lung cancer 2 Flashcards

1
Q

what are the paraneopladtic syndromes associated with small cell lung cancer?

A

SIADH, Cushings, Labert-Eaton, cerebellar degeneration, peripheral neuropathy?

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2
Q

What are the driver mutations for NSCLC?

A

KRAS, EML4-ALK, EGFR

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3
Q

How does adenocarcinoma present radiographically?

A

peripherally. usually begins at the bronchioles or the alveolar walls

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4
Q

You have a female, non-smoker patient with clubbed digits, and frothy sputum. Which diagnostic tool should you use? Are negative results reliable?

A

transthoracic needle biopsies are excellent for peripheral lesions. This patient has peripheral lesions because she has adenocarcinoma. Negative results are not reliable (unless it’s benign).

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5
Q

hypertrophic osteoarthritis.. what is it and what cancer does it present with?

A
  • clubbing of digits
    periostitis of long bones
    arthritis

presents with adenocarcinoma usually, as well as other NSCLC

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6
Q

adenocarcinoma is most common in which patients?

A

women, non-smokers

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7
Q

What do squamous cell carcinoma cells secrete?

A

PTH like compound leading to hypercalcemia, causing weakness, dehydration, mental changes

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8
Q

Where is squamous cell carcinoma located in the lung?

A

centrally, so it can cause some obstruction of the airway with distal atelectesis

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9
Q

Which cancerous tumor exhibits cavitation?

A

squamous cell carcinoma

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10
Q

Which cancerous tumor exhibits desmosomes and keratin pearls

A

squamous cell carcinoma

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11
Q

What are the driver mutations for NSCLC?

A

KRAS, EML4-ALK, EGFR

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12
Q

How does adenocarcinoma present radiographically?

A

peripherally. usually begins at the bronchioles or the alveolar walls

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13
Q

If a child comes in with a solitary cartilaginous nodule in her lung, what would be the most likely diagnosis?

A

Hamartoma, a benign lung neoplasm. you would see cartilage in disarray under a microscope

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14
Q

hypertrophic osteoarthritis.. what is it and what cancer does it present with?

A
  • clubbing of digits- periostitis of long bones-arthritispresents with NSCLC
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15
Q

adenocarcinoma is most common in which patients?

A

women, non-smokers

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16
Q

What do squamous cell carcinoma cells secrete?

A

PTH like compound leading to hypercalcemia, causing weakness, dehydration, mental changes

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17
Q

Where is squamous cell carcinoma located in the lung?

A

centrally, so it can cause some obstruction of the airway with distal atelectesis

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18
Q

Which cancerous tumor exhibits cavitation?

A

squamous cell carcinoma

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19
Q

Which cancerous tumor exhibits desmosomes and keratin pearls

A

squamous cell carcinoma

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20
Q

What are the paraneoplastic syndromes assoc with NSCLC?

A

hypercalcemia, HPO and clubbing

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21
Q

You have a patient with obstructed airway, and the CXR shows cavitated lesions. What would be the best way to diagnose him?

A

Bronchoscopy is great from central lesions, which this patient has. He has Squamous cell carcinoma, which is evident with the cavitation.

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22
Q

You have a female, non-smoker patient with clubbed digits, and frothy sputum. Which diagnostic tool should you use? Are negative results reliable?

A

transthoracic needle biopsies are excellent for peripheral lesions. This patient has peripheral lesions because she has adenocarcinoma. Negative results are not reliable.

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23
Q

If a patient has a pleural effusion, which diagnostic modality should be used?

A

Thoracentesis

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24
Q

Which staging system is used for NSCLC?

A

T (size and location of tumor)

N (spread to lymph nodes)

M (distant metastases)

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25
Treatment for early stage NSCLC?
surgery surgery + chemo for stage II
26
treatment for locally advanced stage III NSCLC
chemo and radiation, sometimes chemo and surgery
27
Treatment for advanced stage IV NSCLC?
chemo, radiation for brain and bone mets, and targeted therapy for driver mutations
28
What cancer is characterized by a bulky central tumor with extensive mediastinal and hilar lymph node involvement?
small cell lung cancer
29
how is small cell lung cancer staged?
limited (encompassed in a radiation port) extensive (beyond a radiation port, including malignant pleural effusion)
30
What screening modality do we have for lung cancer?
low dose spiral CT, which is very sensitive. Adults 55-80 with a 30 pack year history should do this grade B recommendation
31
If a child comes in with a solitary cartilaginous nodule in her lung, what would be the most likely diagnosis?
Hamartoma, a benign lung neoplasm. you would see cartilage in disarray under a microscope
32
What two stains are most useful for mesothelioma?
keratin and calretinin
33
first degree lung neoplasms are usually ______, whereas first degree pleural neoplasms are usually _______
carcinomas and mesotheliomas
34
what are the driver mutations for NSCLC?
KRAS, EML4-ALK, EGFR EGFR more common in women, asians and never-smokers
35
How does adenocarcinoma present radiographically?
peripherally. usually begins at the bronchioles or the alveolar walls
36
Does adenocarcinoma present with glands or mucin?
with or without glands. with or with our mucin
37
hypertrophic osteoarthritis.. what is it and what cancer does it present with?
- clubbing of digits periostitis of long bones arthritis presents with NSCLC
38
adenocarcinoma is most common in which patients?
women, non-smokers
39
What do squamous cell carcinoma cells secrete?
PTH like compound leading to hypercalcemia, causing weakness, dehydration, mental changes
40
Where is squamous cell carcinoma located in the lung?
centrally, so it can cause some obstruction of the airway with distal atelectesis
41
Which cancerous tumor exhibits cavitation?
squamous cell carcinoma
42
Which cancerous tumor exhibits desmosomes and keratin pearls
squamous cell carcinoma
43
what is one of the main carcinogens in cigarettes?
polycyclic hydrocarbons
44
outdoor pollution mainly increases the risk for which lung cancer?
adenocarcinoma also women are more likely than men to develop this cancer
45
you see a cancer that has arisen from an area of previous scarring, which cancer might this be?
adenocarcinoma
46
Which cancer has low contrast uptake on PET and why?
adenocarcinoma because it's slow growing
47
in which cancer is normal architecture preserved, but Type I cells are replaced by neoplastic mutinous cells?
Adenocarcinoma in situ can be mutlifocal and bilateral
48
if you see a <0.5cm invasive component, with multiple architectural patterns, which cancer would it be
minimally invasive adenocarcinoma
49
>0.3cm BAC or >0.5cm invasive carcinoma
invasive adenocarcinoma
50
If someone comes in with mental status changes due to hypercalcemia, what lung cancer might stye have?
squamous cell carcinoma, due to secretion of PTH like compound
51
squamous cell cancers under a microscope characteristically have dark pink _________ and __________
keratin pearls and desmosomal intercellular bridges
52
if someone had NSCLC, what things would definitely and possibly help with prognostics?
definitely- stage and performance status possibly- gender, ploidy, specific mutations
53
If someone comes in with mental status changes due to low sodium, what lung cancer might stye have?
small cell lung cancer
54
treatment for small cell lung cancer?
combined chemo and radiation. radiation just to thorax for limited. If extensive, radiate the brain and bones for mets as well
55
if a patient with lung cancer presents with nonspecific symptoms (weight loss, anorexia, fatigue) what might you worry about?
metastasis
56
if a patient present with muscle weakness of the limbs due to antibodies directed against presynaptic Ca channels, which lung cancer might you worry about?
Small cell lung cancer. This patient has the Lambert-Eaton paraneoplastic syndrome
57
If someone is infected with HPV, which benign lung neoplasm are they at risk for?
Squamous papillomatosis
58
a salivary gland neoplasm is characteristic of which benign lung neoplasm?
pleomorphic adenoma
59
a naval shipyard worker has a pleural effusion, and a deeply invasive cancerous growth pattern on the pleura. What does he have? Use which two stains to ensure the right diagnosis?
mesothelioma from asbestos exposure calretinin and keratin
60
if a patient has melanoma in their lungs, where did it likely originate?
outside of the lungs. extra-pulmonary primary melanoma is much more common than pulmonary primary
61
where do primary lung cancers most commonly occur? (which compartment of the lungs)
upper lobe
62
mediastinal mass ddx
4 T's: thymoma, thyroid cancer, teratoma, terrible lymphoma primary lung cancer (esp small cell)