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Respiratory > Malignancies > Flashcards

Malignancies Flashcards

1
Q

What percent of lung cancers are found to be metastatic at the time of diagnosis?

A

56%

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2
Q

Who is typically affected with Lung CA?

A

70 yo men who smoke

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3
Q

What ethnicity is most affected with lung CA?

A

Males -blacks

Females- whites

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4
Q

What is the average age of death of lung cancer?

A

72

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5
Q

Which ethnicity is least affected by lung cancer?

A

Hispanics

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6
Q

How many genetic mutations are there with every 15 cigarettes smoked?

A

1

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7
Q

What are the genetic predispositions to developing lung cancer?

A

Chromosome fragility

CYP1A1

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8
Q

What element increases the risk for lung cancer?

A

Radon

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9
Q

What type of lung disease increases the risk for lung cancer?

A

Pulmonary fibrosis

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10
Q

What is the major prevention technique for lung cancer?

A

Smoking cessation and prevention

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11
Q

What percent of people who get diagnosed with lung cancer never smoked or in those who quit for at least a year?

A

60%

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12
Q

Which gender is more affected with lung cancer unrelated to smoking?

A

Women

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13
Q

What is the increase in lung cancer incidence with environmental smoke?

A

20-30%

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14
Q

True or false: CXRs are not reliable for diagnosing lung malignancies

A

True

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15
Q

What are the typical ssx of lung cancer, beside B symptoms?

A
  • Chest pain
  • Bone pain
  • Wheezing and stridor
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16
Q

SVC obstruction is usually pathognomonic for what?

A

Lung CA

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17
Q

If you find something on a CXR that is suspicious for a mass, what should you look for?

A

Old films

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18
Q

What is the size of nodules that are benign?

A

Less than 2 cm in size

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19
Q

What is the morphology of nodules that are most likely benign?

A

Central, concentric popcorn calcifications

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20
Q

Over what age should raise your suspicious of lung cancer if you find a mass in the lungs?

A

35

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21
Q

If a lung nodule is calcified, is this most likely benign or malignant?

A

Benign

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22
Q

What is the most common causes of nodules in CXR in Iowa?

A

Histoplasmosis

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23
Q

What is the most common cause of lung cancer?

A

Cannonball lesions (secondary metastases)

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24
Q

What percent of malignant solitary tumors of the lungs are metastatic lesions?

A

10%

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25
Q

What are the cancers that like to metastasize to the lung?

A
  • Breast
  • Colorectal
  • Prostate
  • Cervical
  • Endometrial
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26
Q

Multiple masses in the lungs suggests what source of cancer?

A

Metastatic (secondary tumors)

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27
Q

What are the three major NSCLCs?

A
  • Squamous cell CA
  • Adenocarcinoma
  • Large cell carcinoma
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28
Q

What are NSCLCs?

A

Lung cancers that arise from the respiratory epithelium

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29
Q

What is SCLC?

A

usually a centrally located neuroendocrine tumor that is associated with tobacco smoking

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30
Q

What are the histological characteristics of SCLC? (3)

A

Rosettes
Trabeculae
Palisades

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31
Q

What are the hormones that are often secreted with SCLC?

A

AVP
ACTH
GRP

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32
Q

What is the prognosis with SCLC?

A

Really Bad–early metastasizes

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33
Q

True or false: SCLC usually comes back after treatment

A

True

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34
Q

What is squamous cell lung CA?

A

Centrally located mass associated with smoking

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35
Q

What are the histological characteristics of squamous cell lung CA?

A

Keratin pearls

36
Q

What are the characteristics of the lesions with squamous cell lung CA?

A

Cavitary

37
Q

Where does squamous cell CA usually met to?

A

Hilar lymph nodes

38
Q

What is the #1 lung cancer in non-smokers?

A

Adenocarcinoma

39
Q

What is adenocarcinoma of the lung?

A

Typically a peripherally located mass

40
Q

What are the histological characteristics of adenocarcinomas of the lung?

A

Signet rings

Mucinous

41
Q

What is the prognosis of adenocarcinoma?

A

Wide mets

42
Q

What are the radiologic findings with adenocarcinoma of the lung?

A

Fluffiness and ground glass appearance

43
Q

What is large cell lung CA?

A

Peripherally located mass with poor differentiation

44
Q

What are the histological characteristics of large cell CA?

A

Sheets of cells, often with necrosis

45
Q

What are the gross findings of large cell carcinoma?

A

Cavitating mass

46
Q

What is the prognosis with large cell CA?

A

Late distant mets

47
Q

What are the classic ssx of a pancoast tumor?

A

Horner’s syndrome + brachial plexus involvement

48
Q

What are the ssx of SVC syndrome?

A
  • Head swelling
  • CNS sx
  • Increased BP in UE
49
Q

What are the ssx of horner’s syndrome?

A

miosis
ptosis
anhidrosis

50
Q

All types of paraneoplastic syndrome can cause what?

A

Dermatomyositis

51
Q

What are the metabolic findings with paraneoplastic syndrome from squamous cell carcinoma? Why? Why lab will be lower with this?

A

Hypercalcemia
Tumor produces PTHrP (parathyroid related hormone)

Low PTH since there is feedback

52
Q

What happens with paraneoplastic syndrome d/t SCLC? (3)

A
  • Cushing syndrome
  • SIADH
  • Eaton-Lambert syndrome
53
Q

What is Eaton Lambert syndrome?

A

AB against Ca channel in presynaptic channel, causing MG

54
Q

What happens with paraneoplastic syndrome with adenocarcinoma? (3)

A
  • DIC
  • Thrombophlebitis
  • Hemolytic anemia
55
Q

How do you differentiate Eaton-Lambert syndrome from MG?

A

MG will get progressively weaker

Eaton-Lambert syndrome will get progressively stronger

56
Q

What happens with paraneoplastic syndrome with large cell CA?

A

Gynecomastia

57
Q

Hematocrit levels below what value is suspicious for metastatic disease?

A

Less than 40% in women

Less than 35% in men

58
Q

What are the lab values that are suspicious of metastases? (LFTs x3, metabolic)

A

Elevated alk phos
GGT
SGOT
Ca

59
Q

What are the four most likely sites of metastases for lung cancer?

A

Liver
Brain
Bone
Adrenals

60
Q

How do you diagnose lung cancer?

A

Biopsy

61
Q

What is endobronchial ultrasound guided biopsy?

A

US guided biopsy

62
Q

What are the indications for annual low dose CT scans for lung CA? (age range, smoking history, current health)

A
  • Age 55-74
  • More than 30 pack year
  • Current smoker or quit in the last 15 years
  • In good health
63
Q

What are the components of the TMN staging of lung cancer?

A

Tumor
Node
Metastasis

64
Q

What is a T4 tumor?

A

So big that it invades other organs, or in a really bad spot

65
Q

What is the general trend of tumor staging?

A

Higher number = bigger

66
Q

What is M1a?

A

Mets to the lung or a malignant pleural effusion

67
Q

What is M1b?

A

Distant metastases

68
Q

True or false: any metastatic lesion means the cancer is stage 3

A

False- stage 4

69
Q

What is the treatment for stage I or II NSCLC?

A

Resection

Chemo/radiation

70
Q

What is the treatment for stage III NSCLC?

A

Chemoradiation

71
Q

What is the treatment for stage IV NSCLC?

A

Palliative

Chemo

72
Q

True or false: surgery is rarely indicated for small cell lung cancer. Why or why not?

A

True– so fast mets

73
Q

What is the treatment for advanced SCLC?

A

Chemo

Radiation

74
Q

What is the MOA of nivolumab? What is it used for?

A

Monoclonal ab against programmed cell death receptor to decreased NSCLC (non-squamous)

75
Q

What is the MOA of Pembrolizumab? What is it used for?

A

IgG3 Ab against PD-L1 ligand for programmed cell death receptor

Metastatic NCLC

76
Q

Does cutting back on smoking have any effect on lung cancer incidence?

A

Nah

77
Q

What is the effect of smoking on chemo?

A

Worsens side effects

78
Q

How long does it take to develop mesothelioma?

A

30+ years

79
Q

What is the risk of getting lung cancer with mesothelioma if you smoke as well?

A

x2

80
Q

What causes the pleuritic chest pain with mesothelioma?

A

Pleural thickening causes rubbing and effusion

81
Q

What is the most common benign pulmonary lung nodules?

A

hamartomas–usually composed of normal tissue

82
Q

Which gender is more often affected with benign pulmonary neoplasms?

A

Males

83
Q

If you get a histology sample of a lung mass back with a lot of necrotic tissue, what should you suspect?

A

SCLC

84
Q

What is the M staging if you cross the midline?

A

M3

85
Q

True or false: ANY metastasis with lung cancer indicates stage 4 cancer

A

True

Respiratory (34 decks)

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