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OS 213 Respiratory Exam 2 > Lung malignancy > Flashcards

Lung malignancy Flashcards

1
Q

Most common cancer and cancer death in both males and female

A

LUNG cancer

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2
Q

Risk Factors of Lung cancer

A

SMOKING

one gentic mutation is induced for every 15 cigarettes smoked

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3
Q

The best known risk factor in developing ANY cancer

A

AGE

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4
Q

High associated with lung cancer and mesothelioma

A

Asbestos

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5
Q

Cancer development

A

Genetic and Environmental factors

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6
Q

Polymorphic variations in the genes…

A

p53 and retinoblastoma suppressor gene expression

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7
Q

The process when carcinogen confers a genetic change on the normal cell

A

Initiation

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8
Q

Happens when those genetic changes confers a growth advantage on the cell over its neighboriing cells

A

Promotion

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9
Q

Lung cancer gene mutations

A

EGFR - cancer susceptibility to never smokers

P450 enzyme system specifically CYP1A1

RB

p53 *Li-Fraumeni syndrome) - 1st degree relatives of lung CA

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10
Q

Hallmarks of Cancer

A

Self sufficiency in growth signals

Insensitivity to antigrowth signals

Tissue invasion and metastasis

Limitless replicative potential

Sustained angiogenesis

Evading apoptosis

Avoidance of host immune system

Tumor promoting inflammation involved

Develop ability to deregulate cellular energetics

Develop genomic instability

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11
Q

Epithelial tumors of the lung counts for 90% of epithelial tumors of the lung counts for 90% of epithelial tumors

A

Bronchogenic carcinoma

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12
Q

NSCLC type

A

Adenocarcinoma
SQCCA
Large cell CA

Account for 90% of all epithelial cancers

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13
Q

Squamous cell lung CA

A

Typically central and close to carina
Frequently presenting with bronchial obstruction and hemoptysis

Highly associated with cigarette smoking

More common in men than in women

areas of squamous metaplasia

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14
Q

MOST frequent histologic subtype of NSCLC

A

Adenocarcinoma

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15
Q

Contains sheet of cells rather than 3D group of cells as with the case of adenocarcinoma

A

Squamous cell carcinoma

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16
Q

Possess a glandular differentiation or mucin production

Typically peripheral, sometimes originating in areas of pre-existing lung scarring

A

Adenocarcinoma

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17
Q

Most common histology found in never smokers, and also in women

A

Adenocarcinoma

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18
Q

Adenocarcinoma may manifest as:

A

Adenocarcinoma in situ

Minimally invasive

Invasive

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19
Q

Main histological patterns of adenocarcinoma

A

Acinar - gland like spaces

Papillary - leaf like thin septa

Solid carcinoma with mucin production - Poorly differentiated

Lepidic mixed subtype tumors with non-mucinous bronchioalveolar CA

Micropapillary

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20
Q

Marker for adenocarcinoma

A

TTF 1 or napsin A

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21
Q

marker for squamous CA

A

p40 or p63 and/or mucin stains

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22
Q

Lung adenocarcinomas can arise when tumorrs express this mutant gene

A

EGFR

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23
Q

What type of cells have the capacity to give rise to adenocarcinoma

A

Type II epithelial cells

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24
Q

LArge malignant cells without evidence of squamous of glandular differentiation

A

Large cell CA

25
Q

Macroscopic features of large ccell CA

A

Peripheral

maybe central

26
Q

Histological features of large CA

A

Large malignant cells that lack the cytologic and architectural features of small cell CA and glandular or squamous differentiation

27
Q

Undifferentiated/oat cell Carcinoma

A

Squamous cell CA

28
Q

Histological characteristic of small cell CA

A

salt and pepper pattern (Very scant cytoplasm, small, hyperchromatic nuclei with a fine chromatin pattern and absent/inconspicuous nucleoli

29
Q

Cell of origin for small cell carcinoma

A

Kulchitsky cells

30
Q

Type of cancer that secrets a lot of polypeptide hormones such as ACTH, AVP, ANF, and GRP

A

Small cell Carcinoma

31
Q

Lung cancer associated with a lot of paraneoplastic syndromes

A

small cell CA

32
Q

Clinical signs of lung malignancy

A 
Cough (80%)
Hemoptysis (70%)
Dyspnea (60%)
Chest pain (40%)
Recurrent or slowly resolving pneumonia
Constitutional signs
Cachexia
Supraclavicular or axillary LAD
Tender ribs
33
Q

Signs of Mediastinal compression

A

SVC syndrome
- facial edema, NVE, plethora, dysphagia, dyspnea

Facial edema
Telagiectasia
Hypotension latter part
Flushing
Neck vein engorgement
34
Q

A tumor that occupies the apex of the lung might affect the nerve specifically ulnar nerve which can result to arm pain

A

Pancoast Tumor

C8, T1 and T2

35
Q

Metastatic signs and symptoms

A

Bone Pain and tenderness
hepatomegaly and jaundice
Confsuion and neurologic signs
Nausea, vomiting, headache

36
Q

Hypertrophic Pulmonary Osteoarthropathy

A

Clubbing
Periostitis
commonly found in small cell lung CA
swelling pain

37
Q

Hypercalcemia (PNPS)

A

most common oncologic emergency

Increase PTH

38
Q

Paraneoplastic syndrome

A 
hypercalcemia
Cushing's syndrome
Carcinoid syndrome
Gynecomastia
Hypoglycemia
39
Q

Carcinoid syndrome (serotonin)

A 
Irregular mottled blushing
Flat angiomas of the skin
Acquired tricuspid and pulmonary stenosis
Diarrhea
Bronchial Spasm
Mental aberratiion
Excretion of large quantities of 5-HIAA
40
Q

Neurological syndrome found in small lung CA

A

Eaton-lambert syndrome

41
Q

Progressive proximal muscle weakness in the absence of dermatomyositis

A

Eaton-Lambert Syndrome

42
Q

Migrating venous thrombophlebitis

A

Trousseau syndrome

43
Q

Establishes a cytologic and/or histologic diagnosis in 80-85% of centrally located lesions

A

Bronchoscopy

44
Q

Four types of specimens

A

Bronchial brush
Bronchial washing
Bronchoalveolar lavage
transbronchial FNAB - most sensitive

45
Q

May diagnose up to 90% of peripheral lung cancers

A

CT guided transthoracic needle biopsy

46
Q

Provides not only histologic dx but also important staging information

A

Mediastinoscopy

47
Q

Scan good for staging

A

PET Scan

48
Q

Checks for the level of glucose metabolism by cells

A

PET

  • uses FDG 18
  • uses scorring called standardized Uptake Values
49
Q

Tumor component (2018)

A 
< = 1 cm =T1a
>1-2 cm = T1b
>2-3cm = T1c
>3-4 cm = T2a
>4-5cm = T2b
>5-7 cm = T3
>7 cm = T4
50
Q

M component (2018)

A

Within the thoracic = M1a
Single extrathoracic = M1b
Multiple extrathoracic = M1c

51
Q

Node invovlement

A 
N0 = no nodes
N1 = ipisilateral bronchopulmonary
N2 = Ipsilateral or subcarinal
N3 = contralateral hilar/mediatinal and ipsilateral
52
Q

Treatment for Lung CA

A

I - Cure
II - Cure
III and IV - Control of local disease and increase length of survival

53
Q

Surgical treatment

A

Wedge resection - not form small cell CA
Lobectomy - small tumors
Pneumonectomy - large tumors

54
Q

Backbone of CRx treatment

A

Cisplatin/Carboplatin

55
Q

Anti EGFR

A

Gefitiib - forst approved tyrosine kinase inhibitor

Erlotinib - 1st-3rd line tx of metastatic NSCLC

Afatinib - 2nd generation tyrosine kinase inhibitor

Ceftuximab

56
Q

ALK inhibitors

A

Crizotinib - targets EML4/ALK fusion protein
Ceritinib
Alectinib

57
Q

Bevacizumab

A

VEGF inhibitor

58
Q

Immunotherapy

A

PD-1/PD-L1 interaction

-mediates inhibition of T cell mediated tumor cell killing and inhibition of T cell activation

nivolumab, pembrolizumab

OS 213 Respiratory Exam 2 (15 decks)

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