Lung Tumors- Rao Flashcards
What is the most common lung tumor?
Bronchogenic carcinoma
How common is lung cancer? How deadly is it?
Most common visceral cancer in males, rising incidence in women
Most frequent fatal malignancy in both genders
How does smoking change your risk of bronchogenic carcinoma?
Smokers have a 10-fold increase
Heavy smokers have a 20-fold increase
Risk levels return to normal 10 years after quitting
How is a smoking habit quantified?
Pack-years
of packs/day * # of years
What about tobacco smoke causes cancer?
Smoke contains initiator (match) and promoters (fuse)
What are industrial hazards that can contribute to cancer risk?
Asbestos, Uranium, Radiation, Nickel, Mustard gases, etc
How does asbestos exposure change your lung cancer risk?
5-fold increase if non-smoker
50-90-fold increase if smoker
What is the most likely cause of lung cancer in non-smokers? Where would they be exposed to this?
Radon
Indoor-air pollution, some areas have naturally high levels
Which lung cancers are the following oncogene mutations associated with? c-myc K-ras EGFR EML4-ALK
c-myc-small cell carcinoma
K-ras- adenocarcinoma
EGFR- adenocarcinoma
EML4-ALK- adenocarcinoma
What is a “scar cancer”? Which came first, the scar or the cancer?
A cancer associated with a scar
variable, sometimes the scar forms in response to the cancer, sometimes it is there first
What type of cancer is typically seen in scar cancers?
usually adenocarcinoma
What is the clinical picture of a bronchogenic carcinoma?
patient is in their 50s
presents with cough, weight loss, chest pain, dyspnea
increase in sputum
What is a pancoast tumor? What are sequelae often seen with them?
Tumor at the apex of the lung
Can cause miosis, anhydrosis, and ptosis because of sympathetic ganglion interference
What are some less common problems that can be seen in lung tumors?
atelectasis- tumor blockage of brochioles
hoarseness- recurrent laryngeal nerve invasion
diaphragm paraylsis- phrenic nerve invasion
dysphagia- esophagela invasion
pericardial tamponade- pericardial invasion
SVC syndrom- impingement of superior vena cava
How are bronchogenic carcinomas grouped?
Grouped according to chemotherapy response
Small cell carcinomas
Non-small cell carcinomas
How common is squamous cell carcinoma? What does the typical patient look like?
25-40% of cancers
typical patient is male smoker
What are some physical traits of a squamous cell bronchogenic carcinoma?
Keratinized
intracellular bridges
usually central (main/lobar bronchi)
polypoid growth
What cancer are females most likely to get?
What cancer are non-smokers most likely to get?
adenocarcinoma for both
HOWEVER the typical adenocarcinoma patient is a smoker
How common is adenocarcinoma?
25-40%, most common lung cancer in the US
What does the progression of adenocarcinoma look like?
Slow-growing
Typically presents at more advanced stage
More likely to metastasize
What are the four subtypes of adenocarcinoma?
glandular
solid
papillary
bronchioloalveolar
What are the two subtypes of bronchioloalveolar adenocarcinomas? Which one has a better prognosis?
nonmucinous- affects clara cells, type 2 pneumocytes
mucinous- worse prognosis
How common is small cell carcinoma? What does the typical patient look like?
20-25% of cancers
typical patient is male, smoker with a central tumor
What does small cell carcinoma look like clinically?
presents at advanced stage (70% metastasis) extensive necrosis paraneoplastic syndrome excellent chemo response median survival is 4 months
What does large cell carcinoma look like clinically?
large, undifferentiated cells
peripheral lung cancer
poor survival (6% 5-year; >10 months)
What does an adenosquamous cancer look like clinically?
present with scar
peripheral tumor
typical patient is a smoker
Where is lung cancer most likely to metastasize?
Adrenal glands, Brain, and Liver
may metastasize to bone, hilar lymph nodes as well
What is the most important determining factor in tumor survival?
Stage at presentation, followed by type
What is paraneoplastic syndrome? What can be released?
hormone overproduction seen in 1-10% of cancers
ACTH, ADH, Serotonin, parathyroid hormone, etc
What are carcinoid tumors?
a rare (1-5%) tumor that is seen in people under 40, largely benign (low-grade malignant), with a very high survival rate
What are some symptoms of a carcinoid tumor?
Hemoptysis, cough, atelectasis
carcinois syndrome- diarrhea, flushing, cyanosis
