Lung Cancer- Bootcamp Flashcards
How common and how deadly is lung cancer?
Lung cancer is the most common cause of cancer death and it is the second most common cancer
* Prostate and breast cancer are more common
_ is a classification of lung cancers that are non-resectable and carry a worse prognosis
Small cell is a classification of lung cancers that are non-resectable and carry a worse prognosis
Non-small cell lung cancer is generally resectable and has a better prognosis; it includes three types:
Non-small cell lung cancer is generally resectable and has a better prognosis; it includes three types:
1. Squamous cell carcinoma
2. Adenocarcinoma
3. Carcinoid tumors
Lung cancer will usually show up as a small opacity on a chest x-ray called a _
Lung cancer will usually show up as a small opacity on a chest x-ray called a coin lesion
Lung cancer commonly presents with the following symptoms:
Lung cancer commonly presents with the following symptoms:
* Low grade fever
* Weight loss
* Cough
* Hemoptysis
* Dyspnea
Lung cancer on the superior sulcus of the lung is called a _ tumor
Lung cancer on the superior sulcus of the lung is called a pancoast tumor
A pancoast tumor may cause symptoms secondary to _
A pancoast tumor may cause symptoms secondary to neurological involvement (brachial plexus, Horner syndrome) and musculoskeletal symptoms (shoulder pain, vertebral, or rib pain)
_ involves ipsilateral ptosis, miosis, and anhidrosis; caused due to interruption of sympathetic nerve chain running to the head
Horner’s syndrome involves ipsilateral ptosis, miosis, and anhidrosis; caused due to interruption of sympathetic nerve chain running to the head
* May be secondary to a pancoast lung tumor
_ involves facial plethora, upper extremity edema, JVD, and headaches and may occur secondary to lung cancer
SVC syndrome involves facial plethora, upper extremity edema, JVD, and headaches and may occur secondary to lung cancer
Phrenic nerve compression due to lung cancer would involve _
Phrenic nerve compression due to lung cancer would involve paralysis of the diaphragm
The _ nerve is a branch off of the vagus nerve that when compressed can lead to hoarseness
* May be affected by lung cancer
The recurrent laryngeal nerve is a branch off of the vagus nerve that when compressed can lead to hoarseness
* May be affected by lung cancer
Lung cancer can also cause (transudative/exudative) pleural effusion
Lung cancer can also cause exudative pleural effusion
Small cell carcinoma is a malignant lung neoplasm derived from _ progenitor cells
Small cell carcinoma is a malignant lung neoplasm derived from neuroendocrine progenitor cells
* In other words, undifferentiated neuroendocrine cells
The biggest risk factor for small cell carcinoma is _
The biggest risk factor for small cell carcinoma is smoking
* Small cell lung cancer has the strongest association with smoking of all the lung cancers
SCLCs often involve upregulations in _ and _ and down regulations in _
SCLCs often involve upregulations in MYC and BCL2 and down regulations in tumor suppressor genes like P53 and RB
Small cell carcinoma is composed of small cells with scant cytoplasm
Small cell carcinoma is often derived from neuroendocrine progenitor cells; therefore the tumor cells may express markers like _ or _
Small cell carcinoma is often derived from neuroendocrine progenitor cells; therefore the tumor cells may express markers like chromogranin or synaptophysin
Small cell carcinoma will often present with metastasis to _
Small cell carcinoma will often present with metastasis to lymph nodes, brain, spinal cord, liver, bone, adrenal glands, skin
_ is a common electrolyte abnormality associated with SCLC due to the common paraneoplastic syndrome SIADH
Hyponatremia is a common electrolyte abnormality associated with SCLC due to the common endocrine paraneoplastic syndrome SIADH
Syndrome of inappropriate ADH secretion (SIADH) causes the kidney to (reabsorb/ secrete) Na+
Syndrome of inappropriate ADH secretion (SIADH) causes the kidney to reabsorb Na+ –> water follows –> leads to increased total body water and hyponatremia
Another common endocrine abnormality that can result from SCLC is Cushing syndrome, which involves over-secretion of _
Another common endocrine abnormality that can result from SCLC is Cushing syndrome, which involves over-secretion of ACTH –> increased cortisol –> hyperglycemia + obesity
Lambert-Eaton syndrome secondary to SCLC will present with _
Lambert-Eaton syndrome secondary to SCLC will present with muscle weakness
* Antibodies made against presynaptic Ca+ channels
SCLC is best diagnosed using bronchoscopy due to its _ location
SCLC is best diagnosed using bronchoscopy due to its central location in the thorax
* Transthoracic needle biopsy risks damage to mediastinal structures
Adenocarcinoma originates in _ cells
Adenocarcinoma originates in mucus-producing epithelial cells
* Typically effects cells lining the outer lung
Adenocarcinoma can result from acquired somatic, _ mutations that speed up the growth factor receptor signaling pathways
Adenocarcinoma can result from acquired somatic, gain-of-function mutations that speed up the growth factor receptor signaling pathways
Adenocarcinoma has been associated with mutations in the tyrosine kinase genes such as _
Adenocarcinoma has been associated with mutations in the tyrosine kinase genes such as:
* EGFR
* ALK
* ROS1
* MET
KRAS is another mutation associated with adenocarcinoma that affects the _ coding gene
KRAS is another mutation associated with adenocarcinoma that affects the GTPase coding gene
Squamous cell carcinoma originates in _ cells
Squamous cell carcinoma originates in flat squamous epithelial cells that line the inside of the lung airways
The most common lung cancer in non-smokers is _
The most common lung cancer in non-smokers is adenocarcinoma
TP53 gene on chromosome _ is commonly inactivated or deleted in squamous cell carcinoma (and other cancers)
TP53 gene on chromosome 17 is commonly inactivated or deleted in squamous cell carcinoma (and other cancers)
Retinoblastoma tumor suppressor gene, RB1 is located on chromosome _
Retinoblastoma tumor suppressor gene, RB1 is located on chromosome 13
Squamous metaplasia is the first step in the progression of squamous cell carcinoma; this is followed by _ and finally _
Squamous metaplasia is the first step in the progression of squamous cell carcinoma; this is followed by squamous dysplasia and finally neoplasia
Neoplasia can be defined as squamous dysplasia that has progressed to _
Neoplasia can be defined as squamous dysplasia that has progressed to full thickness of the epithelium –> this is termed squamous cell carcinoma in situ
* From here, it can progress to invasive squamous cell carcinoma
Adenocarcinomas and large cell carcinomas tend to be found in the _ region
Adenocarcinomas and large cell carcinomas tend to be found in the lung periphery
Squamous cell carcinomas are usually found in _ regions
Squamous cell carcinomas are usually found in bronchial airways, centrally located
* Sometimes squamous cell carcinoma is confused with small cell
Mesotheliomas are not lung cancers but rather cancers of the _
Mesotheliomas are not lung cancers but rather cancers of the pleura
Mesothelioma is almost always associated with exposure to _
Mesothelioma is almost always associated with exposure to asbestos
* More common in construction workers, shipyard workers, factor workers, firefighters
A lung tumor that comes back positive with tumor markers chromogranin and synaptophysin is likely _
A lung tumor that comes back positive with tumor markers chromogranin and synaptophysin is likely small cell carcinoma
* Carcinoid tumor (NSCLC) will also be chromogranin +
Describe the pathophysiology of squamous cell carcinoma
Smoking causes damage to our normal pseudostratified columnar epithelium –> squamous metaplasia –> hyperplasia + rapid cell turnover –> squamous cell carcinoma
_ and _ carcinomas are strongly correlated to smoking and tend to be centrally located in the lungs
Squamous and small cell carcinomas are strongly correlated to smoking and tend to be centrally located in the lungs
Short blunted microvilli on EM will more likely be (adenocarcinoma/ mesothelioma)
Short blunted microvilli on EM will more likely be Adenocarcinoma
Long slender microvilli on EM will more likely be (adenocarcinoma/ mesothelioma)
Long slender microvilli on EM will more likely be mesothelioma
Mutations in EGFR, KRAS, and ALK are most associted with _
Mutations in EGFR, KRAS, and ALK are most associated with adenocarcinoma
A glandular tumor that produces mucin describes _
A glandular tumor that produces mucin describes adenocarcinoma
The most common paraneoplastic syndrome associated with squamous cell carcinoma is _
The most common paraneoplastic syndrome associated with squamous cell carcinoma is PTH related peptide production –> leads to hypercalcemia
Keratin pearls are associated with _
Keratin pearls are associated with squamous cell carcinoma
* These tumors produce lots of keratin
“Intercellular bridges” are associated with _
“Intercellular bridges” are associated with squamous cell carcioma
* Squamous cells have lots of desmosomes between cells
Well differentiated nests of neuroendocrine cells describe _
Well differentiated nests of neuroendocrine cells describe carcinoid tumors
* They will be chromogranin +
* Associated with carcinoid syndrome (high serotonin –> flushing and diarrhea)
Bronchogenic carcinoma is a _ type lung cancer; however, it is distinguished by being well differentiated
Bronchogenic carcinoma is a small cell carcinoma; however, it is distinguished by being well differentiated
Psammoma bodies on histology are indicative of _
Psammoma bodies on histology are indicative of mesothelioma
Cancer of the alveolar type II epithelial cells (pneumocytes)
Cancer of the alveolar type II epithelial cells (pneumocytes): adenocarcinoma
Cancer of the basal epithelial cells
Cancer of the basal epithelial cells: squamous cell carcinoma
Lung cancer that arises in the proximal airways of smokers and cavitates:
Lung cancer that arises in the proximal airways of smokers and cavitates: squamous cell carcinoma
Define the stages of squamous cell carcinoma invasion
Squamous metaplasia: bronchial epithelium goes from columnar to squamous
Squamous dysplasia: loss of cell polarity, increased nuclear hyperchromasia, mitotic activity, etc
Squamous cell carcinoma in situ: neoplastic stage where squamous dysplasia has progressed to involve the full thickness of the epithelium
Invasive carcinoma: invasion of adjacent structures
Squamous cell metaplasia
Squamous cell carcinoma in situ
If we see keratin pearls and intercellular bridges, we are likely in _ stage
If we see keratin pearls and intercellular bridges, we are likely in invasive squamous cell carcinoma stage
Keratin pearls
(squamous cell carcinoma)
Hypertrophic osteoarthritis and clubbing are often syndromes of _ lung cancer
Hypertrophic osteoarthritis and clubbing are often syndromes of adenocarcinoma
Adenocarcinoma in situ
Adenocarcinoma
Small cell
Metastatic lung cancer-
multiple well circumscribed nodules
ARDS Berlin definition
ARDS is _ type of hypoxemia
ARDS is a shunt
* There is an A-a gradient
* After a while we can no longer blow off the CO2 by hyperventilating - expect CO2 to be high
Direct causes of ARDS
Indirect causes of ARDS
