L12- Pulmonary Pathology VI (General Lung Cancer)

Question 1

(1) is the most common lung carcinoma. At time of diagnosis (2)% of patients will have metastatic disease.
- (3)% is 5 yr survival rate all stages of CA
- (4)% is 5 yr survival rate of localized CA

Answer 1

1- bronchogenic, 90-95%
2- 50%
3- 16%
4- 45%

Question 2

• tobacco is more carcinogenic in (men/women)
• heavy smokers (2ppd x 20yrs) inc risk of lung cancer by (2)
• asbestos exposure inc risk by (3)
• asbestos and any smoking inc risk by (4)

Answer 2

1- women, more susceptible to tobacco than men
2- 60x
3- 5x
4- 55x

Question 3

list the classifications of lung tumors

Answer 3

Small Cell CA

Non-Small Cell CA:

• adenocarcinoma
• SCC
• large cell carcinoma
• others

Note- all primary neoplasms

Question 4

non-small cell carcinomas are responsible for (1)% of lung CAs- (2) include the breakdown (% of total lung CAs) of each type NSCC

Answer 4

NSCC- 70-75%

• adenocarcinoma, 30-35%
• SCC, 25-30%
• large cell carcinoma, 10-12%

Question 5

small cell carcinomas are responsible for __% of lung CAs

Answer 5

20-25%

Question 6

(non-/small) cell carcinomas metastasize quickly, and usually (do not/have) metastasis at time of diagnosis; therefore treatment includes (3)

Answer 6

1- small cell carcinoma
2- do have metastasis
3- chemotherapy +/- radiation

Question 7

list common genetic mutations seen in non-small cell carcinoma

Answer 7

• 3p del
• p16 / CDKN2a

Adenocarcinoma- KRAS, EGFR
Signet Ring Adenocarcinoma / non-smokers- ALK

Question 8

list common genetic mutations seen in small cell carcinoma

Answer 8

• myc amplification
• p53
• RB
• 3p del

Question 9

compare the clinical features of peripheral and central lung cancer

Answer 9

Peripheral: possibly clinically silent

Central:

• obstruction (total, partial)
• infection (pneumonia, abscess, bronchiectasis)
• atelectasis

Question 10

list the common clinical Sxs of most lung cancers

Answer 10

cough
weight loss
hemoptysis
dyspnea
chest pain
pulmonary osteoarthropathy / finger clubbing

Question 11

list the 3 possible neurological local effects of lung cancer

Answer 11

• Horner Syndrome: cervical SNS plexus compression / damage –> ipsilateral enopthalmos, ptosis, miosis, anhidrosis
• hoarseness (laryngeal nerve)
• diaphragm paralysis (phrenic nerve)

Question 12

local effects of lung cancer:

• (1) structural lung changes and possible infections
• (2) affecting blood vessel(s)
• (3) results from direct extension of lung cancer
• (4) non-neurological / non-vascular compression
• (5) bone changes

Answer 12

1- atelectasis, pneumonitis, abscesses
2- SVC syndrome via compression: venous congestion + edema of head/arm
3- pleural / pericardial effusion
4- dysphagia
5- rib destruction (via bone disruption)

Question 13

(1) is an apical neoplasm that involves destruction of (2) nerves, evident directly through (3- indicate nerve) symptoms / presentation.

Answer 13

1- Pancoast tumor
2- T1/T2 nerves
3- wasting of hand muscles + pain in arm (Ulnar Nerve)

Question 14

list the 5 compression effects of a Pancoast tumor

Answer 14

(apical tumor- T1/T2 destruction)

• Horner Syndrome: cervical SNS plexus compression / damage –> ipsilateral enopthalmos, ptosis, miosis, anhidrosis
• recurrent laryngeal nerve compression
• compression of BVs –> edema
• compression of esophagus –> dysphagia
• thoracic duct obstruction –> chylothorax (lymph fluid between chest wall and lung)

Question 15

describe Horner Syndrome

Answer 15

compression / damage of cervical sympathetic plexus –>

• ipsilateral enopthalmos (posterior displacement of eye due to volume loss)
• ptosis
• miosis
• anhidrosis

Question 16

define paraneoplastic syndrome and why it is important clinically (3 reasons)

Answer 16

Defn: symptom complex in cancer patients that are not readily explained by local or distant spread OR by elaboration of hormones by tumor cells

Importance due to:

• earliest manifestation of occult neoplasm
• significant clinical problem (possibly lethal)
• may mimic metastasis and difficult to treat

Question 17

Paraneoplastic syndrome is seen in (1)% of all lung cancers, usually (2) type.

Answer 17

1- 10%

2- SCLC (small cell lung carcinoma)

Question 18

list the possible paraneoplastic syndromes seen in lung cancer and indicate due to which type of cancer

Answer 18

-hypercalcemia: PTH related peptide /// SCC

• Cushing’s syndrome: ACTH, bilateral adrenal hyperplasia /// SCLC
• SIADH- hyponatremia /// SCLC
• Myasthenic like syndrome OR Lambert-Eaton syndrom /// SCLC
• hypocalcemia: calcitonin /// SCLC
• gastrin-releasing peptide ///SCLC

Question 19

describe Lambert-Eaton syndrome

Answer 19

Abs against pre-synaptic Ca channels in the NMJ –> dec ACh release and therefore muscle paralysis

Question 20

describe the metastasis of Lung Cancer

Answer 20

• lymph node is most common
• adrenal, 50% (rarely Addison’s / insufficiency)
• liver, 30-50%
• brain, 20%
• bone, 15-20%