Malignancies Flashcards
What percent of lung cancers are found to be metastatic at the time of diagnosis?
56%
Who is typically affected with Lung CA?
70 yo men who smoke
What ethnicity is most affected with lung CA?
Males -blacks
Females- whites
What is the average age of death of lung cancer?
72
Which ethnicity is least affected by lung cancer?
Hispanics
How many genetic mutations are there with every 15 cigarettes smoked?
1
What are the genetic predispositions to developing lung cancer?
Chromosome fragility
CYP1A1
What element increases the risk for lung cancer?
Radon
What type of lung disease increases the risk for lung cancer?
Pulmonary fibrosis
What is the major prevention technique for lung cancer?
Smoking cessation and prevention
What percent of people who get diagnosed with lung cancer never smoked or in those who quit for at least a year?
60%
Which gender is more affected with lung cancer unrelated to smoking?
Women
What is the increase in lung cancer incidence with environmental smoke?
20-30%
True or false: CXRs are not reliable for diagnosing lung malignancies
True
What are the typical ssx of lung cancer, beside B symptoms?
- Chest pain
- Bone pain
- Wheezing and stridor
SVC obstruction is usually pathognomonic for what?
Lung CA
If you find something on a CXR that is suspicious for a mass, what should you look for?
Old films
What is the size of nodules that are benign?
Less than 2 cm in size
What is the morphology of nodules that are most likely benign?
Central, concentric popcorn calcifications
Over what age should raise your suspicious of lung cancer if you find a mass in the lungs?
35
If a lung nodule is calcified, is this most likely benign or malignant?
Benign
What is the most common causes of nodules in CXR in Iowa?
Histoplasmosis
What is the most common cause of lung cancer?
Cannonball lesions (secondary metastases)
What percent of malignant solitary tumors of the lungs are metastatic lesions?
10%
What are the cancers that like to metastasize to the lung?
- Breast
- Colorectal
- Prostate
- Cervical
- Endometrial
Multiple masses in the lungs suggests what source of cancer?
Metastatic (secondary tumors)
What are the three major NSCLCs?
- Squamous cell CA
- Adenocarcinoma
- Large cell carcinoma
What are NSCLCs?
Lung cancers that arise from the respiratory epithelium
What is SCLC?
usually a centrally located neuroendocrine tumor that is associated with tobacco smoking
What are the histological characteristics of SCLC? (3)
Rosettes
Trabeculae
Palisades
What are the hormones that are often secreted with SCLC?
AVP
ACTH
GRP
What is the prognosis with SCLC?
Really Bad–early metastasizes
True or false: SCLC usually comes back after treatment
True
What is squamous cell lung CA?
Centrally located mass associated with smoking
What are the histological characteristics of squamous cell lung CA?
Keratin pearls
What are the characteristics of the lesions with squamous cell lung CA?
Cavitary
Where does squamous cell CA usually met to?
Hilar lymph nodes
What is the #1 lung cancer in non-smokers?
Adenocarcinoma
What is adenocarcinoma of the lung?
Typically a peripherally located mass
What are the histological characteristics of adenocarcinomas of the lung?
Signet rings
Mucinous
What is the prognosis of adenocarcinoma?
Wide mets
What are the radiologic findings with adenocarcinoma of the lung?
Fluffiness and ground glass appearance
What is large cell lung CA?
Peripherally located mass with poor differentiation
What are the histological characteristics of large cell CA?
Sheets of cells, often with necrosis
What are the gross findings of large cell carcinoma?
Cavitating mass
What is the prognosis with large cell CA?
Late distant mets
What are the classic ssx of a pancoast tumor?
Horner’s syndrome + brachial plexus involvement
What are the ssx of SVC syndrome?
- Head swelling
- CNS sx
- Increased BP in UE
What are the ssx of horner’s syndrome?
miosis
ptosis
anhidrosis
All types of paraneoplastic syndrome can cause what?
Dermatomyositis
What are the metabolic findings with paraneoplastic syndrome from squamous cell carcinoma? Why? Why lab will be lower with this?
Hypercalcemia
Tumor produces PTHrP (parathyroid related hormone)
Low PTH since there is feedback
What happens with paraneoplastic syndrome d/t SCLC? (3)
- Cushing syndrome
- SIADH
- Eaton-Lambert syndrome
What is Eaton Lambert syndrome?
AB against Ca channel in presynaptic channel, causing MG
What happens with paraneoplastic syndrome with adenocarcinoma? (3)
- DIC
- Thrombophlebitis
- Hemolytic anemia
How do you differentiate Eaton-Lambert syndrome from MG?
MG will get progressively weaker
Eaton-Lambert syndrome will get progressively stronger
What happens with paraneoplastic syndrome with large cell CA?
Gynecomastia
Hematocrit levels below what value is suspicious for metastatic disease?
Less than 40% in women
Less than 35% in men
What are the lab values that are suspicious of metastases? (LFTs x3, metabolic)
Elevated alk phos
GGT
SGOT
Ca
What are the four most likely sites of metastases for lung cancer?
Liver
Brain
Bone
Adrenals
How do you diagnose lung cancer?
Biopsy
What is endobronchial ultrasound guided biopsy?
US guided biopsy
What are the indications for annual low dose CT scans for lung CA? (age range, smoking history, current health)
- Age 55-74
- More than 30 pack year
- Current smoker or quit in the last 15 years
- In good health
What are the components of the TMN staging of lung cancer?
Tumor
Node
Metastasis
What is a T4 tumor?
So big that it invades other organs, or in a really bad spot
What is the general trend of tumor staging?
Higher number = bigger
What is M1a?
Mets to the lung or a malignant pleural effusion
What is M1b?
Distant metastases
True or false: any metastatic lesion means the cancer is stage 3
False- stage 4
What is the treatment for stage I or II NSCLC?
Resection
Chemo/radiation
What is the treatment for stage III NSCLC?
Chemoradiation
What is the treatment for stage IV NSCLC?
Palliative
Chemo
True or false: surgery is rarely indicated for small cell lung cancer. Why or why not?
True– so fast mets
What is the treatment for advanced SCLC?
Chemo
Radiation
What is the MOA of nivolumab? What is it used for?
Monoclonal ab against programmed cell death receptor to decreased NSCLC (non-squamous)
What is the MOA of Pembrolizumab? What is it used for?
IgG3 Ab against PD-L1 ligand for programmed cell death receptor
Metastatic NCLC
Does cutting back on smoking have any effect on lung cancer incidence?
Nah
What is the effect of smoking on chemo?
Worsens side effects
How long does it take to develop mesothelioma?
30+ years
What is the risk of getting lung cancer with mesothelioma if you smoke as well?
x2
What causes the pleuritic chest pain with mesothelioma?
Pleural thickening causes rubbing and effusion
What is the most common benign pulmonary lung nodules?
hamartomas–usually composed of normal tissue
Which gender is more often affected with benign pulmonary neoplasms?
Males
If you get a histology sample of a lung mass back with a lot of necrotic tissue, what should you suspect?
SCLC
What is the M staging if you cross the midline?
M3
True or false: ANY metastasis with lung cancer indicates stage 4 cancer
True
