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Pulmonology > Lung Cancer- Bootcamp > Flashcards

Lung Cancer- Bootcamp Flashcards

1
Q

How common and how deadly is lung cancer?

A

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

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1
Q

_ is a classification of lung cancers that are non-resectable and carry a worse prognosis

A

Small cell is a classification of lung cancers that are non-resectable and carry a worse prognosis

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2
Q

Non-small cell lung cancer is generally resectable and has a better prognosis; it includes three types:

A

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

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3
Q

Lung cancer will usually show up as a small opacity on a chest x-ray called a _

A

Lung cancer will usually show up as a small opacity on a chest x-ray called a coin lesion

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4
Q

Lung cancer commonly presents with the following symptoms:

A

Lung cancer commonly presents with the following symptoms:
* Low grade fever
* Weight loss
* Cough
* Hemoptysis
* Dyspnea

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5
Q

Lung cancer on the superior sulcus of the lung is called a _ tumor

A

Lung cancer on the superior sulcus of the lung is called a pancoast tumor

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6
Q

A pancoast tumor may cause symptoms secondary to _

A

A pancoast tumor may cause symptoms secondary to neurological involvement (brachial plexus, Horner syndrome) and musculoskeletal symptoms (shoulder pain, vertebral, or rib pain)

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7
Q

_ involves ipsilateral ptosis, miosis, and anhidrosis; caused due to interruption of sympathetic nerve chain running to the head

A

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

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8
Q

_ involves facial plethora, upper extremity edema, JVD, and headaches and may occur secondary to lung cancer

A

SVC syndrome involves facial plethora, upper extremity edema, JVD, and headaches and may occur secondary to lung cancer

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9
Q

Phrenic nerve compression due to lung cancer would involve _

A

Phrenic nerve compression due to lung cancer would involve paralysis of the diaphragm

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10
Q

The _ nerve is a branch off of the vagus nerve that when compressed can lead to hoarseness
* May be affected by lung cancer

A

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

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11
Q

Lung cancer can also cause (transudative/exudative) pleural effusion

A

Lung cancer can also cause exudative pleural effusion

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12
Q

Small cell carcinoma is a malignant lung neoplasm derived from _ progenitor cells

A

Small cell carcinoma is a malignant lung neoplasm derived from neuroendocrine progenitor cells
* In other words, undifferentiated neuroendocrine cells

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13
Q

The biggest risk factor for small cell carcinoma is _

A

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

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14
Q

SCLCs often involve upregulations in _ and _ and down regulations in _

A

SCLCs often involve upregulations in MYC and BCL2 and down regulations in tumor suppressor genes like P53 and RB

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15
Q
A

Small cell carcinoma is composed of small cells with scant cytoplasm

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16
Q

Small cell carcinoma is often derived from neuroendocrine progenitor cells; therefore the tumor cells may express markers like _ or _

A

Small cell carcinoma is often derived from neuroendocrine progenitor cells; therefore the tumor cells may express markers like chromogranin or synaptophysin

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17
Q

Small cell carcinoma will often present with metastasis to _

A

Small cell carcinoma will often present with metastasis to lymph nodes, brain, spinal cord, liver, bone, adrenal glands, skin

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18
Q

_ is a common electrolyte abnormality associated with SCLC due to the common paraneoplastic syndrome SIADH

A

Hyponatremia is a common electrolyte abnormality associated with SCLC due to the common endocrine paraneoplastic syndrome SIADH

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19
Q

Syndrome of inappropriate ADH secretion (SIADH) causes the kidney to (reabsorb/ secrete) Na+

A

Syndrome of inappropriate ADH secretion (SIADH) causes the kidney to reabsorb Na+ –> water follows –> leads to increased total body water and hyponatremia

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20
Q

Another common endocrine abnormality that can result from SCLC is Cushing syndrome, which involves over-secretion of _

A

Another common endocrine abnormality that can result from SCLC is Cushing syndrome, which involves over-secretion of ACTH –> increased cortisol –> hyperglycemia + obesity

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21
Q

Lambert-Eaton syndrome secondary to SCLC will present with _

A

Lambert-Eaton syndrome secondary to SCLC will present with muscle weakness
* Antibodies made against presynaptic Ca+ channels

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22
Q

SCLC is best diagnosed using bronchoscopy due to its _ location

A

SCLC is best diagnosed using bronchoscopy due to its central location in the thorax
* Transthoracic needle biopsy risks damage to mediastinal structures

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23
Q

Adenocarcinoma originates in _ cells

A

Adenocarcinoma originates in mucus-producing epithelial cells
* Typically effects cells lining the outer lung

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24
Q

Adenocarcinoma can result from acquired somatic, _ mutations that speed up the growth factor receptor signaling pathways

A

Adenocarcinoma can result from acquired somatic, gain-of-function mutations that speed up the growth factor receptor signaling pathways

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25
Q

Adenocarcinoma has been associated with mutations in the tyrosine kinase genes such as _

A

Adenocarcinoma has been associated with mutations in the tyrosine kinase genes such as:
* EGFR
* ALK
* ROS1
* MET

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26
Q

KRAS is another mutation associated with adenocarcinoma that affects the _ coding gene

A

KRAS is another mutation associated with adenocarcinoma that affects the GTPase coding gene

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27
Q

Squamous cell carcinoma originates in _ cells

A

Squamous cell carcinoma originates in flat squamous epithelial cells that line the inside of the lung airways

28
Q

The most common lung cancer in non-smokers is _

A

The most common lung cancer in non-smokers is adenocarcinoma

29
Q

TP53 gene on chromosome _ is commonly inactivated or deleted in squamous cell carcinoma (and other cancers)

A

TP53 gene on chromosome 17 is commonly inactivated or deleted in squamous cell carcinoma (and other cancers)

30
Q

Retinoblastoma tumor suppressor gene, RB1 is located on chromosome _

A

Retinoblastoma tumor suppressor gene, RB1 is located on chromosome 13

31
Q

Squamous metaplasia is the first step in the progression of squamous cell carcinoma; this is followed by _ and finally _

A

Squamous metaplasia is the first step in the progression of squamous cell carcinoma; this is followed by squamous dysplasia and finally neoplasia

32
Q

Neoplasia can be defined as squamous dysplasia that has progressed to _

A

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

33
Q

Adenocarcinomas and large cell carcinomas tend to be found in the _ region

A

Adenocarcinomas and large cell carcinomas tend to be found in the lung periphery

34
Q

Squamous cell carcinomas are usually found in _ regions

A

Squamous cell carcinomas are usually found in bronchial airways, centrally located
* Sometimes squamous cell carcinoma is confused with small cell

35
Q

Mesotheliomas are not lung cancers but rather cancers of the _

A

Mesotheliomas are not lung cancers but rather cancers of the pleura

36
Q

Mesothelioma is almost always associated with exposure to _

A

Mesothelioma is almost always associated with exposure to asbestos
* More common in construction workers, shipyard workers, factor workers, firefighters

37
Q

A lung tumor that comes back positive with tumor markers chromogranin and synaptophysin is likely _

A

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 +

38
Q

Describe the pathophysiology of squamous cell carcinoma

A

Smoking causes damage to our normal pseudostratified columnar epithelium –> squamous metaplasia –> hyperplasia + rapid cell turnover –> squamous cell carcinoma

39
Q

_ and _ carcinomas are strongly correlated to smoking and tend to be centrally located in the lungs

A

Squamous and small cell carcinomas are strongly correlated to smoking and tend to be centrally located in the lungs

40
Q

Short blunted microvilli on EM will more likely be (adenocarcinoma/ mesothelioma)

A

Short blunted microvilli on EM will more likely be Adenocarcinoma

41
Q

Long slender microvilli on EM will more likely be (adenocarcinoma/ mesothelioma)

A

Long slender microvilli on EM will more likely be mesothelioma

42
Q

Mutations in EGFR, KRAS, and ALK are most associted with _

A

Mutations in EGFR, KRAS, and ALK are most associated with adenocarcinoma

43
Q

A glandular tumor that produces mucin describes _

A

A glandular tumor that produces mucin describes adenocarcinoma

44
Q

The most common paraneoplastic syndrome associated with squamous cell carcinoma is _

A

The most common paraneoplastic syndrome associated with squamous cell carcinoma is PTH related peptide production –> leads to hypercalcemia

45
Q

Keratin pearls are associated with _

A

Keratin pearls are associated with squamous cell carcinoma
* These tumors produce lots of keratin

46
Q

“Intercellular bridges” are associated with _

A

“Intercellular bridges” are associated with squamous cell carcioma
* Squamous cells have lots of desmosomes between cells

47
Q

Well differentiated nests of neuroendocrine cells describe _

A

Well differentiated nests of neuroendocrine cells describe carcinoid tumors
* They will be chromogranin +
* Associated with carcinoid syndrome (high serotonin –> flushing and diarrhea)

48
Q

Bronchogenic carcinoma is a _ type lung cancer; however, it is distinguished by being well differentiated

A

Bronchogenic carcinoma is a small cell carcinoma; however, it is distinguished by being well differentiated

49
Q

Psammoma bodies on histology are indicative of _

A

Psammoma bodies on histology are indicative of mesothelioma

50
Q

Cancer of the alveolar type II epithelial cells (pneumocytes)

A

Cancer of the alveolar type II epithelial cells (pneumocytes): adenocarcinoma

51
Q

Cancer of the basal epithelial cells

A

Cancer of the basal epithelial cells: squamous cell carcinoma

52
Q

Lung cancer that arises in the proximal airways of smokers and cavitates:

A

Lung cancer that arises in the proximal airways of smokers and cavitates: squamous cell carcinoma

53
Q

Define the stages of squamous cell carcinoma invasion

A

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

54
Q
A

Squamous cell metaplasia

55
Q
A

Squamous cell carcinoma in situ

56
Q

If we see keratin pearls and intercellular bridges, we are likely in _ stage

A

If we see keratin pearls and intercellular bridges, we are likely in invasive squamous cell carcinoma stage

57
Q
A

Keratin pearls
(squamous cell carcinoma)

58
Q

Hypertrophic osteoarthritis and clubbing are often syndromes of _ lung cancer

A

Hypertrophic osteoarthritis and clubbing are often syndromes of adenocarcinoma

59
Q
A
60
Q
A

Adenocarcinoma in situ

61
Q
A

Adenocarcinoma

62
Q
A

Small cell

63
Q
A
64
Q
A

Metastatic lung cancer-
multiple well circumscribed nodules

65
Q

ARDS Berlin definition

A
66
Q

ARDS is _ type of hypoxemia

A

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

67
Q

Direct causes of ARDS

A
68
Q

Indirect causes of ARDS

A

Pulmonology (16 decks)

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