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pathology > pulmonary -- lung cancer > Flashcards

pulmonary -- lung cancer Flashcards

1
Q

what percentage of lung tumors are carcinomas?

A

90%

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2
Q

know about lung cancer occurrence and mortality rates

A

2 most common (14% of US cancers),

#1 deadly (~28% of all CA deaths in the US)
leading cause of CA death both M and F
15% 5-yr survival rate

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3
Q

what are the two major classifications which account for ~90% of LCA?

A
  • non-small cell: (SCC, large cell carcinoma, adenocarcinoma – all three behave and are treated similarly)
  • small cell carcinoma (WORSE than non-small cell carcinomas but respond better to tx)
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4
Q

know the differences between small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)

A

SCLC || NSCLC
20-25% of LCA || more common (80%)
grows quickly || grows slower
greater risk of METS || less risk of METS
aka oat cell CA || 3 types (and %):
adenocarcinoma (30-35%)
SCC (25-40%)
large-cell carcinoma (10-15%)

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5
Q

pathogenesis of LCA

A

normal bronchial mucosa =>
metaplastic/dysplastic mucosa =>
carcinoma-in-situ (SCC, adenocarcinoma) =>
infiltrating cancer

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6
Q

top environmental risk factors of LCA

A 
smoking (#1)
asbestos exposure [proof data is old]
chemical fumes
metallic dust inhalation
radiation exposure (including radon)
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7
Q

which category of smoker (current, former, never) accounts for the most new LCA cases?

A

former (60%)

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8
Q

factors in smoking’s role in cancer

A

> 1200 substances (tobacco is a super-sponge)

  • polycyclic aromatic hydrocarbons
  • phenol derivatives
  • radioactive elements (C-14, K-40)
  • others: nickel, mold, arsenic
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9
Q

what is bronchiogenic carcinoma:

A

any malignant neoplasm arising in the lung tissue

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10
Q

in what age group is LCA dx most likely?

A

40-70…only 2% of cases appear before 40

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11
Q

LCA sx

A
  • cough: first and most common (existing cough may become more severe)
  • hemoptysis (coughing blood)
  • w/large tumors: chest pain, loss of weight/appetite, DOE
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12
Q

locations of LCA by type

A
  • small-cell: anywhere, but likely central near hilum
  • SCC: central
  • adenocarcinoma: outer periphery
  • large cell: anywhere
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13
Q

which is the most frequently dx’d subtype of LCA?

A

adenocarcinoma (30-35% of cases)

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14
Q

in what two groups is adenocarcinoma the most common LCA

A

women and non-smokers

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15
Q

adenocarcinoma is associated with what physical finding in the lung?

A

scarring

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16
Q

why might adenocarcinoma be on the rise over the last 30 years?

A

men have stopped smoking and women have not – women prone to adenocarcinoma

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17
Q

where do adenocarcinomas develop and why is this symptomatically important?

A

occur on lung periphery below the pleura… usually asx until late (central shows sxs first)

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18
Q

what are the ‘three p’s’ of adenocarcinoma morphology?

A

peripheral, pigmented, puckered

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19
Q

what substance may be overproduced by an adenocarcinoma tumor?

A

mucus

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20
Q

to what activity is SCC strongly linked?

A

hx of smoking

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21
Q

what is the proposed root cause of SCC

A

chronic inflamx and injury to bronchial epithelium. this leads to metaplasia of normal ciliated columnar epithelium (protective measure from smoke)

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22
Q

where in the lung is an SCC likely to be found?

A

centrally. off the main, lobar, or segmental bronchi……may also ulcerate through mucosa into parenchyma.

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23
Q

talk through the histology progression of SCC

A

early on:
ciliated columnar epithelium lose their cilia and basal cells begin hyperplasia.

mild, moderate, then severe dysplasia => cancer in situ (superficial)

late:
penetration of the basement membrane involving lamina propria to become invasive carcinoma

24
Q

what histologic finding characterizes SCC

A

intercellular bridges of keratinization (may be squamous pearls or individual cells with eosinophilic dense cytoplasm)

25
Q

describe gross morphology of SCC

A

firm, non-encapsulated masses
gray-white with ‘dry’ surface
large tumors often outgrow supply: hemorrhage, necrosis, cavitation my ensue

26
Q

what are three sequelae of SCC

A
  • endobronchial tumors may cause obstruction =>post-obstructive pneumonia or atelectasis
  • chronic bronchitis and centriacinar emphysema
  • cavity lesion may break through bronchus wall with possible death due to aspiration of the blood (can’t bleed out)
27
Q

what are SCLC cells meant to resemble?

A

oats

28
Q

where is SCLC commonly found?

A

centrally near hilum

29
Q

what are some histological findings with SCLC?

A

-small, round cells (oats)
-granular nuclear chromatin (salt & pepper)
-scant cytoplasm and absent nucleoli
-ill-defined borders
-packed in sheets
(these grow fast and shape is lost – trouble)

30
Q

what hormonal syndrome is common with SCLC?

A

paraneoplastic syndrome: the cancer cells produce hormones or neuroendocrine compounds which produce remote/systemic effects.

  • ADH - severe hyponatremia
  • ACTH - cushing’s dz
  • gonadotropins, serotonin, bradykinin, PTH
31
Q

which form of NSCLC is most resistant to tx?

A

large cell carcinoma

32
Q

where is large cell carcinoma found?

A

anywhere in the lung

33
Q

how does large cell carcinoma appear histologically?

A

large polygonal cells (big nucleoli/nuclei, moderate cytoplasm)

no glandular or squamous differentiation or features of SCLC (no sheet formation)

34
Q

what are bronchial carcinoid tumors?

A

derived from neuroendocrine tissue and produce amines (Epi, NE, Serotonin)

can form anywhere…GI #1, lungs #2

35
Q

in what group are bronchial carcinoid tumors the most common?

A 
#1 primary lung neoplasm in kids
NOT ASSOCIATED W/SMOKING
36
Q

what are the features and prognosis of carcinoid syndrome?

A

diarrhea, facial flushing, and wheezing (usually only seen if liver METS)

good prognosis - 85% 5yr survival

37
Q

describe morphology of bronchial carcinoid tumor

A

smooth, cherry red, polypoid endobronchial nodule; small, uniform cells are organized and functional.

submucosal lesion may protrude into bronchial lumen

38
Q

what is the most common type of benign tumor of the lung and what is it made of?

A

hamartoma (~75%) - disorganized growth of tissues native to the lung. cartilage nest surrounded by CT and fat.

39
Q

what other structures may be impacted and what might happen as a lung tumor extends into pleural space?

A

laryngeal nerve: hoarseness
phrenic nerve: diaphragmatic paralysis
esophagus: obstruction

40
Q

What is pancoast tumor syndrome? where does it occur? what structures are involved and how might it present?

A

tumor in the apex of the lung that infiltrates brachial plexus. also may involve phrenic and vagus nerves (Horner’s) as well as subclavian vein (superior vena cava syndrome).

pain, numbness, weakness like thoracic outlet syndrome.

41
Q

What are two syndromes that may result from pancoast tumor syndrome and what are the associated sxs?

A

Horner’s: sympathetic ganglion compression - ipsilateral miosis, ptosis, facial anhidrosis

Superior vena cava syndrome:: ovstruction of venous drainage (subclavian) - dilation of neck veins, neck and facial edema, redness or more often cyanosis

42
Q

To what does TNM always relate?

A

biologic behaviour of a tumor

43
Q

What is the most common site for metastatic tumors regardless of their origin? Why is this so?

A

The lungs…..all the blood passes through.

Especially favored by sarcomas.

44
Q

Where do lung cancers prefer to travel?

A

Other lung, pleura, brain, liver, adrenals (often first)

45
Q

Which is more common, primary lung cancer or mets to the lung?

A

mets

46
Q

Which cancers can extend into the lungs without mets?

A

lymphomas, esophageal

47
Q

What type of cancer produces cannon ball lesions of the lung? How does it get to the lung?

A

prostate – pelvic venous drainage goes thru the spine and has no valves

48
Q

Are pleural dzs usually primary or secondary?

A

usu secondary, can be primary

49
Q

To what does pleural dz usually lead?

A 
pleural effusion
(fluid | lung restriction | atelectasis | pneumonia)
50
Q

how much fluid in the lungs is normal? how much can be in before it is seen on CXR?

A

15 ml normally. up to 700 before CXR reveals it.

51
Q

how are pleural effusion defined?

A

protein/ldh concentration, specific gravity, cellular components.

  • transudate: CHF, nephrotic syndrome, cirrhosis
  • exudate: CA, pneumonia, lymphoma
52
Q

What tumor staging includes a tumor that has infiltrated the chest wall or caused atelectasis?

A

T3

53
Q

What tumor staging includes metastasis to a supraclavicular lymph node?

A

N3

54
Q

What tumor staging includes invasion of the heart, trachea and esophagus?

A

T4

55
Q

What is it called when a lung transplant patient experiences chronic organ rejection?

A

broncholitis obliterans

pathology (5 decks)

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