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Respi LE3 > Lung tumor and pleural effusions > Flashcards

Lung tumor and pleural effusions Flashcards

1
Q

What is the most common cause of cancer mortality worldwide?

A

Lung cancer is the most common cause of cancer mortality worldwide.

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2
Q

At what age is lung cancer most commonly diagnosed?

A

Lung cancer is most often diagnosed between the ages of 40 and 70, with a peak in the 50s and 60s.

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3
Q

What is the major presenting symptom in lung cancer patients?

A

Cough is the major presenting symptom, affecting 75% of patients.

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4
Q

What percentage of lung cancer cases occur in active or former smokers?

A

80% of lung cancers occur in active smokers or those who recently quit.

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5
Q

What is the relationship between smoking and lung cancer risk?

A

There is a direct correlation between the frequency, duration, and intensity of smoking and lung cancer risk.

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6
Q

How much more likely are smokers exposed to asbestos to develop lung cancer?

A

Smokers exposed to asbestos have a 50-90 times greater risk than nonsmokers.

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7
Q

What is the role of secondhand smoke in lung cancer?

A

Secondhand smoke contains carcinogens and has no safe level of exposure.

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8
Q

What industrial hazard is strongly linked to lung cancer in miners?

A

Uranium exposure increases the risk of lung cancer, especially in miners.

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9
Q

Which radioactive gas is a contributor to lung cancer risk?

A

Radon is a radioactive gas found in homes that contributes to lung cancer risk.

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10
Q

Name a key oncogene implicated in lung cancer development.

A

EGFR (Epidermal Growth Factor Receptor) is a key oncogene implicated in lung cancer.

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11
Q

What type of lung cancer is most common in women and nonsmokers?

A

Adenocarcinoma is the most common type in women and nonsmokers.

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12
Q

Which lung cancer subtype is most strongly associated with smoking?

A

Squamous cell carcinoma (SCC) is strongly associated with smoking.

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13
Q

What mutation is frequently found in squamous cell carcinoma of the lung?

A

p53 mutations are frequently found in squamous cell carcinoma.

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14
Q

What is the main histological characteristic of small cell carcinoma?

A

small cells with scant cytoplasm and finely granular chromatin

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15
Q

Which lung cancer subtype is highly sensitive to chemotherapy?

A

Small cell carcinoma (SCLC) is highly sensitive to chemotherapy.

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16
Q

What syndrome is associated with small cell lung cancer?

A

Paraneoplastic syndromes such as Cushing syndrome are associated with SCLC.

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17
Q

What is the prognosis for small cell lung cancer?

A

The prognosis for SCLC is poor, with a median survival of around 10 months.

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18
Q

What is the common treatment for non-small cell lung cancer?

A

Surgery (lobectomy or pneumonectomy) is common for localized non-small cell lung cancer (NSCLC).

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19
Q

What therapy can improve survival in patients with adenocarcinoma of the lung?

A

Tyrosine kinase inhibitors can improve survival in adenocarcinoma patients with EGFR mutations.

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20
Q

What is the primary cause of pleural effusion?

A

Pleural effusion is most commonly caused by infections or inflammation of the underlying lung.

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21
Q

What condition is characterized by a bloody pleural effusion?

A

Hemorrhagic pleuritis is characterized by bloody pleural effusion.

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22
Q

What is hydrothorax and its common cause?

A

Hydrothorax is a serous effusion, commonly caused by heart failure.

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23
Q

What is a chylothorax and how is it typically caused?

A

Chylothorax is an effusion of milky lymphatic fluid, often caused by thoracic duct obstruction or trauma.

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24
Q

What is the difference between spontaneous and traumatic pneumothorax?

A

Spontaneous pneumothorax occurs without any apparent cause, while traumatic pneumothorax is caused by injury to the chest wall.

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25
Q

What is a tension pneumothorax?

A

Tension pneumothorax - air enters the pleural space but cannot escape, increasing pressure on the heart and lungs.

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26
Q

What is the most common site for metastasis from other cancer?

A

The lungs are a common site for metastasis from cancers originating elsewhere in the body.

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27
Q

What is malignant mesothelioma and what is it associated with?

A

Malignant mesothelioma is a rare cancer of the pleura, strongly associated with asbestos exposure.

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28
Q

How long is the latent period for malignant mesothelioma after asbestos exposure?

A

The latent period for malignant mesothelioma is 25 to 45 years.

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29
Q

What is the prognosis for malignant mesothelioma?

A

The prognosis for malignant mesothelioma is poor, with a median survival of less than two years.

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30
Q

Pulmonary hamartomas are considered clonal neoplasms due to the presence of which chromosomal aberrations?

A

6p21 or 12q14-q15

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31
Q

What is the most common lung tumor in never-smokers?

A

Adenocarcinoma is the most common lung tumor in never-smokers.

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32
Q

What are the common clinical manifestations of lung cancer?

A

Cough, chest pain, weight loss, and dyspnea are common clinical manifestations of lung cancer.

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33
Q

What is the role of EGFR mutations in lung cancer treatment?

A

EGFR mutations can guide treatment with tyrosine kinase inhibitors to improve survival.

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34
Q

What is the typical histological appearance of adenocarcinoma of the lung?

A

glandular differentiation
mucin production

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35
Q

What is the most common paraneoplastic syndrome associated with small cell lung cancer?

A

Hyponatremia due to inappropriate ADH secretion is the most common paraneoplastic syndrome in SCLC.

36
Q

What is the characteristic feature of a pulmonary hamartoma?

A

Pulmonary hamartoma is a benign lesion composed of disorganized lung tissue.

37
Q

How is a pulmonary hamartoma typically detected?

A

Pulmonary hamartoma is often detected incidentally on a chest x-ray as a “coin lesion.”

38
Q

What is the primary treatment for advanced non-small cell lung cancer?

A

Chemotherapy, radiation therapy, and targeted therapies are used for advanced non-small cell lung cancer.

39
Q

What mutation is associated with resistance to EGFR inhibitors in lung cancer?

A

KRAS mutations are associated with resistance to EGFR inhibitors.

40
Q

Which lung cancer subtype has a high frequency of p53 mutations?

A

Squamous cell carcinoma has the highest frequency of p53 mutations.

41
Q

What is a key feature of large cell carcinoma in the lung?

A

Large cell carcinoma is an undifferentiated tumor with large cells and prominent nucleoli.

42
Q

What type of lung cancer arises from neuroendocrine cells?

A

Small cell carcinoma arises from neuroendocrine cells in the bronchial epithelium.

43
Q

What is the treatment for early-stage non-small cell lung cancer?

A

Surgery is the treatment for early-stage non-small cell lung cancer.

44
Q

How does smoking affect the risk of lung cancer in nonsmokers?

A

Smoking significantly increases the risk of lung cancer, even in nonsmokers who are exposed to secondhand smoke.

45
Q

What is the most common histological subtype of lung cancer in men?

A

Squamous cell carcinoma is more common in men than in women.

46
Q

low-grade malignant neuroendocrine tumors

A

Carcinoid tumor

47
Q

What is the survival rate for typical carcinoid tumors?

A

The 5-year survival rate for typical carcinoid tumors is about 95%.

48
Q

What is the most common complication of lung cancer metastasis?

A

Pleural effusion is a common complication of lung cancer metastasis.

49
Q

What is the treatment for empyema caused by lung cancer?

A

Empyema is treated with drainage and antibiotics.

50
Q

What is the primary risk factor for mesothelioma?

A

Asbestos exposure is the primary risk factor for mesothelioma.

51
Q

What condition is commonly associated with hemorrhagic pleuritis?

A

Trauma, malignancy, and bleeding disorders are commonly associated with hemorrhagic pleuritis.

52
Q

What is the role of immunotherapy in lung cancer treatment?

A

Immunotherapy using checkpoint inhibitors shows promise in treating both adenocarcinoma and squamous cell carcinoma.

53
Q

How does a tumor cause superior vena cava syndrome in lung cancer?

A

Tumor invasion into surrounding structures, such as the superior vena cava, can lead to superior vena cava syndrome.

54
Q

What is the most common site for distant metastasis in small cell lung cancer?

A

The brain is a common site for distant metastasis in small cell lung cancer.

55
Q

What is the role of surgery in treating non-small cell lung cancer?

A

Surgery is an option for early-stage non-small cell lung cancer, especially for adenocarcinoma and squamous cell carcinoma.

56
Q

What is the relationship between lung cancer and weight loss?

A

Weight loss is a common presenting symptom, affecting about 40% of lung cancer patients.

57
Q

What is a common complication of pleural effusion from lung cancer?

A

Pneumonia or lobar collapse due to airway obstruction is a common complication.

58
Q

What is the statistical correlation between smoking and lung cancer development?

A

Approximately 80% of lung cancers occur in active smokers or those who recently quit. There is a strong statistical association between the frequency of lung cancer and the amount of daily smoking tendency to inhale and the duration of the smoking habit.

59
Q

What are the three main categories of lung cancer based on histology?

A

The three main categories of lung cancer based on histology are adenocarcinoma squamous cell carcinoma and small cell carcinoma. These are further classified as non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC).

60
Q

What are two key distinguishing features of adenocarcinoma in situ?

A

Adenocarcinoma in situ is characterized by being less than 3 cm in size and composed entirely of dysplastic cells growing along pre-existing alveolar septa without basement membrane invasion.

61
Q

Describe the typical gross morphology of a squamous cell carcinoma.

A

gray-white firm to hard mass arising centrally from the bronchi.

It may demonstrate areas of hemorrhage or necrosis and necrotic foci can cavitate.

62
Q

What are two neuroendocrine markers that can help differentiate small cell lung carcinoma?

A

chromogranin and synaptophysin.

These markers indicate the presence of neurosecretory granules within the tumor cells.

63
Q

What are the differences in metastasis and chemotherapy response between small cell and non-small cell lung carcinoma?

A

Small cell lung carcinoma almost always metastasizes early and shows a high initial response to chemotherapy. Conversely non-small cell lung carcinoma is less prone to early metastasis and is less responsive to chemotherapy.

64
Q

What are two common local effects of lung tumor spread and their underlying pathologic basis?

A

Two common local effects of lung tumor spread are pneumonia/abscess and pleural effusion. Pneumonia or abscess formation arises from tumor obstruction of the airway while pleural effusion is caused by tumor spread into the pleural space.

65
Q

List three hormones or hormone-like factors elaborated by lung cancers and their associated paraneoplastic syndromes.

A

Three hormones/hormone-like factors elaborated by lung cancers include: (1) Antidiuretic hormone (ADH) leading to hyponatremia; (2) Adrenocorticotropic hormone (ACTH) causing Cushing syndrome; (3) Parathyroid hormone-related peptide (PTHrP) leading to hypercalcemia.

66
Q

Differentiate inflammatory and non-inflammatory pleural effusions providing an example of each.

A

Inflammatory pleural effusions result from increased vascular permeability due to inflammation such as in pneumonia. Non-inflammatory pleural effusions arise from factors like increased hydrostatic pressure as seen in congestive heart failure.

67
Q

What is the primary risk factor for malignant mesothelioma and what cell type does it originate from?

A

Heavy asbestos exposure is the primary risk factor for malignant mesothelioma which originates from mesothelial cells lining the pleura.

68
Q

What are the four main histological classifications of lung carcinoma?

A

The sources list the four main types as adenocarcinoma squamous cell carcinoma small cell carcinoma and large cell carcinoma.

69
Q

Which histological type of lung carcinoma is most strongly associated with smoking?

A

Small cell carcinoma and squamous cell carcinoma are most strongly associated with smoking.

70
Q

Describe the histological features that distinguish adenocarcinoma from squamous cell carcinoma.

A

Adenocarcinoma - glands and mucin production.

Squamous cell carcinoma- keratinization intercellular bridges and a sheet-like growth pattern.

71
Q

What are the precursor lesions for adenocarcinoma and squamous cell carcinoma?

A

atypical adenomatous hyperplasia which progresses to adenocarcinoma in situ.

Squamous cell carcinoma arises from squamous metaplasia or dysplasia which progresses to carcinoma in situ.

72
Q

How does the prognosis of small cell carcinoma differ from that of non-small cell carcinoma?

A

Small cell carcinoma has a much poorer prognosis than non-small cell carcinoma. This is because small cell carcinoma is more aggressive and tends to metastasize widely before diagnosis.

73
Q

List three local effects of lung tumor spread and their corresponding pathological basis.

A

Pneumonia abscess lobar collapse: These are caused by tumor obstruction of the airway.

Lipoid pneumonia: This is caused by tumor obstruction which leads to the accumulation of cellular lipids in foamy macrophages.

Pleural effusion: This is caused by tumor spread into the pleura.

74
Q

What are paraneoplastic syndromes? Name three hormones or hormone-like factors that may be elaborated by lung cancer cells and describe the associated syndromes.

A

Paraneoplastic syndromes are symptom complexes that occur in individuals with cancer but cannot be explained by the local or distant spread of the tumor.

Antidiuretic hormone (ADH): This can induce hyponatremia due to inappropriate ADH secretion.

Adrenocorticotropic hormone (ACTH): This can produce Cushing syndrome.

Parathormone parathyroid hormone-related peptide prostaglandin E and some cytokines: These are implicated in the hypercalcemia often seen with lung cancer.

75
Q

Compare and contrast typical and atypical carcinoid tumors.

A

Both typical and atypical carcinoids are low-grade malignant epithelial neoplasms. Typical carcinoids have fewer than two mitoses per 10 high-power fields and lack necrosis. Atypical carcinoids have between two and 10 mitoses per 10 high-power fields and/or foci of necrosis. Atypical carcinoids also show increased pleomorphism have more prominent nucleoli and are more likely to grow in a disorganized fashion and invade lymphatics.

76
Q

What are the different types of pleural effusion and what are their causes?

A

Inflammatory:
Serous or serofibrinous pleuritis: causes are inflammatory diseases within the lungs such as tuberculosis pneumonia lung infarcts lung abscesses and bronchiectasis.

Empyema: This is a purulent pleural exudate that results from bacterial or mycotic seeding of the pleural space.

Hemorrhagic pleuritis: This is characterized by sanguineous inflammatory exudates and is most often associated with hemorrhagic diatheses rickettsial infections and neoplastic involvement of the pleural cavity.

Non-inflammatory:
Hydrothorax: This is a non-inflammatory collection of serous fluid within the pleural cavities. The most common cause is heart failure.

Hemothorax: This refers to blood in the pleural cavity.

Chylothorax: This is an accumulation of milky fluid usually of lymphatic origin in the pleural cavity.

77
Q

What is pneumothorax and what are the different types?

A

Pneumothorax is the presence of air or gas in the pleural cavities. It can be:

Spontaneous: This may complicate any form of pulmonary disease that causes rupture of an alveolus.

Traumatic: This is caused by a perforating injury to the chest wall.

Therapeutic: This is intentionally induced for medical purposes.

78
Q

What is the role of asbestos in the development of malignant mesothelioma?

A

Malignant mesothelioma is strongly associated with asbestos exposure. Asbestos fibers can become lodged in the pleura and cause chronic inflammation which can eventually lead to the development of this cancer.

79
Q

Describe the gross and microscopic morphology of malignant mesothelioma.

A

Malignant mesothelioma is a diffuse lesion that spreads widely in the pleural space. It is usually associated with extensive pleural effusion and direct invasion of thoracic structures. Microscopically it can be classified into three types: epithelioid sarcomatoid and biphasic.

80
Q

What are the markers for adenocarcinoma and mesothelioma?

A

TTF-1 is a marker for adenocarcinoma
calretinin is a marker for mesothelioma.

81
Q

What is the marker for adenocarcinoma?

A

TTF-1 (Thyroid Transcription Factor 1)

82
Q

What are the markers for squamous cell carcinoma?

A

p53 protein overexpression

83
Q

What markers are seen in small cell carcinoma?

A

Chromogranin

84
Q

What can be observed in small cell carcinoma via electron microscopy?

A

Dense-core neurosecretory granules

85
Q

What markers are associated with solitary fibrous tumor?

A

CD34

86
Q

What markers help diagnose malignant mesothelioma?

A

Keratin proteins

87
Q

How is large cell carcinoma diagnosed?

A

By exclusion; it lacks specific markers

Respi LE3 (9 decks)

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