L12 Tumors of Lung and Pleura

Question 1

Commonest cause of Cancer Death?

Answer 1

Lung Cancer
Commonest Cause of Cancer Death
2nd-Most prevalent incidence of cancer

higher lung cancer incidence in Young Women than Young Men

Question 2

Histologic and Experimental Evidence against smoking ________

Epidemiologic Evidence ________

Answer 2

Histologic and Experimental Evidence against smoking Weak

Epidemiologic Evidence Strong

Question 3

Biggest Risk factors for lung cancer?

Answer 3

Smoking

80% of Lung Cancer Cases

10% of all smokers get lung cancer

Radon Gas (2nd most significant environmental factor after smoking)

Question 4

Diagnosis of Lung Cancer

Answer 4

Cytology Diagnosis

• Sputum (Not sensitive enough)
• BAL : Wash fluid into distal alveoli and suction back up)
• Endoscopic FNA(EBUS): Ultrasound on scope, identify node beyond traceha and aspirate with needle
• Percutaneous FNA (CT guided needle into tumor)

Surgical Pathology Diagnosis

• Endoscopic Biopsy
• Percutaneous CT guided biopsy
• Open Biopsy +/- frozen section
• Surgical resection

Question 5

Clinical Presentation of Lung Cancer

Answer 5

Clinical Presentation:

• Cough
• Sputum
• Hemoptysis (Coughing up blood)
• Breathlessness
• Incidental
• Paraneoplastic syndrome
• Metastatic
• Weight loss
• Clubbing of fingers

Question 6

Classification of Bronchogenic Carcinoma?

Answer 6

Adenocarcinoma (40%)

Squamous (20%)

Endocrine-Small Cell (15%)

Large Cell Undifferentiated (3%)

Question 7

Squamous Carcinoma

Males or Females?

Association with smoking?

Scaring?

Other Characteristics?

Answer 7

Squamous(20%)

Males > Females

Strongly associated w/smoking

Central scarring

OTHER:

Grows rapidly, spreads late

Adjacent Epithelial Atypia

Paraneoplastic Hypercalcemia

Positive for CK5/6 and p63

Question 8

Adenocarcinoma

Males or Females?

Association with smoking?

Scaring?

Other Characteristics?

Answer 8

Adenocarcinoma(40%)

Females > Males

Less Strongly associated w/ Smoking

Peripheral Scaring

Lepidic Pattern (Atypical Adenomatous Hyperplasia or in situ):

Mutation of EGFR Tyrosine Kinase domain

Subtype of Lung Cancer

Good prognosis

Often: Female, East Asian, Non-Smokers

Question 9

Non-mucinous adenocarcinoma may respond to __________________________ and are usually _______ Pos

Answer 9

Non-mucinous adenocarcinoma may respond to EGFR (Epidermal Growth Factor Receptor) Tyrosine Kinase inhibition and are usually TTF1 Pos

Question 10

__________________

Not associated w/ smoking

Good prognosis

Kulchitsky Cell

Tumourlets —Small cell

Answer 10

Bronchial Carcinoid

Not associated w/ smoking

Good prognosis

Kulchitsky Cell

Tumourlets (Carcinoid)—Small cell

Question 11

____________________

Intermediate b/n classic carcinoid and small cell carcinoma

Higher rate of metastasis than Bronchial

Answer 11

Atypical Carcinoid

Intermediate b/n classic carcinoid and small cell carcinoma

Higher rate of metastasis than Broncial

Question 12

____________________

Associated w. Smoking

Aggressive – Mean survival <2years

Neuroendocrine- Kulchitsky cell

Small round hyperchromatic cells, scant cytoplasm, salt, and pepper chromatin

Answer 12

Small Cell Carcinoma

Associated w. Smoking

Aggressive – Mean survival <2years

Neuroendocrine- Kulchitsky cell

Small round hyperchromatic cells, scant cytoplasm, salt and pepper chromatin

Question 13

Large Cell Undifferentiated(3%)

More cytoplasm than small cell w/ more promient _______

________________ architecture

Pos for ___________ markers– Chromogranin, Synaptophysin, CD56

Treated similarly to small cell

Where can it spread?

Answer 13

Large Cell Undifferentiated(3%)

More cytoplasm than small cell w/ more promient nuclei

Endocrine architecture

Pos for endocrine markers– Chromogranin, Synaptophysin, CD56

Treated similarly to small cell

Can spread to any organ:

One of the few cancers to affect adrenal glands!!

– Liver

– Bone

– Brain

Question 14

Therapy for small cell carcinoma?

Answer 14

Chemoradiation

Surgery uncalled for

Question 15

Non-Small Cell Cancer Therapy?

Answer 15

Low Stage: Surgery +/- radiation

High Stage: Chemotherapy, Checkpoint Inhibition +/- Radiation

Question 16

______ and ______ are checkpoint inhibitors used for squamous carcinomas

Answer 16

PDL1 and TMB are checkpoint inhibitors used for squamous carcinomas

Question 17

Secondary Pathody of Bronchogenic Carcinoma?

Answer 17

Obstructive

Emphysema / Bronchiectasis (scaring)

Pneumonia

Local Invasion

Superior Vena Cava

Pericarditis/Pleuritis

Pancoasts Tumour

Tumor in Apex of Lung

Invasion to surrounding tissues

Lower bracial plexus

Sympathetic Chains => Horner’s syndrome

Paraneoplastic Syndromes:

Syndromes not directly related to the tumor rather hormones excreted by the tumor

ie Hypertrophic pulmonary osteoarthropathy(Clubbing of Fingers)

Question 18

__________________: Tumor in Apex of Lung

Invasion to which surrounding tissues and associations?

Answer 18

Pancoasts Tumour

Tumor in Apex of Lung

Invasion to surrounding tissues

Lower bracial plexus

Sympathetic Chains => Horner’s syndrome

Question 19

_____________________________: Syndromes not directly related to the tumor rather hormones excreted by the tumor

Examples?

Answer 19

Paraneoplastic Syndromes:

Syndromes not directly related to the tumor rather hormones excreted by the tumor

ie Hypertrophic pulmonary osteoarthropathy(Clubbing of Fingers)

Question 20

Screening for Lung cancer?

Answer 20

• High-risk individuals via low dose CT

=> 20% reduction in lung cancer related mortality

Question 21

Mesothelioma:

Arise in _____________________

Uncommon

Caused by exposure to Asbestos

Surrounds and encases lungs => ________ prognosis

Answer 21

Mesothelioma:

Arise in visceral or parietal pleura

Uncommon

Caused by exposure to Asbestos

Surrounds and encases lungs => POOR prognosis