Lung Cancer

Question 1

What is the most common cause of cancer mortality in the US? What is the average age of presentation? What are risk factors? How does it present?

Answer 1

Lung cancer. Average age at presentation is 60 years. Key risk factors are cigarrette smoke, radon and asbestos. Non specific symptoms (cough, weight loss, hemoptysis and postobstructive pneumonia)

Question 2

How does cigarette smoke cause lung cancer?

Answer 2

Contains over 60 cacinogens. 85% of lung cancer occurs in smokers. Polycyclic aromatic hydrocarbons and arsenic are particularly mutagenic. Pack years related to cancer risk.

Question 3

What is the second most common cause lung carcinoma in the US? Where does it come from and which area does it favor? Which people are especially affected?

Answer 3

Radon which is formed by radioactive decay of Uranium present in the soil. Accumulates in closed spaces such as basements. Increased risk of lung cancer is also seen in uranium miners.

Question 4

What does imaging reveal in lung cancer? What is necessary for diagnosis?

Answer 4

Sloitary nodule (‘coin lesion’). Biosy is necessary for cancer diagnosis.

Question 5

Which benign lesions produce a ‘coin lesion’ on imaging?

Answer 5

1. Granuloma often due to TB or Histoplasma

2. Bronchial hamartoma

Question 6

Which benign lesions produce a ‘coin lesion’ on imaging?

Answer 6

1. Granuloma often due to TB or Histoplasma

2. Bronchial hamartoma

Question 7

Which type of cancer is not amenable to surgical resection and is treated with chemotherapy?

Answer 7

Small cell carcinoma (15%)

Question 8

Which type of cancer is amenable to surgical resection and is not treated with chemotherapy? What are the 4 subtypes?

Answer 8

Non small cell carcinoma. 
Subtypes are 
1. adenocarcinoma (40%) 
2. squamous cell carcinoma (30%) 
3. large cell carcinoma (10%) 
4. Carcinoid tumor (5%)

Question 9

How is lung cancer staged? What is the survival like? When does it present? Where does it like to metastasize?

Answer 9

TNM staging. 15% - 5 year survival. Often presents late due to absence of an effective screening method. ADRENAL GLAND.

Question 10

What does the T in TNM staging stand for? What are some features?

Answer 10

T - Tumor size and local extension.

1. Pleural involvement is classically seen with adenocarcinoma
2. Obstruction of SVC leads to distended head and neck veins with edema and blue discoloration of arms and face (superior vena cava syndrome)
3. Involvement of recurrent laryngeal (hoarseness) or phrenic (diaphgramatic paralysis) nerve
4. Compression of sympathetic chain leads to Horner syndrome due to an apical (Pancoast) tumor

Question 11

What do the N and M represent in TNM staging?

Answer 11

N - spread to regional lymph nodes (hiar and mediastinal)

M - Metastasis

Question 12

What do the N and M represent in TNM staging?

Answer 12

N - spread to regional lymph nodes (hilar and mediastinal)

M - Metastasis

Question 13

What do the N and M represent in TNM staging?

Answer 13

N - spread to regional lymph nodes (hilar and mediastinal)

M - Metastasis

Question 14

What is the histology, smoking association, location and growth pattern of SMALL CELL CARCINOMA? What can it produce and what syndrome can it cause?

Answer 14

Poorly differentiated cells, arises from neuroendocrine (Kulchiitsky) cells. Male smokers. Central location. Rapid growth and early metastasis. May produce ADH or ACTH or cause Eaton-Lambert syndrome (paraneoplastic syndromes)

Question 15

What is the histology, smoking association, location of SQUAMOUS CELL CARCINOMA? What can it produce?

Answer 15

Keratin pearls or inter cellular bridges. Most common tumor in male smokers. Central location. May produce PTHrP.

Question 16

What is the histology, smoking association, location and growth pattern of ADENOCARCINOMA?

Answer 16

Glands or mucin. Most common tumor in non smokers and female smokers. Peripheral

Question 17

What is the prognosis, histology, smoking association, location and growth pattern of LARGE CELL CARCINOMA?

Answer 17

Poorly differentiated large cells (no Keratin pearls or inter cellular bridges, Glands or mucin). Smoking association. Central or peripheral. Poor prognosis.

Question 18

What is the prognosis, histology, smoking association, location and growth pattern of BRONCHIOLOALVEOLAR CARCINOMA? How does it present?

Answer 18

Columnar cells that grow along preexisting bronchioles and alveoli. Arises from Clara cells. Not related to smoking. Peripheral. May present with pneumonia-like consolidation on imaging. Excellent prognosis.

Question 19

What is the prognosis, histology, smoking association, location and growth pattern of CARCINOC tumor?

Answer 19

Well differentiated neuroendocrine cells; chromogranin positive. Not related to smoking. Central or peripheral. When central classically forms a polyp-like mass in the bronchus. Low grade malignancy. Rarely can cause carcinoid syndrome.

Question 20

What is the histology, smoking association, location and of ADENOCARCINOMA?

Answer 20

Glands or mucin. Most common tumor in non smokers and female smokers. Peripheral

Question 21

What is the prognosis, histology, smoking association, location of LARGE CELL CARCINOMA?

Answer 21

Poorly differentiated large cells (no Keratin pearls or inter cellular bridges, Glands or mucin). Smoking association. Central or peripheral. Poor prognosis.

Question 22

What is the prognosis, histology, smoking association, location and origin of BRONCHIOLOALVEOLAR CARCINOMA? How does it present?

Answer 22

Columnar cells that grow along preexisting bronchioles and alveoli. Arises from Clara cells. Not related to smoking. Peripheral. May present with pneumonia-like consolidation on imaging. Excellent prognosis.

Question 23

What is the prognosis, histology, smoking association, location and growth pattern of CARCINOID tumor?

Answer 23

Well differentiated neuroendocrine cells; chromogranin positive. Not related to smoking. Central or peripheral. When central classically forms a polyp-like mass in the bronchus. Low grade malignancy. Rarely can cause carcinoid syndrome.

Question 24

What is the histology, location and commonality of METASTASIS TO LUNG compared to primary tumors?

Answer 24

Most common sources are breast and colon carcinoma. Multiple ‘cannon ball’ nodules on imaging. More common than primary tumors.