Pulm Path IV Flashcards
What is the most common primary tumor?
Hamartoma (benign)
-approximately 95% of tumors
Top 3 most prevalent cancers in men by number of cases
- Prostate
- Lung & Bronchus
- Colon & Rectum
Top 3 most prevalent cancers in women by number of cases
- Breast
- Lung & Bronchus
- Colon & Rectum
Top 3 killer cancers
- Lung & Bronchus
- Prostate/Breast
- Colon & Rectum
Percent of lung carcinomas that occur in smokers?
90%
Increased chance of developing lung cancer if you smoke?
- Average smokers have 10x risk
- Heavy smokers have 60x greater risk
Other facts about smoking and cancer
- women more susceptible than men
- second hand smoke increases risk by 2 compared to non-smoking
- cessation of smoking decreases risk but may not return person to baseline
- associated with alterations in p53
Which organ has no evidence of being at higher risk of cancer due to smoking?
Breast
Types of Lung cancer by percentage
- Small cell carcinoma (20%)
- —-Non-small cell carcinoma (80%)
- Squamous cell carcinoma (25-30%)
- Adenocarcinoma (30-40%)
- Unclassifiable/Large cell (10-15%)
Is Squamous cell carcinoma more common in men or women?
Men
Is Squamous cell carcinoma associated with smoking?
yes
Which elevated hormone is Squamous cell carcinoma associated with?
inappropriate PTH secretion (elevated Ca++)
What is the progression of Squamous cell carcinoma?
- Squamous metaplasia –> dysplasia –> carcinoma in situ
- arises centrally
Describe the immunohistochemistry of Squamous cell carcinoma
- intercellular bridges or keratinization
- diffuse p63/p40
- local nodes involved in 70 - 90%
- spreads outside the thorax, later than other histological types
- highest frequency of p53 mutations
What is the 5 year survival?
5 - 7.5%
Clinical presentation of Adenocarcinoma
Female non-smokers
What is the progression of Adenocarcinoma?
Atypical Adenomatous Hyperplasia –> Adenocarcinoma in situ –> Minimally invasive adenocarcinoma
-more often peripheral
Another name for Adenocarcinoma in situ?
Bronchioalveolar Carcinoma
What are subtypes of Adenocarcinoma?
- Acinar
- Papillary
- Solid
- Mucinous
What are mutations of Adenocarcinoma?
- —-EGFR
- 30 - 40% asians
- targeted therapy: erlotinib (EGFR inh.)
- —-ALK gene fusions
- targeted therapy: Crizotinib (ALK inhibitors)
- —-KRAS
- most common in caucasians
- presence leads to worst outcome
- confers resistance to EGFR inhibitors and no targeted therapy
Large cell/undifferentiated carcinoma
- un-differentiated
- poor prognosis
- metastasize to liver, adrenal, brain
- 2 - 3 % 5 year survival
Where does small cell carcinoma arise from?
- tissue
- location
- rapidly growing, high grade neuroendocrine tumor
- central
Is small cell carcinoma associated with smoking?
yes
Characteristics of small cell carcinoma
- widely metastatic
- Paraneoplastic syndromes
- –ACTH, ADH
- Rarely resectable
Treatment for small cell carcinoma
Radiotherapy
Chemotherapy
2 year survival for small cell carcinoma
5 - 8%
Histologic characteristics of small cell carcinoma
densely packed “small blue” tumor
- size is 3 times larger than small, resting lymphocytes
- round to ovoid nucleus
- scant cytoplasm
- finely dispersed chromatin, inconspicuous nucleoli, high mitotic activity
Mutations in small cell carcinoma
- inactivation of p53
- inactivation of RB
What is a Bronchial Carcinoid?
Low grade malignant neuroendocrine tumor
-locally invasive, rarely metastatic
Average age of person who gets Bronchial Carcinoid?
40 y/o
Clinical presentation of Bronchial Carcinoid
- carcinoid syndrome
- intermittent diarrhea, flushing, and cyanosis
Classification of Bronchial Carcinoid
- Typical = low mitotic rate and absent necrosis
- Atypical = more frequent mitosis and focal necrosis
Outcomes for Bronchial Carcinoid
- often resectable and curable
- 5 to 10 year survival rate: 50 - 95%
What is the importance of differentiating between small cell carcinoma and Non small cell lung carcinoma?
- non small cell carcinoma is generally resectable
- small cell carcinoma has wide spread metastases by the time of diagnosis (requires chemotherapy with or without radiotherapy)
Clinical presentations of Lung cancer
- Cough
- Weight loss
- Chest pain
- Dyspnea
Clinical features of lung cancer
- pneumonia, access
- pleural effusion
- pericardial tamponade
- hoarseness
- dysphagia
- diaphragm paralysis
- rib destruction
Superior vena cava syndrome
- facial swelling
- cyanosis
- dilatation of veins in head and neck
Paraneoplastic syndromes
- SIADH
- Cushings
- Calcitonin
Eaton-Lambert
- Autoantibodies against calcium channels
- muscle weakness
- most commonly associated with small cell carcinoma
Survival for Mesothelioma
rarely over a year
Types of Mesothelioma
- Epithelioid
- Sarcomatoid
- Mixed
Histology of Mesothelioma
- Asbestos body
- Ferruginous body
Clinical presentation of Mesothelioma
- Chest pain
- Dyspnea
- Recurrent pleural effusion
