Pulmonary carcinoma Oct16 M1 Flashcards by Django E.

T-F all lung cancers are carcinomas

F. Vast majority are pulmonary carcinomas but there are other types too

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Lung cancer prognosis

Bad. High chance of dying from it if get it.

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Carcinoma appearance on CT

node

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old carcinoma (that is gone) appearance on CT

opacity

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4 main causes of pulmonary carcinoma

tobacco smoke, minerals, chemicals, radiation

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incidence of carcinoma in smokers vs non smokers + a number

greater in smokers.

15-30 to 1 incidence in heavy smokers vs non smokers

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what % of lung carcinomas are found in non-smokers

10-15%

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how epidemiological studies related smoking to cancer?

found relationship between number and type of cigarettes smoked and the incidence of carcinoma

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how risk changes with how much you smoke and how long you smoke

The more you smoke and the longer you smoke, the greater the risk

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what minerals associated with pulm CA

asbestos. risk is dose related and risk of pulm CA is x50 if smoke cigarettes too
Arsenic, nickel, silica, chromium, cadmium

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disease caused by silica exposure associated with developing cancer

silicosis

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asbestos in mesothelioma vs pulm carcinoma

very important in mesothelioma but numbers in pulm CA are more important

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What kind of radiations can cause pulm CA

radiations of atom bomb
radon and radon-daughters (radon decay products)
Uranium and other mines
Personal dwellings

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how atom bomb influences pulm CA risk

Survivors of atom bomb have 3-4x risk of pulm CA

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Lung CA risk factor other than environmental

genetic

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Common mutations in lung CA (3)

25-30% have K-RAS mut.
Some have EGFR mut.
Some have ALK mut.

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Function of K-RAS, EGFR and ALK genes

Involved in proliferation and reducing cell death.

EGFR on surface sends signal to via proteins. K-ras in signal transduction. Alk inhibits K ras

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Drugs for lung CA, what they act on

act on prots upstream of K-Ras

act to inhibit Alk action on K-Ras.

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What is deduced if lung CA patient has K-Ras mutation (2)

1) Bad prognosis

2) No benefit from tyrosine kinase inhibitor (TKI) therapy

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What is deduced if lung CA patient has EGFR mutation (2)

1) Adenocarcinoma

2) Exon 19, 21 mutations predict response to tyrosine kinase inhibitors

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What ALK stands for

anaplastic lymphoma kinase

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What is deduced if lung CA patient has ALK mutation (2)

1) Adenocarcinoma

2) High resp rate and increased progression free survival with critoztinib

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5 categories of lung cancer, similar to other organs

epithelial tumours, mesenchymal tumours, lymphohistiocytic tumours, tumours of ectopic origin, metastatic tumours

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4 types of carcinomas that make up 98-99% of lung CAs

Squamous cell carcinoma
Adenocarcinoma
Neuroendocrine tumours
Large cell carcinoma

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squamous cell carcinoma where

proximal lung (main, lobar, segmental bronchi)

squamous cell carcinoma what problem it creates

replaces resp epithelium, tends to go on lumen and obstruct bronchus (no more air going in or substances drained out)

squamous cell carcinoma what happens when it grows

invades through wall and through adjacent lung tissue, becomes a great mass

squamous cell carcinoma: what happens to central portion

necrotizes and drained out (coughed or swallowed) and creates cavity

squamous cell carcinoma: microscopy features (3)

Keratinization, intracellular bridges, IHC (CK 5/6)

squamous cell carcinoma: name when fills bronchus

Polypoid intrabronchial squamous cell carcinoma

squamous cell carcinoma: name of obstruction created

obstructive pneumonitis

obstructive pneumonitis: what we see on CXR

opacity

squamous cell carcinoma: cytology

hyperchromatic, large nuclei, variable nuclear size of cells

unusual but possible location of squamous cell carcinoma

near pleura (peripheral), even though these are usually adenocarcinomas

squamous cell carcinoma: CXR findings

One or both hilum enlarged

Neuroendocrine tumours: 2 types

Small cell carcinoma | Carcinoid tumour

Small cell carcinoma: location

proximal airways: main, lobar bronchi

Small cell carcinoma: how it grows

grows in IS tissue (non parenchymal IS) rather than in lumen

Small cell carcinoma: where invades and metastasizes

Regional lymph nodes and visceral metastases (brain, liver, bones, adrenals)

Small cell carcinoma: cytology

small cells, high N/C ratio, dispersed chromatin

Small cell carcinoma: which histological layer it grows in and consequence on bronchus

in submucosa, creates compression on bronchus lumen

Small cell carcinoma: how resp epithelium is affected

intact

Neuroendocrine tumours microscopy appearance

neurosecretory granules

Neuroendocrine tumours: what they release

neuropeptides, hormone or hormone-related things

carcinoid tumour location when invades and consequence

bronchial lumen. distal atelectasis and lumenitis

carcinoid tumour: risk increase with smoking

not related to smoking

carcinoid tumour: worse scenario and consequence

metastasize to regional lymph nodes but no significant problems

carcinoid tumour cytology

smaller nuclei, vary less in size and shape, no hyperchromia

most common lung CA

adenocarcinoma (40-50% lung CA)

adenocarcinoma appearance on CXR and CT

appears as nodules

T-F: adenocarcinoma obstructs airways

doesn't obstruct airways

3 types of adenocarcinoma to know

acinar, lepidic, adenocarcinoma in situ

adenocarcinoma location

peripheral, subpleural

acinar adenocarcinoma: histological charact

irregularly shaped clusters of malignant cells, surround empty gland-like spaces

what can see around acinar adenocarcinoma

fibroblastic (desmoplastic) CT (stroma)

what acinar adenocarcinoma looks like and what structures of the lung remain

looks like glands. no lung parenchyma remains

best adenocarcinoma to have and why

in situ adenocarcinoma: didn't metastasize, by definition

adenocarcinoma in situ where it grows

along alveolar walls

lepidic adenocarcinoma def

combination of in situ pattern and invasive pattern

what lepidic adenocarcinoma is thought to be

a step between adenocarcinoma growth from in situ to acinar

in situ adenocarcinoma appearance on histology

Normal alveoli except enlarged alveolar walls

in situ adenocarcinoma: why alveolar septum enlarged

because of inflammation

in situ adenocarcinoma: where neoplastic cells are

on lining of alveolar surface

large cell carcinoma location and features

peripheral/subpleural | large, LOT OF NECROSIS, well circumscribed

large cell carcinoma on microscopy

large cells. undifferentiated

large cell carcinoma: why cells are large + nucleus size compared to small cell CA nucleus

Bc lot of cytoplasm. Nucleus is same size as small cell CA nucleus

large cell carcinoma nucleolus features

easily visible