Pulmonart IV Flashcards
Why are lung tumors the biggest killer in USA?
Not the most prevalent, but HIGHER mortality.
15% 5 year survival
Two classifications of lung CA
Small cell carcinoma and non-small cell carcinoma
Which is worse–small cell carcinoma or non-small cell?
Small cell
Which responds better to tx? small cell or non-small cell carcinoma
Small cell
Which lung CA are classified as non-small cell? (3)
- Squamous cell carcinoma
- Adenocarcinoma
- Large Cell Carcinoma
How are the non-small cell carcinomas similar?
They behave the same way and are treated similarly
4 facts about Small Cell lung CA
- 20-25% of lung cancer
- Grows more quickly (than non-small cell)
- Greater risk of METS
- Often referred to as oat cell cancer
3 facts about non-small cell lung cancer
- 80% of LCA
- Grows more slowly
- less risk of metastasis
What is SCLC often referred to as?
Oat cell CA
1 environmental risk of LCA
smoking
5 environmental risk factors of smoking?
- smoking
- asbestos
- exposure to chemical fumes
- inhalation of metallic dusts
- radiation exposure
Why does every living thing have C14 in it?
C goes into the atmosphere (fires, etc) and UV light adds neutrons and it gets heavy and falls
Plants absorb it and C14 is dated and eaten
Bronchogenic Carcinoma
Any malignant neoplasm that arises in lung tissue
What is the age range for most Lung CA?
40-70
What percent of Lung CA appears before 40?
2%
What is the prognosis for survival?
5 year 15%
Lung CA sx, most common?
Cough
Increasing smokers cough indicates…?
neoplasm
Possible lung CA sx?
hemoptysis
Larger tumor lung CA sx? (4)
- chest pain
- loss of appetite
- weight loss
- DOE
Adenocarcinoma location
in the outer periphery, below the pleura
What is the most frequently diagnosed type of LCA
adenocarcinoma
Adenocarcinoma is most common in which 2 groups?
women and non-smokers
Frequency of adenocarcinoma has increased over past 30 years…why?
- -women smokers develop more adenocarcinomas
- -cigarette filtration
Sx of peripheral tumors in adenocarcinoma?
asx
How will adenocarcinoma appear on an x-ray?
There will be pleural retraction and thickening
Gross morphology of adenocarcinoma? (4)
- well circumscribed and may contain necrotic core
- 2-5 cm at time of resection
- Cut surface: white to pale gray with black anthracitic pigment; glistening if mucous is present
Squamous cell carcinoma is what fraction of LCA?
1/3
Cause of SCC?
- strongly linked with Hx of cigarette smoking
2. Related to chronic inflammation and injury of bronchial epithelium
Which tumor location shows symptoms earlier
central location shows faster than periphery
adenocarcinoma (tissue)
glandular epithelial
sarcoma (tissue type)
non-epithelial–muscle or connective
most common kind of LCA (small or non-small)
non-small cell
Small or non-small cell has better prognosis
small cell
2 types of bronchogenic carcinoma
small cell and non-small cell carcinoma
Bronchialcarcinoid is not
Bronchogenic carinoma
Prominent ages for LCA
40-70
Squamous cell carcinoma located in
center
Large cell carcinoma located
anywhere in Lungs
Most common type of LCA
adenocarcinoma
adenocarcinoma is associated with…
scarring
How do you find adenocarcinoma?
Routine chest x-ray (unexpected and asx)
adenocarcinoma tumor borders…
well circumscribed
Adenocarcinoma tumor produces…
mucin
SCC is caused by______________and is thought to be from__________of the lungs
smoking
injury
Small cell carcinoma is located usually located_______________but can be located_____________
centrally, near hilum
anywhere
Squamous cell carcinoma has____________
the amount of these determines that it is Squamous cell carcinoma
pearls and ridges
Small cell has____________in histo to identify it is small cell
sheets
Small cell carcinoma can produce__________________syndrome which means
paraneoplastic
it can produce hormones (ADH or ACPH, cushings)—can be first sign, cushings
Bronchial Carcinoid Tumors derived from….
neuroendocrine cells
6 characteristics of Bronchial Carcinoid Tumor Syndrome
- Easy to diagnose and tx
- The FLUSHING can look like allergy or rash
- The WHEEZING can simulate asthma
- The DIARRHEA can mimic spastic colon
- It would be better to have the correct diagnosis before the right side of heart has inner scarring
- Even when it’s metastatic in the liver, debunking the tumor can increase lifespan
Bronchial Carcinoid are associated with smoking T/F
False
Bronchial Carcinoid syndrome due to
Due to release of seritonin
Common lung neoplasm in children
Bronchial Carcinoid
Hamartoma is….
most common benign lung tumor, disorganized growth of tissues normal present in lungs
Teratoma comes from a tissue that has…
3 germ layers
Hamartoma has (3)
Cartilagenous nests
are well-circumscribed
disorganized growth of tissues
Tumor that goes up to apex of lungs and goes into brachial plexus
Pancoast tumor syndrome
Pancoast tumor presents as
TOS- pain, numbness and weakness in arm
Tumor extension-horner’s syndrome 3 sx and involves which nerves
miosis
facial anhidrosis
ptosis
cervical and thoracic sympathetic
tumor extension-superior vena cava syndrome 3 sx and cause
dilation of neck veins
facial and neck edema
redness
is due to obstructed venous drainage
2ndary site of lung metastasis
adrenals
Regardless of origin, ___________is the most common place for cancer to metastasize
lung
is secondary or primary lung ca more commone
2nd
Mesothelioma is associated with
asbestos
Pyogenic granuloma versus irritation fibroma
pyogenic will blanches (highly vascularized, fibroma does not blanch
Assess for herpes with what method?
Tzank smear
Candida is stained with
PES
What color does yeast stain in PES test?
red
Why does babies mouth turn purple with candida
gentian violet
Sialolithiasis
stones in salivary glands
sialadenitis
inflammation in salivary glands
most common sialadenitis cause
mumps
Xerostomia
Dry mouth due to lack of salivary gland secretion
Mucocele
salivary gland duct is blocked
Mukulicz
salivary and lacrimal gland enlargement
salivary gland tumors are what type of cancer
adenocarcinoma
Pleomorphic adenoma
if you remove the parotid gland, reoccurrence is low—if you try to denucleate it or remove just the tumor, it can return
usually benign
ameloblastomas are of what origin? are they malignant?
odontogenic and are malignant
Nasal polyps should raise what red flag?
cystic fibrosis, especially in young caucasians
Samter’s triad
aspirin intolerance:
rhinosinusitis and nasal polyps
asthma
Brachial cleft cysts….
lateral and move when patient swallows
thyroglossal duct cysts are….
midline, and move when patient swallows
epiglottitis and croup in xray
epi- thumbprint
croup- steeple sign
Allergic Rhinitis... (4) What kind of reaction? Mediated by? Sx? sx due to?
- Sensitivity rxns
- IgE mediated
- Mucosal edema, redness
- leukocytic infiltration
Chronic Rhinitis (3)
usually due to?
what is impaired? due to?
looks like?
- usually due to repeated acute
- impaired drainage due to septum deviation and nasal polyps
- superficial desquamation or ulceration of mucosal epithelium
Nasal Polyps are focal protrusions of mucosa- description
- Edematous mucosa with loose stroma
- often with cystic or hyper plastic mucous glands
- Lymph infitration
- 3-4 cm
Most polyps are atopic or not
not atopic
although mucosa is intact in nasal polyps, they may be_______________ or _______________
ulcerated or infected
Acute sinusitis is categorized as
allergic
infectious
autoimmune
Sinusitis can be divided into which 3 categories
- acute: duration of sx less than 4 wks
- subacute 4-12 wks
- chronic 12+ wks
Problems of sinusitus
drain uphill
boney cavities, not a lot of vessels
mixed microbes
Kartagener syndrom
genetic ciliary dyskinesia
2 necrotizing upper airway lesions
Wegener—granulomatosis, can cause necrotizing gingival ulcerations
Lethal–midline ganuloma- NK cells
Very serious and often fatal
To treat NK cell lymphoma
use radiotherapy locally, otherwise if disseminated, fatal
Sinonasal papilloma
Inverted are more aggressive and exophytic are most common
Both benign and can invade cranial vault
locally aggressive if you do not excise whole thing
Plasmacytoma will turn into ____________if not surgically removed
multiple myeloma
Olfactory Neuroblastoma
uncommon head and neck malignancy
tend toward wide metastases
Nasopharyngeal Carcinomas is in one of three patters
- Keratinizing
- non-keratinizing
- Undifferentiated carcinomas that have non-neoplastic infiltrate
3 common proliferations benign-malignant
- polyp
- papilloma
- carcinoma
Large cell carcinoma is not found in_______________ histologically
sheets
LCC is an epithelial tumor with_____________nuclei and ______________ amounts of _______________
Large
Moderate
cytoplasm
