA adducts in animal models * Benzo-A-pyrine induces molecular signaling and mutations in p53 and other tumor suppressor genes

Question 34

main mutation in cancer

Answer 34

K-ras (oncogene) esp in non-small cell lung cancers also correlates with cigarette smoking

Question 35

3 mutations in cancer

Answer 35

K-ras EGFR EML4-ALK translocation

Question 36

Epidermal Growth Factor Receptor (EGFR) mutation in cancer who most common in

Answer 36

mutation in tyrosine kinase domain non smoker, women, east asian

Question 37

EML4-ALK Translocations in cancer most frequent in metastases to

Answer 37

fusion of those 2 genes non smokers brain

Question 38

carcinoids (rare) are in 2 subtypes smoking or not? growth? do not cause

Answer 38

neuroendroceine cells of bronchial epitehlium typical and atypical not smoking grow slower DO NOT cause paraneoplastic syndromes

Question 39

mesothelioma (rare) is in caused by sx prognosis

Answer 39

pleural lining asbestos pleural effusion or a pleural mass, chest pain, and nonspecific symptoms, such as weight loss and malaise poor- die in 18 months

Question 40

metastasis via most spread to which part of lung

Answer 40

lymphs or blood edges and lower lobes

Question 41

metastasize to lung from

Answer 41

* Bladder cancer * Breast cancer * Colorectal cancer * Kidney cancer * Melanoma * Sarcomas * Testicular