Lecture 10 Pulmonary Neoplasms Flashcards
____ causes 80-90% of all lung cancer. what is the most important carcinogen in it?
tobacco smoking; polyaromatic hydrocarbons (accoring to pathoma)
who has a higher risk of developing lung cancer, women or men?
women
what is the most common histological subtype of lung cancer?
adenocarcinoma
adenocarcinoma most likely arises from ____ cells in the _____ (central or peripheral?) bronchi. it stains ____ positive
mucin secreting, peripheral, mucin
the bronchioalveolar subtype of adenocarcinoma is characterized by ____ cells that grow along bronchioles/alveoli. they arise from ___ cells and ____ to smoking
columnar;
clara, unrelated
what is the prognosis with bronchioloalveolar carcinoma? CXR shows a ____ infiltrate similar to ____
good. hazy, pneumonia
what is the ‘S’ pneumonic?
Squamous cell and Small cell carcinoma are Sentrally located, caused by Smoking, and have paraneoplastic Syndromes associated with them.
squamous cell carcinoma presents as a ____ mass arising from the ____.
hilar, bronchus
characteristic histological findings of squamous cell carcinoma
keratin pearls and intercellular bridges
what are the “C”s of squamous cell carcinoma?
cavitation, cigarretes, hyperCalcemia (due to PTHrP)
large cell carcinoma:
central or peripheral?
surgery or chemo?
good or bad prognosis?
peripheral, surgery; bad prognosis (aggressive)
small cell carcinoma: neoplasm of ____ _____ cells which are small dark ___ cells on histology
neuroendocrine Kulchitsky, blue
small cell carcinoma can produce ____, causing cushing syndrome. they can also cause ____. they can produce antibodies against ____ channels causing lambert eaton myasthenic syndrome
ACTH, SIADH;
presynaptic calcium
what might you see histologically in small cell carcinoma?
lot of mitotic activity
bronchial carcinoid tumor: highly ___ lesions that arise in ____ glands in the bronchial wall. characterized by red/pink ___ mass protruding from the bronchial wall
vascularized, submucosal;
polyploid
bronchial carcinoid tumor: stains positively to ____ markers such as _____
neuroendocrine, chromogranin
diagnosis of bronchial carcinoid tumor is usually made based off of history of frequent ____ or repeated bouts of ___ + bronchoscopy. what’s the prognosis?
hemoptysis, pneumonia;
“excellent”
carcinoid syndrome: release of vasoactive amines such as _____ which cause _____ of face and upper body,diarrhea, and _____
serotonin; flushing;
wheezing
why shouldn’t you biopsy a carcinoid tumor?
severe risk of hemorrhage
bronchial carcinoid tumor shows a nest of slightly spindled cells with strippled ____; “ ____ and ____” pattern
chromatin; salt, pepper
____ is the most common benign tumor of the lung. composed of disorganized elements of tissue normally ____ in the lung
hamartoma; present (ie lung tissue and cartilage)
hamartoma is characterized by a ____ hard smooth mass with the “____ out”
rubber, shell
staging system looks at 3 things:
TNM:
Tumor size/extension, regional lymph node involvement, metastasis
how is small cell carcinoma staged?
limited or extensive disease (ie to contralateral hemithorax)
see his notes for staging system specifics
not the most high yield
presence of metastasis automatically makes the disease stage ___
IV
treatment of limited small cell cancer is ____.
what about extensive stage disease?
chemo + RT;
just chemo
is hypercalcemia in lung cancer typically due to bony metastasis or due to secretion of PTHrP?
PTHrP (80%)
hypoglycmia is due to increased insulin release and is seen typically in what type of lung cancer?
squamous cell
large cell carcinoma can contain cells that secrete _____, leading to ____ or clubbing
gonadotropin, gyneocomastia
a right apical lung mass or thrombosis from indwelling catheter is usually the cause of _____
SVC syndrome
Symptoms of SVC: ___ discoloration and edema of the ____ and ____, JVD.
blue; upper extremity, face
Pancoast tumors involve the ___ dermatomes with invasion of the brachial plexus, resulting in ____ and ___ pain along with weakness and atrophy of ___ muscles. can also cause ____ syndrome
C8-T2; shoulder, arm;
hand;
horner’s
horner’s syndrome causes what 3 symptoms? (better know this or you will be haunted by Dr. Walker);
due to involvement of the sympathetic chain and _____ ganglion. does it cause ipsi or contralateral symptoms?
ptosis, miosis, anhidrosis;
inferior cervical (stellate);
ipsi
acanthosis nigricans is brownish hyperpigmentation and is common with _____
bronchial adenocarcinoma
what is the most useful diagnostic test in screening for cancer? What is the most useful radiologic test?
sputum cytology; CT
look for ____ lesion on CXR or a _____ nodule on CT
“coin”; noncalcified
____ determines the diagnosis of lung cancer and determines the cell type
bronchoscopy
non-small cell lung cancer: for stage 1 and 2, use ____;
for stage 3, use ____; stage 4 use ____
surgery + adjuvant chemo RT;
chemo + RT; chemo
limited disease small cell lung cancer is very responsive to _____; although still low survival :(
chemotherapy + RT
extensive stage small cell lung cancer:
_____ irradiation is used to improve quality of life and decrease mets
brain
asbestos usually causes _____ and can cause _____
lung cancer; mesothelioma
mesothelioma is characterized by pleural _____ or ___
thickening, effusion
mesothelioma stains positive for ____ and _____
cytokeratin, calretinin
characteristic ____ bodies are seen on histology with mesothelioma
psammoma
