Pathoma - Lung Cancer Flashcards
What are the key risk factors for lung cancer?
- Cigarette smoke (85%) - polycyclic aromatic hydrocarbons
- Radon (uranium)
- Asbestos
What is the average age of presentation for lung cancer?
60 yoa
What is the typically presentation of lung cancer?
- Symptoms are nonspecific (cough, weight loss, hemoptysis, pneumonia)
- Imaging often reveals a solitary nodule (“coin lesion”)
- Biopsy is necessary for diagnosis of cancer
What are the two benign lesions that may present like “coin lesions” or solitary nodules?
***More common in patients
What are the two classic divisions of lung carcinoma?
Small cell carcinoma (15%)
Non-small cell carcinoma (85%)
Why is important to distinguish small cell from non-small cell carcinoma?
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.
What are the major sub-types of non-small cell carcinoma?
- Adenocarcinoma (40%) - glands/mucin
- Squamous cell carcinoma (30%) - keratin pearls
- Large cell carcinoma (10%)
- Carcinoid tumor (5%)
What is the characteristic histology of small cell carcinoma?
- poorly differentiated small cells
- arises from neuroendocrine cells (Kultchitsky)
- central location
What paraneoplastic syndromes are common in small cell carcinoma?
-Production of ADH or ACTH (cushing)
-Cause Eaton-Lambert Syndrome
(Mnemonic: SSS’s: Small Cell Central Smoking paraneoplastic Syndrome)
What are the two classic histological findings in Squamous Cell Carcinoma?
Keratin pearls & Intercellular bridges
What paraneoplastic syndrome is common in Squamous Cell Carcinoma?
PTHrP = Parathyroid Hormone related Peptide
What is the most common tumor in male smokers?
Squamous cell carcinoma (central)
What is the most common tumor in nonsmokers and female smokers?
Adenocarcinoma (peripheral)
-see glands or mucin
What do you call a lung neoplasm with no keratin pearls, no intercellular bridges, no glandular tissue, and no mucin?
Large cell carcinoma - poorly differentiated large cells
(can be central or peripheral)
What is Bronchioloalveolar carcinoma?
- Columnar cells that grow along preexisting bronchioles and alveoli
- arises from Clara cells
- **Not related to smoking
How does Bronchioloalveolar carcinoma present?
- May present with pneumonia-like consolidation on imaging
- Peripheral
- Good prognosis!
What is a carcinoid tumor?
- Well differentiated neuroendocrine cells
- Low grade malignancy, rarely causes carcinoid syndrome
- **Chromogranin POSITIVE!
- **Not related to smoking
Where does a carcinoid tumor grow?
Central or peripheral:
-classically forms a polyp-like mass in the bronchus
What are the most common sources of metastases to the lung?
Breast and colon carcinoma
How common are metastases to the lung from another primary cancer?
More common than primary tumors of the lung!
What are local complications of lung cancer?
- 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)
