Lung CA

Question 1

What is the progression of Squamous cell carcinoma?

Answer 1

Irritation, squamous metaplasia, dysplasia, Carcinoma in situ, invasive SCC

Question 2

Clara cells

Answer 2

adenocarcinoma precursors. Non ciliated

Question 3

From which cells does Adenocarcinoma arise?

Answer 3

from the ones that line alveoli.

Question 4

what is the progression of AdCa?

Answer 4

irritant or mutation, type 2 and clara hyperplasia, dysplasi (AAH), AIS (lepidic), invasive

Question 5

How high is the correlation b/w smoking and CA?

Answer 5

for Squamous and small cell it is very high. For adenocarcinoma ~80%

Question 6

What preinvasive lesions are there for NETs (Small cell)?

Answer 6

bronchial neuroendocrine cell prolif.

Question 7

Squamous cell: where? histo?

Answer 7

central, involves major bronchi. Keratin pearls

Question 8

Adenocarcinoma: who? where? histo?

Answer 8

women. peripheral. glandular (acinar). AIS is lepidic.

Question 9

Small cell: associations? histo?

Answer 9

high grade malignancy, widespread mets, paraneoplastic syndromes. Small cells w/ little cytoplasm and finely granular chromatin. high mitotic rate, neurosecretory granules

Question 10

With which cancers do we look at molecular mutations? What are the top three mutations? Which can be treated and with what?

Answer 10

Adenocarcinoma. EGFR, KRAS, EML4/ALK. Tyrosine kinase inhibitors treat EGFR.

Question 11

What do you need in order to treat AdCA with TKI?

Answer 11

EGFR mutation with wild type KRAS

Question 12

ALK translocations. Tx?

Answer 12

translocates with EML4. Tx with crizotinib. Use FISH to diagnose. No involvement of EGFR/Ras

Question 13

-mab, -nib

Answer 13

biologics, monoclonal ab’s. TKIs

Question 14

Who most commonly has EGFR mutations? Implications?

Answer 14

women, non-smokers, asians. Can be treated with TKI’s

Question 15

what percent of americans smoke?

Answer 15

20%

Question 16

How does CA risk decrease with cessation?

Answer 16

Decreases for 10-15 yrs then holds steady at about 2x normal

Question 17

National Lung Screening Trial: who was included? what did it show?

Answer 17

older than 55, >30 pack years. Ct scans improve mortality but have high FP rate. CXR don’t improve mortality. Wait for more studies before we use it for screening

Question 18

Tx fo SCLC

Answer 18

Limited stage (seen in one radiograph)- rad/chemo. Extensive stage-chemo

Question 19

Staging

Answer 19

Stage 1-no nodal. Stage 2-invasive tumor or small tumor with same side nodes. Stage3-Advanced tumor with opposite side nodes. Stage 4-any tumor, any node, metastasis

Question 20

Pancoast’s Tumor

Answer 20

Superior sulcus. Usually SCC. Involves brachial plexus so you get elbox pain

Question 21

Horner’s syndrome

Answer 21

Involves sympathetic chain. Ptosis, miosis, anhidrosis

Question 22

Superior Vena Cava Syndrome

Answer 22

facial edema, collateral veins over chest

Question 23

Paraneoplastic syndromes more common in what CA? What are some?

Answer 23

more common in Small cell. SIADH, Cushings, Calcium problems,Lamber-eaton, Hypertrophic Osteoarthopathy

Question 24

Lambert-Eaton syndrome

Answer 24

similar to myasthenia gravis but strength increases with exercise. Ab’s interfere with Ca channels

Question 25

Hypertrophic osteoarthopathy

Answer 25

Painful, common in adenocarcinoma. Clubbing

Question 26

Who gets adjuvant therapy?

Answer 26

Stage 2 and 3, esp if node is involved

Question 27

Bevacizumab targets what?

Answer 27

VEGF

Question 28

Erlotinib

Answer 28

EGFR TKI. Trial shows only six week benefit but can be much larger if you have the mutation.

Question 29

What are the three most common mutations

Answer 29

KRAS, EGFR, ALK-EML4, CML