Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonology > Lectures 23-24: Lung cancer and pathology > Flashcards

Lectures 23-24: Lung cancer and pathology Flashcards

1
Q

Cigarette smokers who have never quit have a ___x risk of lung cancer as compared to non-smokers

A

20x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

About what % of lung cancer cases in females occur in never smokers? Males?

A

~10%; ~5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Other risks for lung cancer (7). Which two are fairly important?

A

Passive tobacco smoke, radiation exposure, air pollution, cooking oil fumes, prior lung disease, FAMILY HISTORY, OCCUPATIONAL EXPOSURE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Genes and lung cancer: gene and risk increase and difficulty

A

15q24-25 locus (nAChR subunit), 30% increased risk, may be related to smoking addiction itself!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common presentation of lung cancer

A

Pulmonary nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T/F: A nodule is asymptomatic; T/F: The majority of nodules are metastatic; T/F: Single pulmonary nodules (SPNs) are common x-ray findings in smokers AND non-smokers

A

True; False (majority are actually BENIGN); True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do we deal with pulmonary nodules?

A

If you’re high risk, all nodules are cancerous until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can we distinguish a benign vs malignant SPN? (4)

A

Stability over time, calcification pattern, appearance, metabolic characteristics (tumors tend to take up more glucose on PET)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are two calcification patterns? What does calcium mean? Suggestive that it’s not cancerous?

A

Popcorn or central; calcium means it’s been around for a while –> probably not cancerous (CALCIUM GOOD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some other appearances of a potentially cancerous SPN?

A

Spiculated borer or cavitation BAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dx of primary lung cancer (2)

A

Cytology (from sputum, bronchoscopy, transthoracic needle aspiration), biopsy (needle, bronchscopy, surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk of transthoracic needle aspiration

A

Pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Histological categories of lung cancer

A

Small cell (~15%) and non-small cell (~85%) = squamous cell carcinoma, adenocarcinoma, large cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Characteristics of small cell lung cancer

A

Responsive to chemo but common relapses, grows very fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the predominant NSCLC?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe squamous cell tumors

A

Central, cavitary, strong smoking assocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe adenocarcinomas

A

Peripheral, most occur in former smokers BUT most common histologic subtype in never smokers; doubling time = about a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What about adenocarcinoma in situ (Lepidic adenoca) that is difficult?

A

Lines alveolar spaces like a pneumonia (looks like this)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Characteristics of squamous cell carcinoma and compare doubling tie to adenoca

A

Bulky, invade adjacent structures, may cavitate; faster doubling time than adenoca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe large cell lung cancer (what they look like, prognosis)

A

Bulky tumors with large cells, poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a carcinoid tumor? Present with? Common?

A

Well-differentiated neuroendocrine tumor that arises in central airways; present with wheezing or cough; rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe small cell carcinomas: association, where they arise from, and where they are found

A

Associated most strongly with smoking; arise from pulmonary neuroendocrine cells; present as central, perihilar masses with associated lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does a small cell look like under a microscope?

A

Large, dark cells with giant nuclei taking up whole cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What category of syndromes is associated with small cell carcinoma?

A

Paraneoplastic syndrome because they are made from neuroendocrine tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Survival for small cell lung carcinoma; metastases?

A

5 year, 6.2%; commonly metastasize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When a lung cancer progresses, what does it mean?

A

Advanced disease –> early cancers are asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Lung cancer symptoms (5 categories)

A

Airway (cough), pleural (chest pain = BAD), mediastinal spread (hoarseness), SVC syndrome, and diaphragm paralysis, distant spread (headache, weakness), others (weight loss, clubbing, paraneoplastic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Presentation of SVC syndrome

A

Facial swelling, headache, dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What kind of lung tumor can present with arm pain? What other syndrome is associated?

A

Pancoast tumor; Horner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are two exceptions to the rule that paraneoplastic syndromes are associated with small cell carcinoma?

A

Hypercalcemia = squamous cell and clubbing = NSCLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Three typical paraneoplastic syndromes

A
  1. Cushing’s syndrome (cortisol production by SCC), 2. SIADH (ADH production by SCC), 3. Eaton-Lambert myasthenic syndrome (autoantibodies to voltage-sensitive calcium channels)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What dx modality is best for central tumors? For peripheral tumors?

A

Central = bronchoscopy; Peripheral = CT-guided biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

T stage

A

Site, size, local invasion; TX - T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

N stage

A

Spread to lymph nodes, NX - N3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

M stage

A

Distant metastatic sites, MX - M1b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Staging scale

A

Stage I - IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do we stage non small cell lung cancer?

A

TMN and staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do we stage small cell lung cancer?

A

Limited = confined to half chest; Extensive = spread beyond half the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Is imaging a perfect test for staging?

A

Nope, you have to do tissue sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Stage I

A

No nodes, no metastaes, no invasion; 65% 5-year survival; tx = resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Stage II

A

Ipsilateral peribronchial/hilar nodes or limited invasion; 40% 5-year survival; tx = surgery and chemo +/- radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Stage III a and b

A

Positive ipsilateral mediastinal nodes, greater local invasion; 15% 5-year survival; tx = chemo +/- radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Stage IV

A

Distant metastases or other lung lobe;

44
Q

Two questions of NSCLC

A

Is the patient resectable: chance of getting the whole tumor AND Is the patient operable: will the patient survive an operation?

45
Q

What is the ONLY cure for NSCLC

A

Surgery

46
Q

Post-op FEV1 rule of thumb

A

Rule is to leave with post op FEV1 > 30% or >800 mL

47
Q

Treatment of small cell lung cancer

A

Chemotherapy +/- radiation

48
Q

Describe chemotherapy and radiation therapy for NSCLC

A

Chemo is life-extending and radiation for local disease control and palliation

49
Q

Three biomarkers in lung cancer

A

EGFR (more common in non smokers, respond well to EGFR-TKI); K-Ras mutation (more common in smokers, poor response to TKI and chemo/poor prognosis); EML4-ALK (response to ALK inhibitors)

50
Q

Lung cancer screening guidelines

A

Screen with CT for those 55-74 year old smokers, former smokers who quit less than 15 years ago

51
Q

Precursor lesion for squamous cell carcinoma

A

Squamous dysplasia and carcinoma in situ

52
Q

Precursor lesion for adenoarcinoma

A

Atypical adenomatous hyperplasia

53
Q

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia can lead to what (non-specific)?

A

Some carcinoids

54
Q

5-year survival rate for lung carcinoma

A

18%

55
Q

Clinical presentation for lung cancer

A

Local disease, disseminated disease (bone pain), paraneoplastic syndromes

56
Q

Lung cancer is often found…

A

Incidentally

57
Q

Vast majority of tumors are…

A

Epithelial (90-95%)

58
Q

We also see what kind of lung tumor?

A

Mesothelial

59
Q

Breakdown epithelial tumor types…(2)

A

90-95% are carcinomas, 5% are carcinoids (neuroendocrine)

60
Q

Three NSCLC types. Which is more common?

A

Squamous, adeno and large cell; adeno (previously squamous)

61
Q

Small cell carcinoma is what %

A

20%

62
Q

Centrally located tumors

A

Squamous and small cell

63
Q

Peripherally located tumors

A

Adeno and large cell

64
Q

Squamous cell carcinoma: who, presentation

A

Men, smoking history; sx: central, so bronchial obstruction/atelectasis

65
Q

What happens to respiratory epithelium before you get squamous cell carcinoma (3 steps)?

A

Squamous metaplasia –> dysplasia –> carcinoma in situ –> invasive carcinoma; 25% of dysplasia and 50% of Cis get invasive carcinoma

66
Q

Squamous cell: invasion, neoplasm, gross finding

A

Locally aggression with late metastasizes; hypercalcemia; cavity in middle due to necrosis

67
Q

Squamous cell: microscope

A

Sheets/islands of large polygonal malignant cell with keratinization: keratin pearls or intracellular bridges

68
Q

Adenocarcinoma: who, mutations

A

Women, non-smokers; associated with EGFR/EML4-ALK mutations; advances with targeted gene therapy

69
Q

Who typically has EGFR mutations?

A

Non-smoking Asian females

70
Q

Adenocarcinoma: precursor

A

Atypical adenomatous hyperplasia (AAH) = proliferation of atypical type II pneumoctyes and/or Clara cells lining alveolar walls

71
Q

How to identify AAH

A

Pneumocyte proliferation with no surrounding lung problems

72
Q

What comes after AAH?

A

Adenocarcinoma in situ = growth of cells entirely along alveolar septa (lepidic growth), greater than 5 mm (bigger than AAH)

73
Q

Why is the AAH/Ai important classification?

A

Survival is nearly 100% compared to similar size invasive adenomas

74
Q

Adenocarcinoma in situ: radiographically; how many nodules?

A

Called “ground glass,” can have multiple nodules

75
Q

What happens after Ais? Survival

A

Minimally invasive adenocarcinoma = 3 cm or less with predominately lepidic pattern and

76
Q

Most cases of adenos are what kind? Characteristic finding?

A

Invasive adenocarcinomas = more than 5 mm invasion, characterized by gland formations

77
Q

Invasive adenocarcinomas: pleural finding

A

“Pleural puckering” due to pleural invasion

78
Q

Invasive adenocarcinomas: histologically

A

Tumor with irregular glands and destruction of lung architecture

79
Q

Invasive adenocarcinomas: stain

A

Mucin stain (these produce mucin)

80
Q

Large cell carcinoma: definition

A

Undifferentiated malignant epithelial tumor that lacks cytologic features of small cell carcinoma as well as glandular or squamous differentiation; likely squamous or adeno with correct stain

81
Q

Invasive adenocarcinomas: histologically

A

Looks like sheets of cells, like undifferencetiated adeno

82
Q

Small cell carcinoma: who, basic typing, prognosis

A

Older men, exclusively in cigarette smokers; high grade neuroendocrine carcinoma; very aggressive with early mediastinal lymph node involvement (>5% 5 year survival)

83
Q

Small cell carcinoma: gross

A

Central/hilar, white-tan, friable, extensive necrosis

84
Q

Small cell carcinoma: micro

A

Small to medium sized dark cells with minimal cytoplasm (high N/C ratio), nuclear modling

85
Q

Neoplastic syndromes: squamous

A

PTH hormone activity –> hypercalcemia

86
Q

Neoplastic syndromes: small cell

A

ACTH production or ADH production, Eaton-Lambert (like Myasthenia Gravis)

87
Q

Carcinoid: define, who, presentation

A

Low grade neuroendocrine carcinoma; young males and females, non-smokers; often a central endobronchial mass leading to obstructive symptoms (cough, hemoptysis, bronchiectasis)

88
Q

Three neuroendocrine tumors. Common EM finding?

A
  1. Carcinoid; 2. Large cell neuroendocrine carcinoma (rare); 3. Small cell; neurosecretory granules (especially in carcinoid)
89
Q

T/F: Can carcinoid tumors elaborate vasoactive amines?

A

Yes, sometimes

90
Q

Carcinoid syndrome

A

Intermittent attacks of diarrhea, flushing, and cyanosis (usually with metastatic disease)

91
Q

Carcinoid association

A

Cushing’s

92
Q

Carcinoid: gross and histologically

A

Intraluminal mass with dilation behind it; histologically: uniform, organoid/ball-like pattern with bleeding due to vascularization

93
Q

Carcinoid: prognosis

A

Typical = 90%; atypical = 60%

94
Q

“N” staging based on…

A

Location of lymph nodes and contralateral involvement

95
Q

What is the most common site for a metastases from elsewhere?

A

The lung

96
Q

How do tumor cells spread to the lung?

A

Blood or lymph

97
Q

How do we tell if a lung cancer is metastatic or primary?

A

Metastatic = multiple lesions

98
Q

What is superior vena cava syndrome?

A

Insidious compression of SVC and is LIFE THREATENING = big purple lead

99
Q

Describe Pancoast tumor

A

Tumor in apex of the lung and is associated with Horner syndrome and horseness due to recurrent laryngeal nerve disurption

100
Q

Pleural tumors are typically…

A

Metastatic

101
Q

What is a primary pleural tumor?

A

Malignant mesothelioma

102
Q

Mesothelioma: who, when

A

Asbestos exposure (rarely idiopathic and NOT related to smoking), men; develop after long latency period of ~20 years

103
Q

Mesothelioma: gross

A

Multiple small nodules that coalesce into confluent “rind”, typically respect pleural boundary and rarely metastasize

104
Q

Mesothelioma: histological subtypes (3). Why these differences?

A

Epithelial (round cells), sarcomatoid (spindle cells), Bi-phasic (both morphologies); because it’s not an epithelial cancer, but a mesoderm cancer

105
Q

Mesothelioma: prognosis

A

Very poor, most die within 18 months

Pulmonology (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions