Lung tumors Flashcards

1
Q

Tumors of the lung

A

Bronchogenic carcinoma: 90-95% originate in the brochial (or bronchiolar) epithelium

Carcinoids- 5%
Other tumors: 2-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bronchogenic carcinoma, epidemiology

A

Most common cancer in the world, incidence is decreasing in men and increasing in women, 1/3 of cancer deaths in males >females, dramatic increase in women due to cigarette smoking
Lung cancer has surpaassed breast cancer as a cause of death in women
most frequent fatal malignancy in men and women

A disease of the middle life, <2% in people below 40

Tobacco smoking, industrial hazards, air pollution, molecular genetics, scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bronchogenic carcinoma etiology and pathogenesis

A

Tobacco smoking,
Amount of daily smoking: smokers at 10x risk, heavy smoker at 20x greater risk, done smoke for 10 yrs back down to normal

Tendency to inhale, duration of smoking habit, duration of smoking habit. Pack year: a way to measure the amount a person has smoked over a long period of time, Multiply the number of packs per day by the mumber of years they smoke, 97% of smokers have atypical bronchial epithelium

Carcinogens: initiatiors and promotersm radioactive elements, contqminants, mice had skin tumors

Industrial hazards: radiation, uranium miners, asbestos without smoking 5x risk, asbestos w/ smoking 90x risk

Air pollution (radan)

Molecular genetics: C-myc (small cell carcinoma), K ras, EGFR, EML4 ALK- adenocarcinoma

Tumor suppressor genes: p53, RB, p16

Benzopyrene causes DNA damage at the same codons of the p53 gene, familial clustering and variable risk among heavy smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Scarring in bronchogeninc carcinoma

A

scar cancers- cancers occurring in the vicinity of pulmonary scars, usually adenocarcinomas, in most cases, the scar is a response to the tumor, sometimes scar precedes cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

bronchogenic carcinoma clinical course and fearures

A

Usually present in their 50s, average duration of symptoms 7 months, major presenting complaints (cough, wt loss chest pain, dyspnea, increased sputum production (CYTOLOGY), may be diagnosed upon secondary spreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

pancoast tumor

A

tumor at the extreme apex of the lung, involvement of superior cervical sympathetic ganglion, Horners syndrome, ipsilateral lid lag, miosis, anhydrosis, (ptosis miosis and anhydrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bronchogenic carcinoma classification

A

Small cell carcinoma: oat cell (lymphocyte like), intermediate cell (polygonal), combined (usually with squamous)

Non small cell carcinoma: Squamous cell carcinoma, adenocarcinoma (glandular- acinar, with mucin), papillary, solid, lepidic bronchioloalveolar, Adenosquamous carcinoma

Large cell carcinoma: neuroendocrine, undifferentiated, giant cell, clear cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bronchogenic carcinoma classification based on chemotherapy response

A

Small cell carcinoma: senstitive to chemotherapy, surgery ineffective

Non small cell carcinoma: NSCLC subclassification used to not be important because of similar treatment strategy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Broncogenic carcinoma subtyping

A

Epidermal growth factor receptor (EGFR), KRAS, and ELM4-ALK mutations: confined to ADENOCARCINOMA, predictive of response (EGFR) and resistance (KRAAS), - erlotinib and gefitinib, ALK inhibitor (Crizotinib)

Bevacuzimab: Ab to VEGF, toxicity in SqCC (hemorrhage)
Pemetrexed: activity in non sqCc

Pembrolizumab: activity in non small cell carcinoma that express PDL1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Bronchogenic carcinoma: squamous cell carcinoma

A

the most common type in males, cigarette smoker, central cavitry necrosis, usually arise centrally (main or lobar bronchi) usually endobronchial, polypoid growth

Histology: Keratin formation, intercellular bridges, cellular atypia, invasion, differentiated subtypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adenocarcinoma- bronchogenic carcinoma

A

Most common type in women and non smokers (most patients with adenocarcinoma are smokers)

Most common form of lung cancer in USA

usually peripheral with pleural retraction or puckering, has scarring, grows slow and mets more frequently, often asymptomatic

Malignant epithelial tumor with glandular differentiation or mucin production

Histologic pattern: glandular (acinar with mucin), papillary, solid, lepidic (bronchioloalveolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

bronchioloalveolar carcinoma

A

a subset of adenocarcinoma
1-9% of all lung carcinomas
gross- single peripheral nodule, multiple nodules (several lobes/bilateral)- multifocal/aerogenous spread, diffuse pneumonia-like infiltrate

Histology: lepidic spread (tumor cells spread along alveolar septa), nonmucinous (clara cells, type 2 pneumocytes- 2/3 cases), mucinous tall columnar mucinous cells worse prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bronchogenic carcinoma: small cell carcinoma

A

20-25%, predominantly in males, high association with smokers, central location, highly malignant, median survival (4months)
Submucosal/cirumferential infiltration; rare endobronchial polypod growth
Subclassification: oat cell, intermediate cel, mixed (small/large cell) combined (small cell/adeno or awuamous)

Extensive necrosis, crush artifact, secretory granules of neuroendocrine type, IHC neuroendocrine markers (synaptophysin, chromogranin, CD56

Mets by the time of diagnosis; 70% pts seen at advanced stage
Ectoopic hormone production (paraneoplastic syndrome)
Responds to chemoradiation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bronchogenic carcinoma: large cell and giant cell

A

Large cell carcinoma, undifferentiated: pleomorphic, large cells without differentiation, may show ultrastructural evidenct of glandular or quamous differentiation, 5 yr survival 6%

Giant cell carcinoma: highly malignant, mostly peripheral, <10 month survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adenosquamous carcinoma

A

1-3% of lung carcinomas, definite evidence of squamous and adeno in the same neoplasm

Peripheral tumor, associated with scar,
Clinical presentation and behavior simlar to adenocarcinoma, majority of pts smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bronchogenic carcinoma spread

A

To hilar lymph nodes, adrenal glands (50%), liver (30%), brain 20%, bone

Distant mets more common with adenocarcinoma or small cell carcinoma

Staging and prognosis: histologic type and tumor staging are the 2 most important factors determining survival and choice of therapy

TNM classification: AJCC, single most important prognostic parameter in non small cell carcinoma, small cell carcinoma (limited disease (hemithorax w/ or w/o LN involvement
Extensice disease Contralateral lung , distant mets

17
Q

Paraneoplastic syndromes

A

Symptom complexes that occur in pts with cancer involving non metastatic systemic effects

Often due to elaboration of hormone or hormone like factors

May be earliest manifestation of occult neoplasm, significat clinical problems, may mimic mets and be difficult to treat

ACTH cushing: small cell carcinoma, Hyponatremia (inappropriate ADH secretion: small cell, Carcinoid sydrome/serotonin- small cell carcinoma, hypercalcemia: parathormone- sq Cell carcinoma, Mysathenic syndrom (eaton- lambert syndrom)- small cell carcinoma

Overall outlook- poor, 5 yr survival 9%

18
Q

carcinoid tumors

A

Low grade malignant neoplasm sof neuroendocrine differentiation
1-5% of all lung tumors

Most pts are <40 yrs of age

M=F

2–40% are non smokers

Nests/cords, masses, uniform cells with round nuclei, salt and pepper chromatin, immunohistochemistry (NSE, chromogranin and synaptophysin)

19
Q

Carcinoidtumors: Clinical course and prognosis

A

hemoptysis, cough obstructive symptoms due to intraluminal growth, infections bronchiectasis, atelectasis, emphysema,

Carcinoid syndromeL diarrhea, flushing cyanosis
Mets occur rarely

5 and 10 year survival 87%