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Pulmonary > Nichols: Lung Cancers > Flashcards

Nichols: Lung Cancers Flashcards

1
Q

In general, lung cancers are more common and fatal in what sex/race? less common less fatal?

A

black males > asians and hispanics

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2
Q

3 major types of lung cancer

A

adenocarcinoma
squamous cell
small cell

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3
Q

assc with inapproprate ADH expression

A

small cell

–> leads to hyponatremia

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4
Q

more commonly peripherial

A

adenocarinomas

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5
Q

assc with Easton-Lambert syndrome

A

small cell

*due to autoantibodies against P/Q type voltage-gated calcium channels

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6
Q

commonly causes hypercalcemia

A

squamous cell carcinomas

**due to the production of a substance resembling parathyroid hormone

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7
Q

commonly metastatic at presentation

A

small cell

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8
Q

causes post-obstructive pneumonia

A

squamous cell carcinoma

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9
Q

more commonly central

A

small cell

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10
Q

commonly causes cavitation

A

squamous cell

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11
Q

assc with cushing syndrome

A

small cell

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12
Q

more common in women, asians, and never smokers

A

adenocarcinomas

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13
Q

common symptoms assc with lung cancer

A

cough (60%) > dyspnea > weight loss, hemoptysis > chest pain > horeseness (10%)

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14
Q

common signs assc with lung cancer

A

none

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15
Q

How is lung cancer Dx?

A
  1. discover via radiology (screen 55-80 y/o with 30+ pack-years Hx)
  2. biopsy
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16
Q

What type of lung cancer is tx with sugery

A

early stage squamous and adenocarcinoma (aka non-small cell)

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17
Q

treatment for non-small cell carcinoma

A

early stages: surgery

later stages: chemo (carboplatin + docataxel)

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18
Q

drug target for mutated ALK

A

crizotinib

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19
Q

WHat is the prognosis of lung caner as a whole?

A

5 year survival of 17%

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20
Q

malignant epithelial tumor of lung with glandular features such as making glands or mucin

A

adenocarcinoma (lung primary adenocarcinoma)

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21
Q

70% of never smokers with lung cancer have

A

adenocarcinoma

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22
Q

role of filtered cigarettes in the increased of adenocarcinoma

A

filter removed large particles = increased particle deposition in small airways

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23
Q

other causes of adenocarcinoma other than cigarette smoke

A

radon gas from ground
radiation
asbestos

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24
Q

Mutation common in adenocarcinomas of never smokers

A

EGFR

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25
Q

Mutation common in adenocarcinomas of smokers

A

KRAS

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26
Q

KRAS mutation confers resistance to what drug?

A

erlotinib

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27
Q

EGFR mutations confers responsiveness to what drug?

A

gefitinib and erlotinib

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28
Q

crizotinib effectiveness requires what mutation?

A

EML4-ALK translocation fusion oncogene

*it is an ALK inhibitor

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29
Q

What mutations are seen in adenocarcinoms?

A 
EFGR
KRAS
EML4-ALK
p53
c-MET
NKX2-1
PIK3CA
BRAF
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30
Q

Tx for inoperable adenocarcinomas

A

pemetrexed

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31
Q

antifolate metabolite inhibitor of thymidylate synthetase, inhibiting the formation of precursor purine and pyrimidine nucleotides, preventing the formation of DNA and RNA

A

pemetrexed

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32
Q

anti-vascular endothelial growth factor (VEGF) monoclonal antibody

A

bevacizumab

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33
Q

What microscopic pathologies of adenocarcinoma are assc with a good prognosis?
bad?

A

good: lepidic (without invasion) = spreading within alveoli
bad: micopapillary, solid

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34
Q

Tx options for adenocarcinomas

A

erlotinib, pemetrexed, bevacizumab

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35
Q

prognosis for adenocarcinomas

A

determined by stage:
early stage live about 20 months on average
late stage about 13 months
**no KRAS = + 5 mos
**EML4-ALK translocation fusion oncogene + 5 mos

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36
Q

Describe the common pathology of adenocarcinomas

A

peripheral, subpleural, solitary, lobulated or spiculated

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37
Q

non-invasive neoplasm characterized by non-destructive growth along intact alveolar septa

A

adenocarcinoma in situ

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38
Q

involves type II pneumocytes and Clara cells

A

non-mucinous adenocarcinoma in situ

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39
Q

metaplasia of bronchilar epithelium

A

municnous adenocarcinoma in situ

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40
Q

can become mulitfocal from tumor spread via airways and the mucocilliary escalator

A

municnous adenocarcinoma in situ

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41
Q

CK20 negative and TTF-1 positive

A

non-mucinous adenocarcinoma in situ

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42
Q

KRAS + and EGFR –

A

municnous adenocarcinoma in situ

43
Q

CK20 postitive and TTF-1 negative

A

municnous adenocarcinoma in situ

44
Q

KRAS – and EGFR +

A

non-mucinous adenocarcinoma in situ

45
Q

size difference between lesions of adenocarcinoma in situ and lung primary adenocarcinoma

A

in situ: < 2 cm

primary: > 4 cm

46
Q

Tx for adenocarcinoma in situ

A

Surgical resection

Inoperable:

  • erlotinib for EGFR +
  • crizotinib for ALK+
  • paclitaxel for EGFR – (mitotic inhibitor)
47
Q

mucinous or non-mucinous adenocarcinoma in situ has a better prognosis

A

non-mucinous

48
Q

desmoplastic reaction

A

lung primary adenocarcinoma

  • occurs around glandular structures
  • *makes it very firm to palpation
49
Q

anthroacotic pigment

A

lung primary adenocarcinoma

50
Q

lepidic growth

A

adenocarcinoma in situ

= non destructive growth long intact alveolar septa

51
Q

large endobronchial mass

A

squamous cell carcinoma

52
Q

Where do squamous cell carcinomas typically arise

A

2/3 from main, lobar, or segmental

1/3 from small periph bronchi

53
Q

What tx is contraindicated in squamous cell carcinoma

A

bevacizumab bc it was assc with hemorrhaging

54
Q

Optimal Tx for squamous cell carcinoma

A

surgical resection

radiation is suboptimal

55
Q

Tx for small cell carcinoma

A

cisplatin or carboplatin + etopside + radiation

56
Q

topoisomerase inhibitor that forms a complex with DNA and the enzyme, preventing re-ligation of DNA strands, causing them to break

A

etopside

57
Q

are primary lung tumors or pulmonary mets more common

Why?

A

pulm mets

  1. receive entire RT heart blood flow with every heart beat
  2. densest capillary bed in body
  3. 1st capillary bed met by venous return from every other organ
  4. 1st capillary bed met by lymphatic drainage after being dumped into SVC by thoracic duct
  5. lots of O2!
58
Q

WHat are the primary sites of lung mets?

A 
Breast
Colon
Stomach 
Melanoma 
Prostate
Liver 
Thyroid

Little Boys Prefer To Meet Silly Cunts

59
Q

______ tend to metastasize to lungs because they tend to spread by vein (hematogenously) rather than by lymphatic channels (characteristic of ________)

A

sarcomas

carcinomas

60
Q

Lymphangitic carcinomatosis

A

metastatic disease can fill lymphatics and infiltrate interstitium without creating mass lesions

61
Q

CK7 and TTF-1 positive and CK20 and CDX2 negative

A

lung primary tumor

62
Q

CK20 and CDX2 positive and CK7 and TTF-1 negative

A

colon primary

63
Q

CK7 positive and CK20, CDX2 and TTF-1 negative

A

breast primary

64
Q

How do lung mets appear compared than primaries

A

Smaller and rounder

65
Q

Lung mets usually appear in what area of the lung

A

Lower/base

66
Q

The bigger lung mets are usually in what area of the lung

A

Lower/base

67
Q

acinar type

A

Lung primary adenocarcinoma

68
Q

Intracellular bridges

A

Squamous cell carcinoma

69
Q

Invades submucosal space

A

Small cell

70
Q

Most likelt to cause hemoptysis

A

Squamous cell carcinoma

71
Q

Keratin pearls

A

Squamous cell carcinoma

72
Q

replacing alveolar lining

A

Adenocarcinoma in situ

73
Q

Near 100% of cell in this type are p63 positive

A

Squamous cell carcinoma

74
Q

Facial, cervical, and arm edema

A

Small cell

75
Q

Usually metastaic and responsive to chemo

A

Small cell

76
Q

100% of cells in this type are p40 positive

A

Squamous cell carcinoma

77
Q

“salt and peper” nuclear chromatin

A

Small cell

78
Q

Many mitoses

A

Small cell

79
Q

Extensive necrosis

A

Small cell

80
Q

Assc with bronchiectasis

A

Squamous cell carcinoma

81
Q

Male smoker

A

Small cell > Squamous cell > adenocarcinoma

82
Q

Female smoker

A

Adenocarcinoma

83
Q

keratinization

A

Squamous cell carcinoma

84
Q

Telomerae mutation

A

Small cell

85
Q

RASSF mutations

A

Small cell

86
Q

RB1 mutation

A

Small cell

87
Q

Parabronchial (without an endobronchial mass)

A

Small cell

88
Q

Central, endobronchial, cavitiating, hemoptysis

A

Squamous cell carcinoma

89
Q

Large central tumor + extensive metastases

A

Small cell

**usually to nearby LN first

90
Q

peripheral, subpleural, solitary, lobulated or speculated lung lesion

A

adenocarcinoma

91
Q

Causes atelectasis

A

Squamous cell carcinoma

92
Q

pancytokeratin positive

A

Small cell

93
Q

Bcl-2 assc with

A

Small cell

94
Q

FHIT assc with

A

small cell

95
Q

Most likely to cause a paraneoplastic syndrome

A

Small cell

96
Q

Spiculation

A

Squamous cell carcinoma

= central hemorrhage

97
Q

Pemberton’s sign

A

Small cell

= development of facial flushing

98
Q

Most aggressive type of lung cancer

A

Small cell

99
Q

Most responsive to chemo

A

Small cell

100
Q

Neuroendocrine carcinoma

A

Small cell

101
Q

pneumonia-like area of consolidation

A

Adenocarcinoma in situ

102
Q

Smooth pick eosinophillic cytoplasm

A

Squamous cell carcinoma

103
Q

SVC syndrome

A

Small cell

104
Q

Inspiratory stridor when pts raise both arm above head

A

Small cell

Pulmonary (31 decks)

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