Lung Cancer Flashcards
1
Q
What is the most common cause of cancer mortality in the US?
A
Lung Cancer!
2
Q
What is the average age at presentation of lung cancer?
A
60 years
3
Q
What are the three cancers with the highest incidence in the US?
A
- Breast/Prostate
- Lung
- Colorectal
4
Q
What are three key risk factors for Lung cancer?
A
Smoke, radon and asbestos
5
Q
How many carcinogens does cigarette smoke contain?
A
Over 60 carcinogens
6
Q
What percentage of lung cancer occurs in smokers?
A
85%
7
Q
What two chemicals in cigarette smoke are particularly mutagenic?
A
- Polycyclic aromatic hydrocarbons
2. Arsenic
8
Q
What does Arsenic increase risk for?
A
It increases risk of squamous cell carcinoma of the lung.
9
Q
What is lung cancer risk directly related to?
A
Duration and Amount of smoking (pack-years)
10
Q
How is radon formed?
A
By radioactive decay of uranium
11
Q
What is radon?
A
Colorless, odorless gas
12
Q
Where is Uranium present?
A
In the soil
13
Q
Where does Radon accumulate?
A
In closed spaces such as basements
14
Q
What is Radon responsible for?
A
Most of the public exposure to ionizing radiation
15
Q
What is the second most frequent cause of lung carcinoma in the US?
A
Radon exposure
16
Q
In what population is increased risk of lung cancer also seen in?
A
Uranium miners
17
Q
What are the presenting symptoms of lung cancer?
A
They are nonspecific:
- Cough
- Weight loss
- Hemoptysis
- Post-obstructive pneumonia
18
Q
What does imaging often reveal in lung cancer?
A
Solitary nodule
19
Q
What is the first step when you see a solitary nodule on CXR?
A
Look and compare it to a previous CXR.
20
Q
What is another name for solitary nodule?
A
‘coin-lesion’
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.
22
Q
In what population do benign ‘coin-lesions’ often occur?
A
Younger patients
23
Q
What are two benign ‘coin-lesions’ that occur in younger patients?
A
- Granuloma
2. Bronchial hamartoma
24
Q
What often causes granulomas in the lungs?
A
Often due to TB or fungus (especially Histoplasma in the Midwest)
25
What is a Bronchial hamartoma?
A benign tumor composed of lung tissue and cartilage.
26
What trait does a Bronchial Hamartoma often have on imaging?
Often calcified on imaging.
27
What two categories are lung carcinoma often divided into?
1. Small cell carcinoma
| 2. Non-small cell carcinoma
28
What percentage of lung carcinoma is small cell carcinoma?
15%
29
What percentage of lung carcinoma is non-small cell carcinoma?
85%
30
How is small cell carcinoma treated?
Chemotherapy
31
What usually is small cell carcinoma usually not amenable to?
Surgical resection
32
What is non-small cell carcinoma treated upfront with?
Surgical resection
33
What does non-small cell carcinoma not respond well to?
Chemotherapy
34
What are the four subtypes of non-small cell carcinoma?
1. Adenocarcinoma
2. Squamous cell carcinoma
3. Large cell carcinoma
4. Carcinoid tumor
35
What percentage of lung carcinoma is Adenocarcinoma?
40%
36
What percentage of lung carcinoma is Squamous cell carcinoma?
30%
37
What percentage of lung carcinoma is Large cell carcinoma?
10%
38
What percentage of lung carcinoma is Carcinoid tumor?
5%
39
What are hamartomas made of?
They contain tissue that normally should be in this area but is disorganized.
40
What is the pathology behind Eaton-Lambert Syndrome?
Patients develop antibodies against presynaptic calcium channels and this leads to muscle weakness
41
What type of cancer is often associated with Eaton-Lambert Syndrome?
Small cell carcinoma
42
What three S's is Small cell carcinoma associated with?
- Smoking
- Sentral (Central)
- Paraneoplastic Syndrome
43
What does the T stand for in TMN staging of lung cancer?
Tumor size and local extension
44
What is classically seen with Adenocarcinoma?
Pleural involvement
45
What is Superior Vena Cava syndrome?
Obstruction of the SVC that leads to distended head and neck veins with edema and blue discoloration of arms and face
46
What does obstruction of the SVC due to lung cancer lead to?
Distended head and neck veins with edema and blue discoloration of arms and face.
47
What nerves can be affected by lung tumors?
- Recurrent laryngeal nerve
- Phrenic nerve
- Sympathetic chain
48
What can lung cancer involving the recurrent laryngeal nerve cause?
Hoarseness
49
What can lung cancer involving the phrenic nerve cause?
Diaphragmatic paralysis
50
What can lung cancer compressing the sympathetic chain lead to?
Horner syndrome
51
What does Horner's syndrome consist of?
- Ptosis (drooping eyelid)
- Miosis (pinpoint pupils)
- Anhidrosis (no sweating)
52
What type of lung tumor usually leads to Horner's syndrome?
Apical (Pancoast) tumor
53
What does the N of TMN staging stand for?
Spread to regional lymph nodes (hilar and mediastinal)
54
What does the M of TMN staging stand for?
Metastasis
55
What is a unique site of distant metastasis in lung cancer?
Adrenal gland
56
What is the overall 5 year survival of lung cancer?
15%
57
When does Lung Cancer often present? And why?
Late due to absence of an effective screening method
58
What is the histology of Small Cell Carcinoma?
Poorly differentiated small cells.
59
What type of cells does Small Cell Carcinoma arise from?
Neuroendocrine (Kulchitsky) cells
60
What groups is Small Cell Carcinoma associated with?
Male smokers
61
In what location is Small Cell Carincoma?
Central
62
What types of lung cancer are primarily treated with chemotherapy?
Small Cell Carcinoma
63
Why types of lung cancer are primarily treated with surgery?
- Squamous Cell Carcinoma
- Adenocarcinoma
- Large Cell Carcinoma
- Bronchioloalveolar Carcinoma
- Carcinoid tumor
- Metastasis to Lung
64
How does Small Cell Carcinoma grow?
Rapid growth and early metastasis
65
What might Small Cell Carcinoma produce?
ADH or ACTH (leads to Cushings) or cause Eaton-Lambert syndrome (paraneoplastic syndromes)
66
What is the histology of Squamous Cell Carcinoma?
Keratin pearls or intercellular bridges
67
What groups is Squamous Cell Carcinoma associated with?
Most common tumor in male smokers
68
In what location is Squamous Cell Carcinoma?
Central
69
What may happen in a subset of Squamous Cell Carcinoma patients?
-May produce PTHrP --> Parathyroid hormone related peptide --> leads to hypercalcemia
70
What is seen on histology of Adenocarcinoma?
Glands or mucin
71
What groups is Adenocarcinoma associated with?
Most common tumor in nonsmokers and female smokers
72
What is the most common tumor in nonsmokers and female smokers?
Adenocarcinoma
73
In what location is Adenocarcinoma?
Peripheral
74
What will NOT happen to a subset of Adenocarcinoma patients?
No paraneoplastic syndrome
75
What is seen on histology of Large Cell Carcinoma?
Poorly differentiated large cells
76
What is NOT seen on histology of Large Cell Carcinoma?
No keratin pearls, intercellular bridges, glands or mucin
77
What groups is Large Cell Carcinoma associated with?
Smoking!
78
In what location is Large Cell Carcinoma?
Peripheral or Central
79
What is the prognosis associated with Large Cell Carcinoma?
Poor prognosis
80
What does Bronchiolo mean?
Airways
81
What does alveolar mean?
Air sacs
82
What histology is associated with Bronchioloalveolar Carcinoma?
Columnar cells that grow along preexisting bronchioles and alveoli
83
What does Bronchioloalveolar Carcinoma arise from?
Clara cells
84
What is Bronchioloalveolar Carcinoma NOT related to?
SMOKING
85
In what location is Bronchioloalveolar Carcinoma?
Peripheral
86
What may Bronchioloalveolar Carcinoma present with?
Pneumonia-like consolidation on imaging
87
What is the prognosis of Bronchioloalveolar Carcinoma?
Excellent Prognosis
88
What histology is associated with Carcinoid tumors?
Well differentiated neuroendocrine cells.
89
What do neuroendocrine cells contain with Carcinoid tumors?
Neuro secretory granules
90
What do neuro secretory granules stain?
Stain chromogranin positive.
91
What does Bronchioloalveolar Carcinoma stain?
Chromogranin positive
92
What are Carcinoid tumors NOT related to?
SMOKING
93
In what location are Carcinoid tumors?
Central or peripheral
94
What happens when Carcinoid tumors are central?
The tumor classically forms a polyp-like mass in the bronchus.
95
What type of malignancy are Carcinoid tumors?
Low-grade malignancy
96
What can Carcinoid tumors rarely cause?
Carcinoid syndrome!
97
What are the most common sources of Metastasis to the lung?
Breast and colon carcinoma
98
What do you see on imaging with Metastasis to the lung?
Multiple 'cannon-ball'/circular nodules on imaging
99
What is Metastasis to the lung more common than?
Primary Tumors
100
On histology what do small cells of Small Cell Carcinoma mimic?
Lymphocytes
| -There is also a small degree of mitotic activity
101
What are the intercellular bridges seen in Squamous Cell Carcinoma?
They are lines connecting the tumor cells --> desmosomal connections between squamous cells
102
What are the walls of the alveolar air sacs replaced with in Bronchioalveolar Carcinoma?
Tall columnar cells
103
What does a Carcinoid tumor show on histology?
Nests of cells!!
