Pathoma - Lung Cancer

Question 1

What are the key risk factors for lung cancer?

Answer 1

1. Cigarette smoke (85%) - polycyclic aromatic hydrocarbons
2. Radon (uranium)
3. Asbestos

Question 2

What is the average age of presentation for lung cancer?

Answer 2

60 yoa

Question 3

What is the typically presentation of lung cancer?

Answer 3

• Symptoms are nonspecific (cough, weight loss, hemoptysis, pneumonia)
• Imaging often reveals a solitary nodule (“coin lesion”)
• Biopsy is necessary for diagnosis of cancer

Question 4

What are the two benign lesions that may present like “coin lesions” or solitary nodules?

Answer 4

***More common in patients

Question 5

What are the two classic divisions of lung carcinoma?

Answer 5

Small cell carcinoma (15%)

Non-small cell carcinoma (85%)

Question 6

Why is important to distinguish small cell from non-small cell carcinoma?

Answer 6

Treatment: small cell has to be treat with chemotherapy and cannot be removed by surgery, non-small cell can be treated with surgery and does not respond to chemotherapy.

Question 7

What are the major sub-types of non-small cell carcinoma?

Answer 7

• Adenocarcinoma (40%) - glands/mucin
• Squamous cell carcinoma (30%) - keratin pearls
• Large cell carcinoma (10%)
• Carcinoid tumor (5%)

Question 8

What is the characteristic histology of small cell carcinoma?

Answer 8

• poorly differentiated small cells
• arises from neuroendocrine cells (Kultchitsky)
• central location

Question 9

What paraneoplastic syndromes are common in small cell carcinoma?

Answer 9

-Production of ADH or ACTH (cushing)
-Cause Eaton-Lambert Syndrome
(Mnemonic: SSS’s: Small Cell Central Smoking paraneoplastic Syndrome)

Question 10

What are the two classic histological findings in Squamous Cell Carcinoma?

Answer 10

Keratin pearls & Intercellular bridges

Question 11

What paraneoplastic syndrome is common in Squamous Cell Carcinoma?

Answer 11

PTHrP = Parathyroid Hormone related Peptide

Question 12

What is the most common tumor in male smokers?

Answer 12

Squamous cell carcinoma (central)

Question 13

What is the most common tumor in nonsmokers and female smokers?

Answer 13

Adenocarcinoma (peripheral)

-see glands or mucin

Question 14

What do you call a lung neoplasm with no keratin pearls, no intercellular bridges, no glandular tissue, and no mucin?

Answer 14

Large cell carcinoma - poorly differentiated large cells

(can be central or peripheral)

Question 15

What is Bronchioloalveolar carcinoma?

Answer 15

• Columnar cells that grow along preexisting bronchioles and alveoli
• arises from Clara cells
• **Not related to smoking

Question 16

How does Bronchioloalveolar carcinoma present?

Answer 16

• May present with pneumonia-like consolidation on imaging
• Peripheral
• Good prognosis!

Question 17

What is a carcinoid tumor?

Answer 17

• Well differentiated neuroendocrine cells
• Low grade malignancy, rarely causes carcinoid syndrome
• **Chromogranin POSITIVE!
• **Not related to smoking

Question 18

Where does a carcinoid tumor grow?

Answer 18

Central or peripheral:

-classically forms a polyp-like mass in the bronchus

Question 19

What are the most common sources of metastases to the lung?

Answer 19

Breast and colon carcinoma

Question 20

How common are metastases to the lung from another primary cancer?

Answer 20

More common than primary tumors of the lung!

Question 21

What are local complications of lung cancer?

Answer 21

• Pleural involvement (usually adenocarcinoma)
• Obstruction of superior vena cava
• Involvement of recurrent laryngeal nerve (hoarseness) or phrenic nerve (diaphragmatic paralysis)
• Compression of sympathetic chain - pancoast tumor (ptosis, pin-point pupil, and anhidrosis)