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Lung Tumors Flashcards

1
Q

What is the most common tumor of the lung?

A

BRONCHOGENIC CARCINOMA 90 – 95%

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2
Q

Most frequent fatal malignancy in men and women

A

Bronchogenic Carcinoma

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3
Q

How is Bronchogenic Carcinoma trending in men vs women?

A

Incidence is decreasing in men and increasing in women

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4
Q

What decades in life is bronchogenic carcinoma most common?

A

A disease of middle and late adult life, with a peak incidence in 50s or 60s

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5
Q

General factors that can lead to bronchogenic carcinoma?

A
  • Tobacco smoking
  • Industrial hazards
  • Air pollution
  • Molecular genetics
  • Scarring
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6
Q

What is a pack year?

A

A way to measure the amount a person has smoked over a long period of time. It is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked

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7
Q

Smoking tobacco: there is a statistical association between frequency of lung cancer and what smoking variables?

A
  • amount of daily smoking
  • tendency to inhale
  • duration of smoking habit
  • Other associations – lip, tongue, mouth, pharynx, larynx, esophagus, UB, pancreas, kidney cancers
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8
Q

What percentage of smokers have histological changes in their respiratory tract?

A

96.7% smokers - atypical changes in bronchial epithelium

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9
Q

What are some industrial hazards for Bronchogenic Carcinoma?

A

– Radiation – Increased incidence in Hiroshima/Nagasaki survivors
– Uranium miners – lung cancer rates higher than general population
– Asbestos – Much higher risk than general population of developing lung cancer
– Other hazards – Nickel, chromates, coal, mustard gas, arsenic, beryllium, iron

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10
Q

How can air pollution contribute to bronchogenic carcinoma?

A
  • indoor air pollution - radon exposure- ubiquitous radioactive gas can cause lung cancer in non smokers
  • Miners exposed to higher concentrations
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11
Q

What are some oncogenes that can contribute to lung cancer?

A
  • C-myc – small cell carcinoma
  • K-ras – adenocarcinoma
  • EGFR – adenocarcinoma
  • EML4-ALK - adenocarcinoma
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12
Q

What are some tumor suppressor gene mutations that could contribute to lung cancer?

A
  • p53
  • Retinoblastoma
  • ? Genes on short arm of Chromosome 3
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13
Q

Benzopyrene causes DNA damage where?

A

codons of the p53 gene

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14
Q

What evidence suggests genetic predisposition?

A

Familial clustering and variable risk among heavy smokers

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15
Q

How is scarring of the lungs associated with lung cancer?

A

– Usually adenocarcinomas
– In most cases, the scar is a response to the tumor
– Sometimes, scar precedes cancer (old infarcts, wounds, granulomatous infections)

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16
Q

What are some major presenting complaints of pt with lung cancner?

A

Cough (75%), wt loss (40%), chest pain (40%), dyspnea (20%) for an average of 7 months

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17
Q

What is a pancoast tumor?

A
  • Tumor at the extreme apex of the lung
  • Involvement of superior cervical sympathetic ganglion causes Horner’s syndrome (Ipsilateral lid lag, Miosis & Ipsilateral anhydrosis)
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18
Q

What are the two major classifications of bronchogenic carcinoma?

A

small cell carcinoma & non small cell carcinoma

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19
Q

What are the subtypes of small cell carcinoma?

A

– Oat cell (lymphocyte-like)
– Intermediate cell (polygonal)
– Combined (usually with squamous)

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20
Q

What are the major subtypes of non small cell carcinoma?

A

– Squamous cell (epidermoid) carcinoma
– Adenocarcinoma
– Large cell carcinoma
– Adenosquamous carcinoma

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21
Q

What are the subtypes of adenocarinoma?

A
  • Glandular (acinar) with mucin
  • Papillary
  • Solid
  • (Lepidic) Bronchioloalveolar
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22
Q

What are the subtypes of large cell carcinoma?

A
  • Neuroendocrine
  • Undifferentiated
  • Giant cell
  • Clear cell
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23
Q

What is classification for differentiation between small cell and non small cell lung cancer based on?

A

Based on response to chemotherapy

24
Q

Epidermal growth factor receptor (EGFR), KRAS and EML4-ALK mutations are confined to adenocarcinoma.

What chemo drugs can be used for cancers with each mutation?

A
  • EGFR Tyrosine Kinase Inhibitors - Erlotinib (Tarseeva) and Gefitinib (Iressa)
  • ALK inhibitor - Crizotinib
25
Q

Bevacuzimab – Antibody to vascular endothelial growth factor (VEGF), but what subtype of lung cancer can it cause fatal hemorrhage?

A

Squamous cell carcinoma

26
Q

What is Pemetrexed used for?

A

Activity in non-SqCC

27
Q

The most common type in of lung cancer in Males:

A

Squamous cell carcinoma

28
Q

What percentage of all lung cancer is Squamous cell carcinoma?

29
Q

Where in the lung is Squamous cell carcinoma usually located?

A

Central cavitary necrosis tumor usually arise centrally (main or lobar bronchi); usually endobronchial, polypoid growth

30
Q

What are key histology aspects of Squamous cell carcinoma?

A

keratin formation as “squamous pearls”, intercellular bridges, atypia (oval, polyhedral cells in nests) and invasion

31
Q

Most common type in women and non-smokers (however, most patients with this cancer are still smokers)

Also, Most common form of lung carcinoma in USA

A

Adenocarcinoma

32
Q

What percentage of lung cancer does Adenocarcinoma account for?

33
Q

Where and how does adenocarcinoma usually form within the lung?

A

– Usually peripheral with pleural retraction or puckering. Associated with scarring.
– Grow more slowly, metastasize more frequently than squamous cell carcinoma

34
Q

What can you see on histology with adenocarinoma?

A
  • Glandular (acinar) with mucin
  • Papillary
  • Solid (sheets or nests of solid cells)
  • (Lepidic) Bronchioloalveolar
35
Q

What is Bronchioloalveolar carcinoma?

A

A subset of adenocarcinoma which is a subtype of non-small cell carinoma

36
Q

How can Bronchioloalveolar carcinoma look grossly?

A
  • Single peripheral nodule
  • Multiple nodules (several lobes/bilateral) – multifocal/aerogenous spread
  • Diffuse pneumonia-like infiltrate
37
Q

How does Bronchioloalveolar carcinoma look on histology?

A

Lepidic spread (tumor cells spread along alveolar septa) can be Nonmucinous (Clara cells, type 2 pneumocytes) – 2/3 cases OR Mucinous (tall columnar mucinous cells) – Worse prognosis

38
Q

Small cell carcinoma accounts for what percentage of lung cancers?

39
Q

Who does small cell carcinoma usually affect?

A

Predominantly in males, smokers (almost always), central location

40
Q

Does small cell carcinoma usually metastasize?

A

Highly malignant, median survival – 4 months – with Submucosal/circumferential infiltration; rare endobronchial polypoid growth

Metastasis by the time of diagnosis; 70% patients seen at advanced stage

41
Q

How does small cell carinoma usually look on histology?

A

– Extensive necrosis, crush artifact
– Secretory granules of neuroendocrine type
– Ectopic hormone production (paraneoplastic
syndrome)

42
Q

How do you treat small cell carcinoma?

A

Excellent response to chemotherapy

43
Q

What happens in Large cell carcinoma?

A

– Pleomorphic, large cells without differentiation
– Ultrastructural evidence of glandular or squamous differentiation
– 5-year survival 6%
– Giant cell carcinoma (Highly malignant, Mostly peripheral, < 10 month survival)

44
Q

Causes 1 – 3% of lung carcinomas?

A

Adenosquamous carcinoma

45
Q

How does Adenosquamous carcinoma look?

A

Definite evidence of squamous cell carcinoma and adenocarcinoma in the same neoplasm and Peripheral tumor, associated with scar

46
Q

How does Adenosquamous carcinoma present?

A

– Clinical presentation and behavior similar to adenocarcinoma
– The majority of patients are smokers

47
Q

Where does Adenosquamous carcinoma like to metastasize?

A 
– Hilar lymph nodes
– Adrenal gland (50%)
– Liver (30%)
– Brain (20%)
– Bone
48
Q

Staging and Prognosis of Bronchogenic carcinoma?

A

Histologic type and tumor staging (TNM) are the two most important factors in determining survival and choice of therapy

49
Q

What is a paraneoplastic syndrome?

A

Symptom complexes that occur in patients with cancer that cannot be readily explained by local or distant spread; or by elaboration of hormones by tumor cells

50
Q

Why are paraneoplastic syndromes important?

A

– Earliest manifestation of occult neoplasm
– Significant clinical problems (may be lethal) occur in 1-10% of pt
– May mimic metastases and be difficult to treat

51
Q

What are each of these paraneoplastic syndromes associated with:

  • Cushing’s syndrome (ACTH)
  • Hyponatremia (inappropriate ADH secretion)
  • Carcinoid syndrome (serotonin)
  • Hypercalcemia (parathormone)
  • Myasthenic syndrome (Eaton-Lambert syndrome)
A

• Cushing’s syndrome (ACTH) – small cell carcinoma
• Hyponatremia (inappropriate ADH secretion) – small cell
carcinoma
• Carcinoid syndrome (serotonin) – small cell carcinoma
• Myasthenic syndrome (Eaton-Lambert syndrome) – small cell carcinoma

• Hypercalcemia (parathormone) – squamous cell carcinoma

52
Q

What is the overall clinical course for pt with lung cancer?

A
  • Overall outlook – poor
  • 5-year survival – 9%
  • 10% for SCC and AdenoCa
  • 3% for small cell ca.
53
Q

What is the incidence of carcinoid tumors?

A
  • 1-5% of all lung tumors
  • Most patients are <40 years of age
  • M=F
  • 20-40% are non-smokers
54
Q

How do carcinoid tumors look microscopically?

A
  • Nests/ cords/ masses
  • Uniform cells with round nuclei
  • “Salt & Pepper” chromatin
  • IHC: NSE, chromogranin, synaptophysin +
55
Q

What is the clinical course of carcinoid tumors?

A
  • Hemoptysis, cough, obstructive symptoms (due to intraluminal growth) – infections, bronchiectasis, atelactasis or emphysema.
  • Carcinoid syndrome – intermittent diarrhea, flushing and cyanosis
56
Q

What is the prognosis of carcinoid tumors?

A
  • Metastases occur rarely (1-5%)
  • Usually follow a benign course for long periods and are amenable to resection
  • 5 and 10 year survival (87%)

Respiratory (15 decks)

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