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Pulmonary > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

Adenocarcinoma cell markers

A

TTF-1, napsin A, cytokeratin 7, CK20-, MOC-31

  • TTF thyroid and lung, ADENO
  • overexpression is favorable prognosis
  • Napsin A- regulated by TTF.
  • If TTF1 and Napsin A positive, highly likely AdenoCA with lung primary (vs mets)
  • MOC 31 can differentiate AdenoCA from meso
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2
Q

Squamous cell markers

A

p63, cytokeratin 5/6

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3
Q

Treatment NSCLC stage 1

A

surgery alone, chemo only in 1B if tumor >4cm

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4
Q

Treatment NSCLC stage 2

A

Surgery (lobectomy), adjuvant chemo. Radiation reserved for poor surgical candidates or positive surgical margins.

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5
Q

Treatment NSCLC stage 3

A

Chemoradiotherapy

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6
Q

Treatment NSCLC stage 4

A

chemotherapy alone + radiation for palliation

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7
Q

Driver mutations that effect treatment in NSCLC

A
  1. EGF-single agent EGF-R TKI (erlotinib, getinib, afatinib)

2. ALK- Crizotinib

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8
Q

Treatment Pancoast tumor

A

The one exception for neoadjuvant chemotherapy + radiation and then resection

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9
Q

Treatment SVC syndrome.

A
  1. small cell- chemo

2. NSCLC- chemo + XRT

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10
Q

Treatment of Carcinoid

A

Typical: segmentectomy and regional LN dissection

-mets: no known benefit of chemo or XRT

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11
Q

Markers Small Cell

A

TTF-1, CD 56, Ki 67, synaptophysin, 1/3 chromogranin

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12
Q

Treatment of small cell

A
  1. Limited (one radiation portal or hemithorax): chemo (Pt + etoposide)+ XRT x4-6 cycles
    - 50% with complete clinical response
  2. Extensive: chemotherapy. Radiation strictly palliative.
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13
Q

Role of prophylactic whole brain radiation in SCLC

A

added if there is complete or partial response in both limited and extensive disease

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14
Q

Adenocarcinoma: send molecular testing

A

EGFR, KRAS, ALK

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15
Q

Marker for Carcinoid

A

CD 56, synaptophysin, chromogranin

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16
Q

Path buzzwords: SCC

A

keratinization, intracellular bridges

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17
Q

Path buzzwords: Adenocarcinoma

A

glandular architecture, cytoplasmic mucin on PAS

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18
Q

Path buzzwords: small cell

A

small/round fusiform shape, scant cytoplasm, “salt and pepper” chromatin

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19
Q

Path buzzwords: Carcinoid

A

Round, oval nuclei, finely dispersed chromatin, inconspicuous nucleoli

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20
Q

Adenocarcinoma mutations.

A
  1. EGFR- women, E Asian, nonsmoker
    - high response to EGF TKI
  2. KRAS- white, smokers- resist TKI and assoc with worse outcomes
  3. ALK- young, nonsmoker.
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21
Q

Erlotinib, gefitinib

A

EGF TKI

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22
Q

Crizotinib, ceritinib

A

ALK inhibitor

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23
Q

EGFR, KRAS, ALK: simultaneous?

A

almost always mutually exclusive

24
Q

Markers for Pleural Lesion

A

Meso: +vimentin, +calretinin, -PAS, -CEA
Adeno: -vimentin, -calretinin, + PAS, +CEA, MOC 31

25
Q

When to get screening CT or MRI brain?

A

If neuro sx, and all patients with stage III/IV disease (3% risk of brain mets in asx individual, 14% all patients)

26
Q

T1 tumor

-subdivide

A 
< or = 3cm
-surrounded by lung or visceral pleural
-without bronchoscopic evidence of invasion to mainbronchus
1a= < or = 1cm
1b>1cm 2cm but
27
Q

T2 tumor

-subdivide

A

Tumor >3cm but < or = 5cm or any tumor:

  1. Involves main bronchus, regardless of distance to carina (without involvement of carina)
  2. Invades visceral pleural
  3. Assoc with atelectasis or obstructive pneumonitis that extends to hilar region, involving part or all of lung
28
Q

T3

A

> 5cm but < or = 7cm or any tumor with:

  1. associated nodule in same lobe as primary.
  2. Chest wall (parietal pleura, superior sulcus)
  3. Phrenic nerve
  4. Parietal pericardium
29
Q

T4

A

Tumor >7cm or associated nodule in different ipsilateral lobe or invades:

  1. Diaphragm
  2. Mediastinum
  3. Heart
  4. Great vessels
  5. Trachea
  6. Recurrent laryngeal nerve
  7. Esophagus
  8. Vertebral body
  9. Carina
30
Q

N0

A

No regional LN involvement

31
Q

N1

A

Mets to ipsilateral peribronchial and/or ipsilateral hilar and intrapulmonary nodes

32
Q

N2

A

ipsilateral mediastinal and/or subcarinal LN

33
Q

N3

A

Mets to contralateral mediastinal, contralateral hilar, ipsilateral/contralateral scalene or supraclavicular

34
Q

If you have N2 involvement, lowest possible stage:

A

IIIA

35
Q

If you have N3 involvement, lowest possible stage

A

IIIB

36
Q

If you have T4 tumor, lowest possible stage

A

IIIA

37
Q

If you have T3 tumor, lowest possible stage

A

IIB

38
Q

Treatment of NSCLC with checkpoint inhibitor

A

(PD-1 and PD-L1 inhibitor) help immune system recognize cancer as foreign and attack it.

First Line: if 50% of cancer cells have positive PD-L1 stain, pembrolizumab is 1st line
Second Line: if 1% of cancer cells have positive PD-L1–> pembrolizumab

-Nivolumab and atezolizumab second-line therapy for progression of NSCLC after receiving Pt-based chemo, regardless of cancer histology or need for PD-L1 testing

39
Q

If you have N1 involvements, at least:

A

Stage II B

40
Q

Low Dose Screening CT- Who to screen

A

55-74yo, asymptomatic patients

  • at least 30 pack year smoking history
  • current or quit within the last 15 years
41
Q

Most common benign lung neoplasm:

  • Pathology
  • Tx
A

Hamartoma

  • mature hyaline cartilage with fat, fibromyxoid tissue, and/or smooth muscle
  • Tx if symptomatic
42
Q

Benign lung neoplasm associated with TS (and sometimes LAM)

A

micronodular pneumocyte hyperplasia

43
Q

N1 at least:

A

IIB

44
Q

T3 at least:

A

IIB

45
Q

N2 at least:

A

III A

46
Q

T4 at least:

A

III A

47
Q

N3 at least

A

IIIB

-also T3 or T4 with N2

48
Q

Masses in ____ mediastinum are more likely to be malignant:

A

Anterior

49
Q

Boundaries of:

  1. Anterior Mediastinum-
  2. Middle Mediastinum-
  3. Posterior
A
  1. Sternum to anterior to great vessels
  2. Heart, pericardium, asc aorta, brachiocephalic veins, trachea, bronchi, LNs
  3. Posterior aspect of heart and trachea to posterior vertebral bodies, include: desc aorta, esophagus, azygous, autonomic ganglia, thoracic LN, fat
50
Q

Paraneoplastic syndromes associated with thymoma:

A

1, Hypogammaglobulinemia

  1. MG
  2. Pure red cell aplasia
51
Q

Paraneoplastic syndromes mostly associated with ___ type of cancer?
-Except Hypercalcemia
and hypertrophic pulmonary osteoarthropathy

A
  • Small cell lung cancer
  • SCC
  • adenoCA
52
Q

Neurogenic Paraneoplastic Syndromes:

  1. Limbic encephalitis, brainstem encephalitis, cerebellar degen, myelopathy
  2. Cerebellar degen
  3. Lambert-Eaton
A

(exclusively in small cell)

  1. Anti-Hu
  2. Anti-Yo
  3. Ab to voltage-gated calcium channel type P/Q
53
Q

Differentiate small cell from carcinoid on markers

A

Both have synaptophysin, chromogranin, CD 56

-Carcinoid lacks TTF-1

54
Q

First line therapy for ALK + NSCLC?

A

Alceitinb, Crizotinib, ceritinib

55
Q

Therapy for EGFR mutation in stage IV NSCLC?

A

osimertinib, erlotinib

56
Q

Markers carcinoid vs Small Cell

A
  • Carcinoid: synaptophysin, chromogranin, CD 56

- SCC synaptophysin, chromogranin, TTF-1, negative Napsin A

Pulmonary (14 decks)

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