Lung CA

Question 1

epi of lung CA

Answer 1

common and deadly

- more women than men

Question 2

connection to smoking

Answer 2

• smoking is #1 cause
• 90% of Ca caused by smoking
• increases with duration and amount
• second hand smoke is a 30% increased risk

Question 3

4 other env. factors

Answer 3

1. tar and soot
2. metals
3. asbestos
4. radiaton

Question 4

5 main epitheliod CA of lung

Answer 4

1. SCC
2. small cell carcinoma
3. adenocarcinoma
4. large cell
5. carcinoid

Question 5

what is old practical diff.

Answer 5

1. small cell

2. non small cell

Question 6

4 reasons they were separated

Answer 6

1. clinical behav.
2. liklihood of mets
3. mol. genetics
4. response to current therapies

Question 7

what is importance of promary or secondary

Answer 7

lung common met locations

• diff. tumor behav.
• diff. prognosis
• diff therapy

Question 8

incidence of different types

Answer 8

SCC - M>F

adeno - F>M

Question 9

def. SCC

Answer 9

malig. epithelial tumor of squamoud cells showing keratinization and intercellular bridges
- strongly assoc. with smoking

Question 10

location of SCC

Answer 10

central hilar lesions

+/- caviations

Question 11

precursor to SCC

Answer 11

• squamous metaplasia and dysplasia of the bronchial epi

Question 12

def. adeno

Answer 12

malig. epithelia tumor with glandular diff. +/- mucin
- usually peripheral
- less assoc. with smoking

Question 13

2 adeno precursor lesiosn

Answer 13

1. atypical adenomatous hyperplasia

2. bronchiolaveolar carcinoma

Question 14

what is bronchiolaveolar carcinoma

Answer 14

• specific in-situ form that may precede the dev. of adenocarcinoma
• non-invasive, but may spread aerogenously (cough)

Question 15

histo of small cell

Answer 15

• malignant tumor of neuroendocrine origin
• small cell with scant cytoplasm
• mitoses and necrosis are common

Question 16

what is grade of small cell

Answer 16

high automatically

- extremely aggressive

Question 17

where is small cell

Answer 17

• typically central
• from neuroendocrine cells of bronchial epi
• able to secrete hormones

Question 18

what is large cell

Answer 18

garbage bag

- undifferentiated malignant tumor that lack squamous or glandular looks

Question 19

what are carcinoid

Answer 19

1-5%

• low grade malignant neuroendocrine tumors
• under 40 yo and M=F

Question 20

where are carcinoid

Answer 20

central or periphery

Question 21

histo of carcinoid

Answer 21

• nest of uniform regular cells

Question 22

2 types of carcinoid

Answer 22

typical - mitotic count

Question 23

what are genes in small cell

Answer 23

Myc, Rb, p53, BCL 2

• overexpress c-kit
• increased telomerase expression

Question 24

what are dominant genes in non-small cell

Answer 24

EGFR, K-ras, p53, p16

- more telomerase

Question 25

**what are 2 important genes for adeno

Answer 25

EGFR and k-ras

Question 26

what are 2 targets for gene therapy

Answer 26

• EGFR have better survivial with inhibitors

- k-ras mutations correlate wit worse outcome and resisstance to EGFR inhibitors

Question 27

grading of CA

Answer 27

non-small cell - based on histo

small cell - automatically high

Question 28

3 general cats. that cause Sx in Ca

Answer 28

1. mets
2. tumor
3. paraneoplastic

Question 29

tumor Sx

Answer 29

• cough
• dyspnea
• hemoptysis
• pain
• hoasrseness - recurrent laryngeal
• Horner’s

Question 30

Sx of horners

Answer 30

• miosis
• ptosis
• anhydrosis - lack of sweat

Question 31

4 Sx of mets

Answer 31

1. liver enzymes
2. bone - pain, alk phos, hypercalcemia
3. adrenal
4. brain - HA, N/v, focal weakness

Question 32

what is hypertrophic osteoathropathy

Answer 32

clubbing

• periostreal new bone formation in long bones
• most common in adenocarcinoma

Question 33

what is used for diagnosis

Answer 33

CT
biopsy
bronchoscopy
PET

Question 34

what is biopsy

Answer 34

perc. transthoracic lung biopsy
- best for peripheral lung lesions
- aspiration and/or core

Question 35

what is bronchoscopy

Answer 35

best for central lesion on bronchus

- can use biopsy foceps to take pieces of tissue

Question 36

6 possible benign causes of solitary lung nodule

Answer 36

1. infectious granuloma
2. other infection
3. benoghn neoplasm
4. vasc. malformation
5. congenital
6. inflamatory

Question 37

2 main patient factors

Answer 37

1. age

2. presence of risk factors

Question 38

4 features that make a nodule suspicious

Answer 38

1. borders - irregular or spiculated
2. size - bigger is worse
3. calcification - stipled
4. growth - very fast or slow is more likely benign

Question 39

what does PET do

Answer 39

measure metabolic activity with radioactively labelled glucose
- malignant cells tend to take up more of the glucose

Question 40

how to stage non-small cell

Answer 40

• size and location of the tumor
• nodal involvement
• mets

Question 41

how to determine the nodal involvment

Answer 41

CT and PET

- transbroncoscopic needle aspiration

Question 42

define stages

Answer 42

1 and 2 - T 7cm , and or nodes

4. any pleural involvement or M

Question 43

Tx for non- small cell

Answer 43

1 and 2 - surgical resection
- need to assess medical suitablity first
- post-op estimated FEV1 and DLCO must be at least 40%
- adjuvant chemo may be given for stage 2
3 - chemo, rads, maybe surg
4 - no surg - chemo, maybe rads

Question 44

Tx for small cell

Answer 44

• limited to ispilateral hemothorax - chemo or rads
• extensive - chemo alone
• generally not surgery