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Bloc B - Respiration > Pulmonary carcinoma Oct16 M1 > Flashcards

Pulmonary carcinoma Oct16 M1 Flashcards

1
Q

T-F all lung cancers are carcinomas

A

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

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2
Q

Lung cancer prognosis

A

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

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3
Q

Carcinoma appearance on CT

A

node

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4
Q

old carcinoma (that is gone) appearance on CT

A

opacity

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5
Q

4 main causes of pulmonary carcinoma

A

tobacco smoke, minerals, chemicals, radiation

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6
Q

incidence of carcinoma in smokers vs non smokers + a number

A

greater in smokers.

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

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7
Q

what % of lung carcinomas are found in non-smokers

A

10-15%

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8
Q

how epidemiological studies related smoking to cancer?

A

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

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9
Q

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

A

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

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10
Q

what minerals associated with pulm CA

A

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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11
Q

disease caused by silica exposure associated with developing cancer

A

silicosis

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12
Q

asbestos in mesothelioma vs pulm carcinoma

A

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

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13
Q

What kind of radiations can cause pulm CA

A

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

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14
Q

how atom bomb influences pulm CA risk

A

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

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15
Q

Lung CA risk factor other than environmental

A

genetic

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16
Q

Common mutations in lung CA (3)

A

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

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17
Q

Function of K-RAS, EGFR and ALK genes

A

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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18
Q

Drugs for lung CA, what they act on

A

act on prots upstream of K-Ras

act to inhibit Alk action on K-Ras.

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19
Q

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

A

1) Bad prognosis

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

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20
Q

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

A

1) Adenocarcinoma

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

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21
Q

What ALK stands for

A

anaplastic lymphoma kinase

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22
Q

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

A

1) Adenocarcinoma

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

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23
Q

5 categories of lung cancer, similar to other organs

A

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

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24
Q

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

A

Squamous cell carcinoma
Adenocarcinoma
Neuroendocrine tumours
Large cell carcinoma

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25
Q

squamous cell carcinoma where

A

proximal lung (main, lobar, segmental bronchi)

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26
Q

squamous cell carcinoma what problem it creates

A

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

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27
Q

squamous cell carcinoma what happens when it grows

A

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

28
Q

squamous cell carcinoma: what happens to central portion

A

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

29
Q

squamous cell carcinoma: microscopy features (3)

A

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

30
Q

squamous cell carcinoma: name when fills bronchus

A

Polypoid intrabronchial squamous cell carcinoma

31
Q

squamous cell carcinoma: name of obstruction created

A

obstructive pneumonitis

32
Q

obstructive pneumonitis: what we see on CXR

A

opacity

33
Q

squamous cell carcinoma: cytology

A

hyperchromatic, large nuclei, variable nuclear size of cells

34
Q

unusual but possible location of squamous cell carcinoma

A

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

35
Q

squamous cell carcinoma: CXR findings

A

One or both hilum enlarged

36
Q

Neuroendocrine tumours: 2 types

A

Small cell carcinoma

Carcinoid tumour

37
Q

Small cell carcinoma: location

A

proximal airways: main, lobar bronchi

38
Q

Small cell carcinoma: how it grows

A

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

39
Q

Small cell carcinoma: where invades and metastasizes

A

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

40
Q

Small cell carcinoma: cytology

A

small cells, high N/C ratio, dispersed chromatin

41
Q

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

A

in submucosa, creates compression on bronchus lumen

42
Q

Small cell carcinoma: how resp epithelium is affected

A

intact

43
Q

Neuroendocrine tumours microscopy appearance

A

neurosecretory granules

44
Q

Neuroendocrine tumours: what they release

A

neuropeptides, hormone or hormone-related things

45
Q

carcinoid tumour location when invades and consequence

A

bronchial lumen. distal atelectasis and lumenitis

46
Q

carcinoid tumour: risk increase with smoking

A

not related to smoking

47
Q

carcinoid tumour: worse scenario and consequence

A

metastasize to regional lymph nodes but no significant problems

48
Q

carcinoid tumour cytology

A

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

49
Q

most common lung CA

A

adenocarcinoma (40-50% lung CA)

50
Q

adenocarcinoma appearance on CXR and CT

A

appears as nodules

51
Q

T-F: adenocarcinoma obstructs airways

A

doesn’t obstruct airways

52
Q

3 types of adenocarcinoma to know

A

acinar, lepidic, adenocarcinoma in situ

53
Q

adenocarcinoma location

A

peripheral, subpleural

54
Q

acinar adenocarcinoma: histological charact

A

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

55
Q

what can see around acinar adenocarcinoma

A

fibroblastic (desmoplastic) CT (stroma)

56
Q

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

A

looks like glands. no lung parenchyma remains

57
Q

best adenocarcinoma to have and why

A

in situ adenocarcinoma: didn’t metastasize, by definition

58
Q

adenocarcinoma in situ where it grows

A

along alveolar walls

59
Q

lepidic adenocarcinoma def

A

combination of in situ pattern and invasive pattern

60
Q

what lepidic adenocarcinoma is thought to be

A

a step between adenocarcinoma growth from in situ to acinar

61
Q

in situ adenocarcinoma appearance on histology

A

Normal alveoli except enlarged alveolar walls

62
Q

in situ adenocarcinoma: why alveolar septum enlarged

A

because of inflammation

63
Q

in situ adenocarcinoma: where neoplastic cells are

A

on lining of alveolar surface

64
Q

large cell carcinoma location and features

A

peripheral/subpleural

large, LOT OF NECROSIS, well circumscribed

65
Q

large cell carcinoma on microscopy

A

large cells. undifferentiated

66
Q

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

A

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

67
Q

large cell carcinoma nucleolus features

A

easily visible

Bloc B - Respiration (36 decks)

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