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Pathoma - Respiratory Tract Pathology > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

What is the most common cause of cancer mortality in the US?

A

Lung Cancer!

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2
Q

What is the average age at presentation of lung cancer?

A

60 years

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3
Q

What are the three cancers with the highest incidence in the US?

A
  1. Breast/Prostate
  2. Lung
  3. Colorectal
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4
Q

What are three key risk factors for Lung cancer?

A

Smoke, radon and asbestos

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5
Q

How many carcinogens does cigarette smoke contain?

A

Over 60 carcinogens

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6
Q

What percentage of lung cancer occurs in smokers?

A

85%

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7
Q

What two chemicals in cigarette smoke are particularly mutagenic?

A
  1. Polycyclic aromatic hydrocarbons

2. Arsenic

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8
Q

What does Arsenic increase risk for?

A

It increases risk of squamous cell carcinoma of the lung.

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9
Q

What is lung cancer risk directly related to?

A

Duration and Amount of smoking (pack-years)

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10
Q

How is radon formed?

A

By radioactive decay of uranium

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11
Q

What is radon?

A

Colorless, odorless gas

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12
Q

Where is Uranium present?

A

In the soil

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13
Q

Where does Radon accumulate?

A

In closed spaces such as basements

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14
Q

What is Radon responsible for?

A

Most of the public exposure to ionizing radiation

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15
Q

What is the second most frequent cause of lung carcinoma in the US?

A

Radon exposure

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16
Q

In what population is increased risk of lung cancer also seen in?

A

Uranium miners

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17
Q

What are the presenting symptoms of lung cancer?

A

They are nonspecific:

  • Cough
  • Weight loss
  • Hemoptysis
  • Post-obstructive pneumonia
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18
Q

What does imaging often reveal in lung cancer?

A

Solitary nodule

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19
Q

What is the first step when you see a solitary nodule on CXR?

A

Look and compare it to a previous CXR.

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20
Q

What is another name for solitary nodule?

A

‘coin-lesion’

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21
Q

What is necessary for a diagnosis of cancer once you’ve seen a solitary nodule on CXR?

A

Biopsy is necessary for a diagnosis of cancer.

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22
Q

In what population do benign ‘coin-lesions’ often occur?

A

Younger patients

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23
Q

What are two benign ‘coin-lesions’ that occur in younger patients?

A
  1. Granuloma

2. Bronchial hamartoma

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24
Q

What often causes granulomas in the lungs?

A

Often due to TB or fungus (especially Histoplasma in the Midwest)

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25
Q

What is a Bronchial hamartoma?

A

A benign tumor composed of lung tissue and cartilage.

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26
Q

What trait does a Bronchial Hamartoma often have on imaging?

A

Often calcified on imaging.

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27
Q

What two categories are lung carcinoma often divided into?

A
  1. Small cell carcinoma

2. Non-small cell carcinoma

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28
Q

What percentage of lung carcinoma is small cell carcinoma?

A

15%

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29
Q

What percentage of lung carcinoma is non-small cell carcinoma?

A

85%

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30
Q

How is small cell carcinoma treated?

A

Chemotherapy

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31
Q

What usually is small cell carcinoma usually not amenable to?

A

Surgical resection

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32
Q

What is non-small cell carcinoma treated upfront with?

A

Surgical resection

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33
Q

What does non-small cell carcinoma not respond well to?

A

Chemotherapy

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34
Q

What are the four subtypes of non-small cell carcinoma?

A
  1. Adenocarcinoma
  2. Squamous cell carcinoma
  3. Large cell carcinoma
  4. Carcinoid tumor
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35
Q

What percentage of lung carcinoma is Adenocarcinoma?

A

40%

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36
Q

What percentage of lung carcinoma is Squamous cell carcinoma?

A

30%

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37
Q

What percentage of lung carcinoma is Large cell carcinoma?

A

10%

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38
Q

What percentage of lung carcinoma is Carcinoid tumor?

A

5%

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39
Q

What are hamartomas made of?

A

They contain tissue that normally should be in this area but is disorganized.

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40
Q

What is the pathology behind Eaton-Lambert Syndrome?

A

Patients develop antibodies against presynaptic calcium channels and this leads to muscle weakness

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41
Q

What type of cancer is often associated with Eaton-Lambert Syndrome?

A

Small cell carcinoma

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42
Q

What three S’s is Small cell carcinoma associated with?

A
  • Smoking
  • Sentral (Central)
  • Paraneoplastic Syndrome
43
Q

What does the T stand for in TMN staging of lung cancer?

A

Tumor size and local extension

44
Q

What is classically seen with Adenocarcinoma?

A

Pleural involvement

45
Q

What is Superior Vena Cava syndrome?

A

Obstruction of the SVC that leads to distended head and neck veins with edema and blue discoloration of arms and face

46
Q

What does obstruction of the SVC due to lung cancer lead to?

A

Distended head and neck veins with edema and blue discoloration of arms and face.

47
Q

What nerves can be affected by lung tumors?

A
  • Recurrent laryngeal nerve
  • Phrenic nerve
  • Sympathetic chain
48
Q

What can lung cancer involving the recurrent laryngeal nerve cause?

A

Hoarseness

49
Q

What can lung cancer involving the phrenic nerve cause?

A

Diaphragmatic paralysis

50
Q

What can lung cancer compressing the sympathetic chain lead to?

A

Horner syndrome

51
Q

What does Horner’s syndrome consist of?

A
  • Ptosis (drooping eyelid)
  • Miosis (pinpoint pupils)
  • Anhidrosis (no sweating)
52
Q

What type of lung tumor usually leads to Horner’s syndrome?

A

Apical (Pancoast) tumor

53
Q

What does the N of TMN staging stand for?

A

Spread to regional lymph nodes (hilar and mediastinal)

54
Q

What does the M of TMN staging stand for?

A

Metastasis

55
Q

What is a unique site of distant metastasis in lung cancer?

A

Adrenal gland

56
Q

What is the overall 5 year survival of lung cancer?

A

15%

57
Q

When does Lung Cancer often present? And why?

A

Late due to absence of an effective screening method

58
Q

What is the histology of Small Cell Carcinoma?

A

Poorly differentiated small cells.

59
Q

What type of cells does Small Cell Carcinoma arise from?

A

Neuroendocrine (Kulchitsky) cells

60
Q

What groups is Small Cell Carcinoma associated with?

A

Male smokers

61
Q

In what location is Small Cell Carincoma?

A

Central

62
Q

What types of lung cancer are primarily treated with chemotherapy?

A

Small Cell Carcinoma

63
Q

Why types of lung cancer are primarily treated with surgery?

A
  • Squamous Cell Carcinoma
  • Adenocarcinoma
  • Large Cell Carcinoma
  • Bronchioloalveolar Carcinoma
  • Carcinoid tumor
  • Metastasis to Lung
64
Q

How does Small Cell Carcinoma grow?

A

Rapid growth and early metastasis

65
Q

What might Small Cell Carcinoma produce?

A

ADH or ACTH (leads to Cushings) or cause Eaton-Lambert syndrome (paraneoplastic syndromes)

66
Q

What is the histology of Squamous Cell Carcinoma?

A

Keratin pearls or intercellular bridges

67
Q

What groups is Squamous Cell Carcinoma associated with?

A

Most common tumor in male smokers

68
Q

In what location is Squamous Cell Carcinoma?

A

Central

69
Q

What may happen in a subset of Squamous Cell Carcinoma patients?

A

-May produce PTHrP –> Parathyroid hormone related peptide –> leads to hypercalcemia

70
Q

What is seen on histology of Adenocarcinoma?

A

Glands or mucin

71
Q

What groups is Adenocarcinoma associated with?

A

Most common tumor in nonsmokers and female smokers

72
Q

What is the most common tumor in nonsmokers and female smokers?

A

Adenocarcinoma

73
Q

In what location is Adenocarcinoma?

A

Peripheral

74
Q

What will NOT happen to a subset of Adenocarcinoma patients?

A

No paraneoplastic syndrome

75
Q

What is seen on histology of Large Cell Carcinoma?

A

Poorly differentiated large cells

76
Q

What is NOT seen on histology of Large Cell Carcinoma?

A

No keratin pearls, intercellular bridges, glands or mucin

77
Q

What groups is Large Cell Carcinoma associated with?

A

Smoking!

78
Q

In what location is Large Cell Carcinoma?

A

Peripheral or Central

79
Q

What is the prognosis associated with Large Cell Carcinoma?

A

Poor prognosis

80
Q

What does Bronchiolo mean?

A

Airways

81
Q

What does alveolar mean?

A

Air sacs

82
Q

What histology is associated with Bronchioloalveolar Carcinoma?

A

Columnar cells that grow along preexisting bronchioles and alveoli

83
Q

What does Bronchioloalveolar Carcinoma arise from?

A

Clara cells

84
Q

What is Bronchioloalveolar Carcinoma NOT related to?

A

SMOKING

85
Q

In what location is Bronchioloalveolar Carcinoma?

A

Peripheral

86
Q

What may Bronchioloalveolar Carcinoma present with?

A

Pneumonia-like consolidation on imaging

87
Q

What is the prognosis of Bronchioloalveolar Carcinoma?

A

Excellent Prognosis

88
Q

What histology is associated with Carcinoid tumors?

A

Well differentiated neuroendocrine cells.

89
Q

What do neuroendocrine cells contain with Carcinoid tumors?

A

Neuro secretory granules

90
Q

What do neuro secretory granules stain?

A

Stain chromogranin positive.

91
Q

What does Bronchioloalveolar Carcinoma stain?

A

Chromogranin positive

92
Q

What are Carcinoid tumors NOT related to?

A

SMOKING

93
Q

In what location are Carcinoid tumors?

A

Central or peripheral

94
Q

What happens when Carcinoid tumors are central?

A

The tumor classically forms a polyp-like mass in the bronchus.

95
Q

What type of malignancy are Carcinoid tumors?

A

Low-grade malignancy

96
Q

What can Carcinoid tumors rarely cause?

A

Carcinoid syndrome!

97
Q

What are the most common sources of Metastasis to the lung?

A

Breast and colon carcinoma

98
Q

What do you see on imaging with Metastasis to the lung?

A

Multiple ‘cannon-ball’/circular nodules on imaging

99
Q

What is Metastasis to the lung more common than?

A

Primary Tumors

100
Q

On histology what do small cells of Small Cell Carcinoma mimic?

A

Lymphocytes

-There is also a small degree of mitotic activity

101
Q

What are the intercellular bridges seen in Squamous Cell Carcinoma?

A

They are lines connecting the tumor cells –> desmosomal connections between squamous cells

102
Q

What are the walls of the alveolar air sacs replaced with in Bronchioalveolar Carcinoma?

A

Tall columnar cells

103
Q

What does a Carcinoid tumor show on histology?

A

Nests of cells!!

Pathoma - Respiratory Tract Pathology (9 decks)

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