lung cancer

Question 1

cough
hemoptysis
chest pain
weight loss, night sweats
pneumonia
pleural effusion
airway obstruction
paraneoplastic syndrome
hoarseness: recurrent laryngeal nerve
Horner syndrome: pancoast tumor
dysphagia: esophageal invasion
superior vena cava syndrome

Answer 1

lung cancer presentation

Question 2

most common cause of death in men and women

Answer 2

lung cancer

Question 3

4 types of lung cancer (based on histological type)

Answer 3

1) small cell lung carcinoma

2) non-small cell carcinoma: adenocarcinoma, squamous cell carcinoma, large cell carcinoma

Question 4

most common type of primary lung cancer OVERALL

Answer 4

adenocarcinoma

Question 5

PERIPHERAL location

most common lung cancer in NON-SMOKERS + FEMALES, also found in SMOKERS

Answer 5

adenocarcinoma

Question 6

activating mutations associated with this lung cancer: EGFR, ALK, ROS, RET, KRAS genes

Answer 6

adenocarcinoma

Question 7

2nd most common type of primary lung cancer

Answer 7

squamous cell carcinoma

Question 8

CENTRAL location
hilar mass arising from bronchus 
cavitated lesion on xray or CT
associated with SMOKING
↑Ca

Answer 8

squamous cell carcinoma

Question 9

keratin pearls

Answer 9

squamous cell carcinoma (characteristic of many squamous cell cancers)

Question 10

squamous cell cancer characteristics

Answer 10

keratin pearls

secrete PTRrP →↑ Ca

Question 11

PERIPHERAL location
associated with SMOKING
anaplastic, undifferentiated cells
giant cells
poor prognosis (poor response to chemo)

Answer 11

large cell carcinoma

Question 12

high nucleus: cytoplasm ratio
CENTRAL location
associated with SMOKING
cushing syndrome or
SIADH (hyponatremia) or Lambert-Eaton syndrome (muscle weakness that IMPROVES with use)
undifferentiated, aggressive - poor prognosis

Answer 12

small cell carcinoma

Question 13

Central
Smokers
Secreting

Answer 13

squamous cell carcinoma (PTHrP)
small cell carcinoma (ACTH, ADH, or Abs against Ca channel)

all S sounds

Question 14

paraneoplastic syndrome associated with squamous cell carcinoma lung cancer

Answer 14

secretes PTHrP → hypercalcemia

Question 15

3 paraneoplastic syndromes associated with small cell carcinoma

Answer 15

lung cancer secretes:

1) ACTH → cushing syndrome
2) ADH → SIADH (hyponatremia)
3) Abs against presynaptic Ca channels → Lambert-Eaton syndrome (muscle weakness that IMPROVES with use)

Question 16

mutations in TP53, Rb, amplification MYC

Answer 16

small cell carcinoma

Question 17

low-grade malignant epithelial tumor

bronchospasm + wheezing, flushing, diarrhea, right-sided heart lesions

Answer 17

carcinoid tumor

Question 18

paraneoplastic syndrome associated with carcinoid

Answer 18

5HT secretion → carcinoid syndrome: BFDR
Bronchospasm and wheezing
Flushing
Diarrhea
Right-sided heart lesions (murmur)

Question 19

most common location for carcinoid tumors

Answer 19

lung
GI tract (most common tumor of appendix)
only get ↑5HT if tumor in lung or mets from GI to liver b/c 5HT goes directly in systemic circulation instead of GI → portal vein → liver for metabolism)

Question 20

defined by where it is found: APEX of lung → compress cervical sympathetic system → horner syndrome (ipsilateral PAM), SVC syndrome, hoarseness)
most are non-small cell lung carcinomas

Answer 20

pancoast tumor

Question 21

obstruction of superior vena cava → impaired drainage from head “facial plethora”, neck (jugular venous distention), upper extremitity (edema)
commonly caused by malignancy or indwelling cathether

Answer 21

superior vena cava syndrome

EMERGENCY

Question 22

located in PLEURA (outer lining of lung)
associated with asbestos exposure
poor prognosis
NOT ASSOCIATED WITH SMOKING

Answer 22

mesothelioma

Question 23

lung cancer mets goes to

Answer 23

brain
bone
liver
adrenal glands

Question 24

lung receives mets from

Answer 24

breast
colon
prostate
bladder

Question 25

risk factors for lung cancer

Answer 25

smoking
silica: coal mines
radon: heavy gas that settles in basements or coal mines
asbestos (mesothelioma)

Question 26

lung cancers not associated with smoking

Answer 26

carcinoid tumor

mesothelioma