Lecture 62 and 63 - Lung Cancer pathology, Dx and Tx

Question 1

In general what are some risk factors for lung cancers?

Answer 1

Smoking –11% of smokers get lung cancer

Occupational Exposures – Arsenic, Asbestos, Berrylium, Nickel

Lung Disease – COPD, TB, IPF

Inherited Predispositions

Question 2

what is the precursor lesion prgression of SCC of the lung?

Answer 2

Squamous metaplasia –> dysplasia –> SCC in situ

Question 3

what is the precursor lesion progression of Adenocarcinoma of the lung?

Answer 3

Atypical adematous hyperplasia –> adenomacarcinoma in-situ

Question 4

what is the main classification of lung cancers?

Answer 4

Small cell lung cancer

Non small cell lung cancer

Question 5

Small cell Lung cancer --
#1 risk factor? 
where in the lung? 
what genes? 
typical treatment? 
histological markers?

Answer 5

Poorly differentiated NET which occurs nearly exclusively in smokers

Central, bulky appearing mass

Amplification of myc genes

Treated with chemoradiation

+Synaptophysin, Chromogranin

Question 6

what are the different non small cell lung cancers?

which is the most common?

Answer 6

Adenocarcinoma – most common cancer among non smokers; most common cancer overall

Squamous Cell Carcinoma

Large Cell

Carcinoid

Question 7

Adenocarcinoma of the lung

- where in the lung? 
Typical Mutations? 
-Progression of pre-invasive lesions? 
-typical treatment? 
- histological marke?

Answer 7

The most common lng cancer
Presents in the periphery of the lung

Mutations: KRAS, EGFR, ALK

Pre-invasive: AAH, AC in situ, leipidic (minimal invasion)

Treatment: Surgical if early enough

Histological marker: TTF1

Question 8

SCC of the lung -

• • precursor lesion
• • # 1 risk factor
• • where in the lung ?
• -classic histological finding?
• • CXR finding? what is this indicative of?

Answer 8

1 Risk Factor: Smoking

Squamous Metaplasia –> dysplasia –> In situ

Where: central appearing; (50% of the time);

histo: Keratin pearls, central necrosis, cavitatins

CXR: fluid/air level; indicatve of Cavitations

Question 9

Carcinoid tumor of the lung

• where does it commonly present?
• • can it cause symptoms?
• • Stains?
• • prognosis
• • what is carcinoid syndrome ?

Answer 9

Mass sitting inside the bronchus (endo-bronchial)
can cause symptoms if its obstructing the lumen

Stains: Neuroendocrine markers (Synaptophysin, chromogramin A)

good prognosis

carcinoid syndrome: the tumor secrets serotonin (for example) which is normally metabolized by the liver; but if there are mets to the liver which impair metabolism, the excess 5HT –> flushing, diarrhea, wheezing

Question 10

what is a Pancoast tumors?

• where is it located ?
• how can it present? (symptoms

Answer 10

Location: In the superior Sulcus;

Associated with destructive lesions of the throacic inlet
Brachial plexus involvement
Involvement of cervical sympathetic nerves

Lots of symptoms

• • Severe shoulder pain
• • atrophy of the arm and hand muscles
• • Horner’s Syndrome
• • SVC syndromes

Question 11

How do metastatic lesions to the lung typically appear? how is the morphology described ?

Answer 11

Round; Multiple Lesions

“Cannonball”

Question 12

what is 1 benign lesion of the lung/

Answer 12

Hemartoma

Question 13

In what stage is lung cancer typically diagnosed?

what are some symptoms of lung cancer?

Answer 13

stage 3

Cough, weight loss, dyspnea, chest pain,

hemotypsis, bone pain, clubbing (all are worrisome)

Question 14

what are some findings of lung cancer related to regional metastasis ?

Answer 14

Recurrent Laryngeal nerve paralysis (hoarseness), or at the region of the VCs

Horner’s Syndrome– ptosis, miosis, anhidrosis

Pancoast syndrome – cervical/thoracic nerve invasion;

Pleural effusion — (lymphatic obstruction)

Vascular obstruction — (SVC syndrome)

Pericaridal Extension – Pericardial Effusion, tamponade

Question 15

what are some paraneoplastic syndromes of lung cancers?

• • which are associated with Small cell ?
• • which are associated with squamous?

Answer 15

Small Cell – SIADH, Lambert Eaton, Cushing (ACTH)

SCC – Hypercalcemia (PTHRP)

Osteoarthropathy

Question 16

what tissue should always be checked for metastasis of lung cancers ?

what are other locations of mets from LC?

Answer 16

the adrenal gland

other: brain, bone

Question 17

SCLC – how is it staged ?

what is general treatment approach?

Answer 17

Limited Disease = limited to the thoracic cage up through to the Supraclavicular LNs

Extensive = other regions of the chest or other parts of the body
70% of SCLCs –

Tx – Chemoradiatin

(Limited stage: In this stage, cancer is found on one side of the chest, involving just one part of the lung and nearby lymph nodes.

Extensive stage: In this stage, cancer has spread to other regions of the chest or other parts of the body.)

Question 18

NSCLC –
Stages 1-4: what do they mean
how does this vary treatment?

if chemo is used what kind?

Answer 18

Stage 1 - Lung only – Surgery
Stage 2 - Local LN — surgery + chemo
Stage 3 - Mediastinal LN — chemo+ XRT (+/- surgery)
Stage 4 - Distant Mets – chemotherapy

Typically use platinum based therapies 
or targetted therapies such as: 
- Erlotinib -- EGFR 
- Crizotinib -- ALK 
- Bevacuzimab -- VEFG

Question 19

what is SVC syndrome?

Answer 19

obstruction of the SVC that impairs blood drainage from the head

symptoms : JVD, upper extremity edema

Commonly in the setting of Pancoast tumors

Medical emergency – raises intracranial pressure