Lung Tumours 🦋

Question 1

Most lung tumors are

Answer 1

Carcinomas (95%)

Question 2

When do carcinomas occur more often

Answer 2

Between 40-70 yrs

Question 3

What’s the peak incidence for carcinomas

Answer 3

50-60 yrs

Question 4

What’s the survival rate for carcinomas

Answer 4

5 yr survival rate (5-10%)

Question 5

What is the etiology and pathogenesis of lung tumors

Answer 5

There is accumulation of genetic abnormalities that transform benign epithelium to neoplastic tissue as well as environmental factors (tobacco smoke)

Question 6

What is the statistical data on tobacco smoke

Answer 6

• 87% carcinomas occur in active smokers or those who recently stopped
• avg smokers have x10 increased risk of acquiring lung cancer than non smokers
• heavy smokers increase their risk by x60
• there is an association with cancer of mouth, larynx,pharynx,esophagus,pancreas,cervix,kidney,bladder

Question 7

What is the clinical data on tobacco smoke

Answer 7

• the sequential changes in the respiratory epithelium
• there is linear correlation between extent of exposure and worrisome epithelial changes ie squamous metaplasia-dysplasia-in situation-invasive carcinoma

Question 8

What are causes of lung cancer

Answer 8

• tobacco smoke
• industrial hazards (high dose ionizing radiation, asbestos)
• air pollution ( ie indoor air pollution such as radon)
• molecular genetics

Question 9

What are the 2 main categories of lung tumors

Answer 9

• small cell carcinoma

- non-small carcinoma

Question 10

What are the subdivisions of non-small carcinoma

Answer 10

• squamous cell CA (25-40%)
• adenocarcinoma (25-40%)
• large cell CA (10-15%)

Question 11

What lung cancer is most common in women and non-smokers

Answer 11

Adenocarcinoma because of increase in number of women smokers

Question 12

What’s the problem with cigarettes that have to be inhaled more deeply, like those with a filter or low nicotine

Answer 12

Because it exposes more peripheral airways and cells to carcinogens

Question 13

Which cancer is more metastatic and has a high initial response to chemotherapy

Answer 13

Small cell carcinoma

Question 14

Which cancer is less metastatic and less responsive to chemotherapy

Answer 14

Non-small cell carcinoma

Question 15

Which cancers have a strong correlation to smoking

Answer 15

• small cell carcinoma

- squamous cell carcinoma

Question 16

Which cancer arises more often in/near the hilum, centrally in the lung or from the 1st-3rd bronchi

Answer 16

• small cell carcinoma

- squamous cell carcinoma

Question 17

Which cancer arises in the periphery of the lung ie alveolar septa or near terminal bronchioles (acinar)

Answer 17

Adenocarcinoma

Question 18

How does squamous cell carcinoma appear

Answer 18

It’s gray-white and firm to hard

Question 19

Where does squamous cell CA metastasize

Answer 19

Outside of the thorax late in its development

Question 20

Squamous cell CA is often found in what gender

Answer 20

Men

Question 21

How does adenocarcinoma appear

Answer 21

Can differentiate into glandular structure and produce mucin

Question 22

What is the most aggressive,highly malignant lung tumor that can metastasize widely

Answer 22

Small cell CA

Question 23

What are the local effects of lung tumor spread

Answer 23

• pneumonia,abscess,lobar collapse (from tumor obstruction of airway)
• lipid pneumonia (from tumor obstruction )
• pleural effusion (from tumor spread into pleura)
• hoarseness (from recurrent laryngeal nerve invasion)
• dysphagia (from esophageal invasion)
• diaphragm paralysis (from phrenic nerve invasion)
• rib destruction ( from chest wall invasion)
• SVC syndrome (from SVC compression by tumor)
• Horner syndrome (from sympathetic ganglia invasion)
• pericarditis, tamponade (from pericardial involvement )

Question 24

What hormones does the small cell CA secrete that cause paraneoplastic syndromes

Answer 24

• it releases adrenocorticotropic hormone which causes the increased production and release of cortisol from the adrenal cortex resulting in atypical Cushing syndrome with facial edema and cachexia and hypokalemic alkalosis
• it also releases ADH which cause the kidney to retain more water resulting in edema, high blood pressure and hyponatremia

Question 25

What hormones does the squamous cell Ca secrete that cause paraneoplastic syndrome

Answer 25

-it releases parathyroid hormone which causes the release of calcium by bones into the blood resulting in hypercalcemia, lethargy,abdominal pain, constipation

Question 26

What hormone can be released by squamous cell CA, small cell CA or adenocarcinoma and cause a paraneoplastic syndrome

Answer 26

Gonadotrophic substances can be releases which cause testicular atrophy and gynecomastia (man boobs)

Question 27

What tumors can form a pancoast tumor (apical lung Ca)

Answer 27

Adenocarcinoma and squamous cell CA

Question 28

What damage can a pancoast tumor cause

Answer 28

• It invades/ compresses on the thoracic inlet,brachial plexus and cervical sympathetic nerves which can lead to Horner syndrome (enophthalmos, ptosis,mitosis,anhydrosis-where you can’t sweat)
• Can cause severe pain in ulnar nerve (pancoast syndrome)

Question 29

What is a pleural tumor

Answer 29

• it’s a tumor that produces serous fluid
• it’s normally a result of metastasis
• it arises from primary CA of lungs, breast,ovary

Question 30

What is malignant mesothelioma

Answer 30

• it arises from pleura
• it is asbestos related
• it has a long latent period (25-50yrs)
• it covers lung, invades thoracic cavity and structures ie pericardium ,infiltrates interlobar fissure

Question 31

What are the symptoms of malignant mesothelioma

Answer 31

• chest pain
• dyspnea
• recurrent pleural effusions