Pathoma - Lung Cancer Flashcards
Most common cause of cancer mortality in the United States and when it hits
Lung Cancer, usually in your 60s
Key risk factors for Lung CA
- Cigarette smoke
- Radon
- Asbestos
What is the most dangerous part of smoking in regards to cancer?
Polycyclic Hydrocarbons - very oncogenic
“Coin Lesion” and what we do next
Solitary nodule 2 - 5cm that leads you to compare that Xray to other ones to see if there is change. Change indicates possible Lung CA, meaning biopsy next
Benign lesion examples
Granuloma - Often due to TB or a fungus
Bronchial hamartoma - Often calcified on imaging
What is a hamartoma?
Benign tumor made of tissue in that area that is just disorganized
Bronchial hamartoma made of what?
Lung tissue and cartilage
Division of cancer types within Lung CA
Small cell carcinoma (15%)
Non-small cell (85%)
Treatment for non-small cell vs. small cell
Small cell = Radiation therapy to treat
Non small cell = surgical resection that does not respond to radiation
Major subtypes of non-small cell carcinoma
Adenocarcinoma - 40%
Squamos cell carcinoma - 30%
Large cell carcinoma - 10%
Carcinoid tumor - 5%
Adenocarcinoma
Gland affected or mucous production from cancer cells
Squamos cell carcinoma
keratin involved or bridges intracellularly
What cells do we call large cell carcinomas?
Don’t see glands, mucin, keratin pearls or bridges
Small cell carcinoma characteristic histology
Poorly differentiated small cells. Arises from neuroendocrine (Kultchitsky) cells
Bronchioalveolar carinoma histology
Columnar cells that grow along preexisting bronchioles and alveoli.
Arise from Clara cells
Histology for Carcinoid tumor
Well differentiated neuroendocrine cells, chromogranin positive
Most common cancers that metastasize to the lungs
Breast and colon
Most common tumor in male smokers
Squamos cell
These two cancers are not related to smoking!
Bronchiovalveolar carcinoma
Carcinoid tumor
These carcinomas are located strictly centrally
Small Cell
Squamos cell
These carcinomas are located strictly peripherally
Bronchioloalveolar
Adenocarcinoma
These carcinomas can be located centrally or peripherally
Large Cell
Carcinoid tumor
Multiple cannon ball nodules on imaging
Metastasis to the lungs
This carcinoma has rapid growth and early metastasis. Also produces ADH or ACTH and can cause _____ _____.
Small cell carcinoma and it can cause Eaton-Lambert Syndrome which is a paraneoplastic syndrome
This cancer produces PTHrP
Squamos Cell
This may present with pneumonia-like consolidation on imaging, excellent prognosis
Bronchioloalveolar carcinoma
This cancer is chromogranin positive
Carcinoid Tumor
This cancer has well differentiated neuroendocrine cells.
Which one has poorly differentiated neuroendocrine cells?
Carcinoid tumor
Poorly = Small Cell
Discuss TNM staging
Use it when discussing lung CA
T: Size and location of the tumor
N: Spread to regional lymph Nodes
M: Unique site of distant spread is the adrenal gland
How bad is the mortality rate for lung CA and why?
Pretty bad because we are so late in finding it
15% 5 year survival
Local complications of Lung CA
- Pleural involvement
- Obstruction of SVC
- Involvement of recurrent laryngeal (hoarseness) or phrenic nerve (diaphragmatic paralysis)
- Compression of sympathetic chains (ptosis, pinpoint pupil, anhidrosis)
Most common cancer in the pleura, in non smokers, and in females
Adenocarcinoma
