Pathoma - lung cancer

Question 1

What are the 3 key risk factors for the development of lung cancer?

Answer 1

Cigarette smoke (polycyclic aromatic hydrocarbons and arsenic are particularly mutogenic)

Radon (formed by radioactive decay of uranium, which is present in soil - can accumlate in basements)

Asbestos (lung cancer > mesothelioma)

Question 2

Where does lung cancer fall on cancer incidence and cancer mortality

Answer 2

1 cancer mortality

Question 3

How will primary lung cancer appear on X-ray

Answer 3

Solitary “coin” lesion

Question 4

What benign lung lesions also appear as “coin lesions”?

Answer 4

Granuloma (TB, fungus)

Bronchial hamartoma (composed of lung tissue + cartilage)

Question 5

What is the lung location and population affected by small cell carcinoma?

Answer 5

“S” cancers = central + smokers

Question 6

Characteristic histology of small cell carcinoma and what cells they arise from

Answer 6

Undifferentiated small cells (poor prognosis)

Arise from neuroendocrine (Kulchitsky) cells

Question 7

What are possible hormones produced by small cell carcinoma

Answer 7

ADH - SIADH

ACTH - Cushing’s

Question 8

What is Eaton-Lambert syndrome?

Answer 8

Antibodies against pre-synaptic Ca2+ channels produced by small cell carcinoma

Question 9

What location and population does Squamous cell carcinoma occur in

Answer 9

“S” = central + smokers

Question 10

Characteristic histology of squamous cell carcinoma

Answer 10

Keratin pearls or intracellular bridges (desmosomes connecting squamous cells become visible when cells are pulled apart)

Question 11

What product may be produced by squamous cell carcinoma?

Answer 11

Parathyroid hormone-related peptide (PTHrP) = hypercalcemia

Question 12

What lung location and population are affected by adenocarcinoma

Answer 12

Peripheral

Most common tumor in non-smokers and female smokers

Question 13

Characteristic histology of adenocarcinoma on histology

Answer 13

Glands or mucin

Question 14

What lung location and population are affected by large cell lung carcinoma

Answer 14

Peripheral + smoking

Question 15

Characteristic histology of large cell lung carcinoma

Answer 15

Poorly differentiated large cells with no keratin pearls, intercellular bridges, glands, or mucin

(process of elimination)

Question 16

What is the lung location and population affected by brochioloalveolar carcinoma

Answer 16

Peripheal - subtype of adenocarcinoma (adenocarcinomo in situ)

Not related to smoking

Question 17

Characterstic histology of brochioloalveolar carcinoma

Answer 17

Columnar cells containing mucin that grow along pre-existing bronchioles and alveoli

Question 18

X-ray presentation of brochioloalveolar carcinoma

Answer 18

Hazy infiltrates similiar to pneumonia

Question 19

Characteristic histology of carcinoid tumor

Answer 19

Well-differentiated neuroendocrine cells

Chromogranin positive

Question 20

Most common sources of metastatic lung cancer

Answer 20

Breast and colon

Question 21

Treatment for small cell carcinoma vs. non-small cell

Answer 21

Small cell: chemo (think: cells so small that surgeon can’t see them)

Non-small cell: surgical resection

Question 22

Complication of lung cancer

Answer 22

SPHERE:

S - Superior vena cava syndrome

P - Pancost tumor

H - Horner syndrome

E - Endocrine (paraneoplastic)

R - Recurrent laryngel nerve compression (hoarsness)

E - Effusions (pleural or pericardial)

Question 23

Common locations for lung cancer to mestasize to

Answer 23

Adrenal gland

Brain

Bone