Lung 3 Flashcards

1
Q

T or F
metastatic tumors are more
common than primary tumors.

A

Tru

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2
Q

In the primary tumors, 90% of the tumors in the

lungs are actually

A

Carcinomas

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3
Q

The rest of the tumors in the lungs would be

A

carcinoids,

mesenchymal tumors, and other rare tumors.

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4
Q

is currently the most frequently
diagnosed major cancer and the most common
cause of cancer mortality worldwide.

A

Lung cancer

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5
Q

Lung cancer is generally a disease of older adults,
occurring most often between ages ________, with a peak incidence
between________________

A

55
and 84 years

65 and 74 years.

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6
Q

Only __ of all cases occur before the age of 40

A

2%

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7
Q

is the most common risk
factor that has an established association with
lung cancer

A

Cigarette smoking

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8
Q

T or F

there is a nearly linear correlation between the
frequency of lung cancer and pack-years of
cigarette smoking.

A

T

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9
Q

other factors that interact with smoking to predispose individuals to this deadly disease

A

acquired mutations, genetic makeup of the individual

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10
Q

T or F

women are
more susceptible to carcinogens in tobacco than
men.

A

T

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11
Q

industrial hazards which increase the risk of developing lung cancer

A

asbestos,
arsenic, chromium, uranium, nickel, vinyl
chloride and mustard gas

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12
Q

T or f

High-dose ionizing radiation is carcinogenic

A

T

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13
Q

weakly radioactive, but lung cancer
rates among nonsmoking _____ miners are
four times higher than those in the general
population

A

Uranium

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14
Q

Asbestos workers who do not smoke
have a______ greater risk of
developing lung cancer

A

five-fold

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15
Q

asbestos + smoke

A

55-fold greater risk

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16
Q

Chronic exposure to air particulates in smog may cause

A

lung irritation, inflammation, and repair, and
you will recall that chronic inflammation and repair
increases the risk of a variety of cancers

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17
Q

is a ubiquitous radioactive gas that has been linked

epidemiologically to increased lung cancer in uranium miners.

A

Radon gas

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18
Q

T or F

Most of the mutations are acquired.

A

T

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19
Q

Smoking-related carcinomas of the lung arise by

A

a stepwise accumulation of
oncogenic “driver” mutations that result in the neoplastic transformation of pulmonary
epithelial cells

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20
Q

Receptor Tyrosine Kinases

A
  1. EGFR – 10-15%
  2. ALK – 3-5%
  3. ROS1 – 1%
  4. MET – 2-5%
  5. RET – 1-2%
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21
Q

most common (Receptor tyrosine kinases)

A

EGFR

ALK

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22
Q

Positive KRAS is associated with

A

poor prognosis

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23
Q

Serine/Threonine kinases

A

BRAF
P13K
KRAS

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24
Q

Oncogenic gain of function mutations

A

Adenocarcinomas

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25
is the most | common subtype in never-smokers
adenocarcinomas
26
Chromosome deletions of tumor | suppressor loci
SQUAMOUS CELL CARCINOMAS
27
site for CDKN2A gene, associated | with P16 mutation
3P9P
28
site of TP52 gene; associated with TP53 mutations and p53 protein overexpression
17p
29
a gene encoding the | fibroblast growth factor receptor tyrosine kinase.
Amplification of FGFR1
30
virtually always smoking related and has the | highest mutational burden among lung cancers
● SMALL CELL CARCINOMA
31
Acquisition of RB loss of function mutations
Small cell carcinoma
32
Non-small cell carcinomas are your
adenocarcinoma and squamous cell | carcinoma
33
is seen even in histologically normal lung epithelium, suggesting that this also is a critical early event
Loss of chromosome 3p
34
Small cell carcinoma
TP53 and RB activation Acquisition of RB loss of function mutations Transformation of non-small cell carcinoma to small cell carcinoma Loss of chromosome 3p ○ Amplification of MYC gene family
35
mutations in lung cancer (never-smokers)
EGFR mutations | TP53 mutations
36
Four types of morphologic precursor epithelial | lesions are recognized:
``` ○ Atypical adenomatous hyperplasia ○ Adenocarcinoma in situ ○ Squamous dysplasia and carcinoma in situ ○ Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia ```
37
T or F Currently it is not possible to distinguish between precursor lesions that progress and those that remain localized or regress.
T
38
Tumor classification (Adenocarcinoma)
Lepidic, acinar, micropapillary, papillary, solid Invasive mucinous adenocarcinoma Minimally invasive adenocarcinoma (nonmucinous, mucinous)
39
``` Tumor classification (squamous cell carcinoma) ```
Keratinizing, nonkeratinizing, basaloid
40
``` Tumor classification (Neuroendocrine tumors) ```
``` Small cell carcinoma Combined small cell carcinoma Large cell neuroendocrine carcinoma Combined large-cell neuroendocrine carcinoma Carcinoid tumor (typical, atypical) ```
41
``` Tumor classification (Other uncommon types) ```
``` Large cell carcinoma Adenosquamous carcinoma Sarcomatoid carcinoma Lymphoepthelioma-like carcinoma and NUT carcinoma Salivary gland-type tumors ```
42
mixtures of histologic patterns, | even in the same cancer
○ squamous cell carcinoma and adenocarcinoma (14%) ○ small cell and squamous cell carcinoma (5%)
43
Epithelium of Atypical adenomatous hyperplasia
cuboidal, and there is mild interstitial fibrosis.
44
ATYPICAL ADENOMATOUS HYPERPLASIA is A small precursor lesion (≤5 mm) characterized by________ lining alveolar walls that are mildly fibrotic.
dysplastic pneumocytes
45
formerly called bronchioloalveolar carcinoma
ADENOCARCINOMA IN-SITU
46
ADENOCARCINOMA IN-SITU lesion that is_____ in size and is composed entirely of _______ growing along pre-existing alveolar sept
less than 3 cm dysplastic cells
47
T or F In adenocarcinoma in-situ, The cells have more dysplasia than atypical adenomatous hyperplasia and may or may not have intracellular mucin
T
48
Most common form of lung cancer in women | and men
adenocarcinomas
49
is an invasive malignant epithelial tumor with glandular differentiation or mucin production by the tumor cells
Adenocarcinomas
50
poorly differentiated type of adenocarcinoma. It is already difficult to differentiate with the squamous cell carcinoma. Hence, we usually end up diagnosing it just like non-small cell carcinoma.
Solid adenocarcinoma
51
Lung carcinomas may arise in the
``` peripheral lung (more often adenocarcinomas) or in the central/hilar region (more often squamous cell carcinomas) ```
52
They vary histologically from well-differentiated tumors with obvious glandular elements (Fig. 15.43A), to papillary lesions resembling other papillary carcinomas, to solid masses with only occasional mucin-producing glands and cells
adenocarcinomas
53
In adenocarcinoma, The majority express ___________, a protein first identified in the thyroid that is required for normal lung development.
thyroid transcription | factor-1 (TTF-1)
54
For _________, we usually request for TTF-1 as an immunohistochemical stain to mark that this is a adenocarcinoma instead of squamous cell carcinoma
solid patterns
55
At the periphery of the tumor there is often a ___ pattern of spread, in which the tumor cells “crawl” along normal-appearing alveolar septa.
lepidic
56
Tumors (≤3 cm) with a small invasive component (≤5 mm) associated with scarring and a peripheral lepidic growth pattern are called
microinvasive adenocarcinoma
57
variant where the major component shows papillary growth pattern, often with complex secondary and tertiary branching structure. The tumor cells are arranged in multiple layers around true fibrovascular cores.
Papillary adenocarcinoma of lung
58
tend to spread aerogenously, forming satellite tumors; thus, these are less likely to be cured by surgery.
Mucinous adenocarcinomas
59
Mucinous adenocarcinomas may present as a solitary nodule or as multiple nodules, or an entire lobe may be consolidated by tumor, mimicking _______
lobar pneumonia
60
a variant where the major tumor component consists of solid sheets and lacks other recognizable patterns of adenocarcinoma such as lepidic, acinar, papillary, or micropapillary growth.
Solid adenocarcinoma
61
T or F | squamous cell carcinoma is more common in men and is strongly associated with smoking
T
62
are often antedated by squamous metaplasia or dysplasia in the bronchial epithelium, which then transforms to carcinoma in situ
Squamous cell carcinomas
63
When it is associated with smoking, it starts as ______ in the bronchi associated gene mutation and eventually it develops into a n invasive cancer
dysplasia
64
Squamous cell carcinoma has a different growth pattern. It can protrude into the lumen of the bronchus and can cause obstruction of the airway. Whatever is obstructed would have
secondary atelectasis
65
T or F Squamous cell carcinoma can invade the lung parenchyma
T
66
How to differentiate adenocarcinoma vs Squamous cell carcinoma
Through biopsy
67
Aside from production of keratin pearls, another thing that can guide you to the differentiation or identification of Squamous Cell Carcinoma differentiation would be the presence of your
intercellular bridges
68
they are present in well differentiated or at least differentiated squamous epithelium
desmosomes
69
Squamous Cell Carcinoma s are associated with your ____and ___ for poorly differentiated Squamous Cell Carcinoma
p63; p40
70
oat cell
Small cell carcinoma
71
T or F Majority of the Small Cell Carcinoma are highly malignant and there’s a very strong relationship to cigarette smoking.
T
72
Most of these tumors arise in the bronchi and | there is no known preinvasive phase.
small cell carcinoma
73
T or F Among the malignant lung CA, small cell carcinoma is the most aggressive and you have a really high mitotic count.
T
74
This is also the tumor associated with extensive necrosis
Small cell carcinoma
75
In small cell carcinoma, cytoplasm is ____
very scanty
76
what pattern is present in the nuclei of small cell carcinoma
chromatin (salt and pepper)
77
crushed hyperchromatic cells wherein you can no longer see them as individual cells.
crushing artifacts (very fragile)
78
Basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells
Azzopardi effect (small cell carcinoma)
79
electron microscopy | for small cell carcinoma shows
dense-core neurosecretory granules, about 100 nm in diameter, in two-thirds of cases of small cell carcinoma.
80
suggest that Small cell carcinoma originates from neuroendocrine progenitor cells, which are present in the lining bronchial epithelium.
occurrence of neurosecretory granules; the expression of neuroendocrine markers such as chromogranin, synaptophysin, and CD56; and the ability of some of these tumors to secrete hormones (e.g., parathormone-related protein, a cause of paraneoplastic hypercalcemia)
81
they are made up of large cells, and the cells that you see are undifferentiated
Large cell carcinoma
82
You should do immunohistochemical staining first before you proceed to a Large cell carcinoma diagnosis because
they are usually negative for your markers: ○ adenocarcinoma - TTF-1, napsin A ○ squamous cell carcinoma - p40, p63
83
has molecular features similar to those of small cell carcinoma, but is comprised of tumor cells of larger size
large cell | neuroendocrine carcinoma
84
T or F Any type of lung carcinoma may extend to the pleural surface and then spread within the pleural cavity or into the pericardium
T
85
Metastases to the | ________ can be found in most cases
bronchial, tracheal, and mediastinal nodes
86
Distant spread of lung carcinoma occurs through | both ______ and ________pathways
lymphatic; hematogenous
87
may be the first manifestation of an | underlying occult pulmonary lesion.
Metastasis
88
No organ or tissue is spared, but the a_____, for obscure reasons, are involved in more than half of the cases.
adrenal glands
89
liver
30-50%
90
brain
20%
91
bone
20%
92
Anterior mediastinum
``` Thymoma Parathyroid tumors Teratoma Metastatic carcinoma Lymphoma Thyroid lesions ```
93
Posterior mediastinum
``` Neurogenic tumors Lymphoma Metastatic tumor Bronchogenic cyst gastroenteric hernia ```
94
Middle mediastinum
bronchogenic cyst pericardial cyst lymphoma
95
partial obstruction
focal emphysema
96
90% total obstruction
atelectasis
97
Impaired drainage of the | airways
Severe suppurative or Ulcerative bronchitis | or bronchiectasis
98
- sometimes call attention | to an otherwise silent carcinoma.
pulmonary abscess
99
Superior Vena Cava Syndrome - compression | or invasion of the superior vena cava can cause ________
venous congestion and edema of the head and | arm and, ultimately, circulatory compromise
100
extension into the | pericardium and pleura
pericarditis and pleuritis
101
○ Apical lung cancers in the superior pulmonary sulcus ○ Invade the neural structures around the trachea, including the cervical sympathetic plexus
Pancoast tumors
102
Produce a group of clinical findings that includes severe pain in the distribution of the ulnar nerve and Horner syndrome (enophthalmos, ptosis, miosis, and anhidrosis) on the same side as the lesion
Pancoast tumors
103
Involvement of central airways
cough
104
hemorrhage from tumor in airways
hemoptysis
105
extension of tumor into mediastinum, pleura, or chestwall
chest pain
106
airway obstruction by tumour
Pneumonia, abscess, lobar collapse
107
tumor obstruction; accumulation of cellular lipid in foamy macrophages
lipoid pneumonia
108
tumor spread into pleura
Pleural effusion
109
recurrent laryngeal nerve invasion
hoarseness
110
esophageal invasion
dysphagia
111
phrenic nerve invasion
diaphragm paralysis
112
chest wall invasion
rib destruction
113
SVC compression by tumor
SVC syndrome
114
sympathetic ganglia invasion
horner syndrome
115
pericardial involvement
pericarditis, tamponade
116
backpain
bone metastases
117
headache, hemiparesis, cranial nerve damage, | and seizures
brain metastases
118
We usually proceed with _________ to determine metastasis
bone scanning, | PETscan
119
are very sensitive to chemotherapy and radiotherapy this is secondary to having very young tumor cells and you have a lot of tumor cell undergoing metastasis hence they are very sensitive to radiation
small cell carcinomas