PULMONARY NEOPLASM AND UPPER AIRWAY TUMOURS Flashcards
1
Q
CHARACTERISTICS OF SMALL CELL LUNG CA (CLUE: 6)
A
- UNDIFFERENTIATED TUMOUR - SMALL CELL, HIGH NC RATIO, LITTLE CYTOPLASM = OAT CELL, NUCLEI WITH SALT PAPER CHROMATIN, WITH NO NUCLEOLI
- HIGH INCIDENCE RATE OF EXTRAPULMONARY SPREAD
- A/W CIGARETTE SMOKING
- MOST CASES ARISE CENTRALLY
- COMMON A/W ECTOPIC HORMONE
- HIGH INITIAL RESPONSE TO CHEMOTHERAPY
2
Q
CHARACTERISTICS OF NON SMALL CELL LUNG CA.
A
- DIFFERENTION TOWARDS SQUAMOUS CELL CA, ADENOCARCINOMA, MILD - MODERATE CYTOPLASM, NUCLEI WITH COARSE CHROMATIN, PROMINENT NUCLEOLI.
- LOWER INCIDENCE RATE OF EXTRAPULMONARY SPREAD
- VARIABLE A/W SMOKING, NON SMOKER -> ADENOCARCINOMA
- SQUAMOUS CELL CA = CENTRALLY, ADENOCARCINOMA = PERIPHERALLY
- LESS COMMON TO BE A/W ECTOPIC HORMONE
- LESS RESPONSIVE TO CHEMOTHERAPY.
3
Q
PEAK AGE OF LUNG CA
A
50 - 60 YRS
4
Q
CAUSE OF LUNG CA (2 CAUSE)
A
- TOBACCO SMOKING
- AMOUNT OF DAILY SMOKING
- TENDENCY TO INHALE
- DURATION OF SMOKING
- WOMEK MORE SUSCEPTIBLE TO CARCINOGEN IN TOBACCO SMOKE
- PASSIVE SMOKER
- SMOKING CIGAR AND PIPES - INDUSTRIAL HAZARD
- CHRONIC EXP TO ASBESTOS: IN SMOKERS
- PEOPLE WHO WORK WITH NICKEL, CHROMATES, COAL, MUSTARD GAS, ARSENIC, BERRYLIUM, IRON: NEWSPAPER WORKER AND AFRICAN GOLD MINER
- RADON GAS, AMONG URANIUM MINERS
- ALL TYPES OF RADIATION MAY BE CARCINOGENIC SUCH AS ATOMIC BOMB BLAST AND URANIUM
5
Q
EXAMPLES OF ACTIVATED ONCOGENES
“ ACTIVE MER MET HER TO KICK (KIT)”
A
- C- MYC
- EGFR
- K- RAS
- C- MET
- HER-2
- C- KIT
“ ACTIVE MER MET HER TO KICK (KIT)”
6
Q
EXAMPLES OF DELETED TM SUPPRESSOR GENE
“ P2ER”
A
P53
P16INK4A
RB1
7
Q
ACTIVATED ONCOGENES WILL CAUSE
A
CELL PROLIFERATION AND HENCE DEVELOP THE CA
8
Q
SOME ADENOCARCINOMAS DEVELOP FROM PRECURSOR LESION WHICH ARE (2 TYPES)
A
- ATYPICAL ADENOMATOUS HYPERPLASIA
- ADENOCARCINOMA INSITU
9
Q
PRECURSOR LESION IN LUNG CARCINOMA
A
- BASAL CELL HYPERPLASIA
- SQUAMOUS METAPLASIA
- SQUAMOUS DYSPLASIA
- CARCINOMA IN SITU
- INVASIVE CA
10
Q
PRECURSOR LESION IN ADENOCARCINOMA
A
- ATYPICAL ADENOMATOUS HYPERPLASIA
- ADENOCARCINOMA INSITU
11
Q
MACROSCOPY OF SCC
A
- LOBULATD, WHITE TO TAN MASS
- MASS LOCATED AT CENTRALLY
- MASS WITH IRREGULAR BORDER
12
Q
MICROSCOPY OF SCC
A
- 5 MALIGNANT FEATURES
- FINELY GRANULAR NUCLEAR CHROMATIN
- ABSENCE OF NUCLEOLI
13
Q
MACROSCOPY OF ADENOCARCINOMA
A
- SINGLE
- LARGE PALE TAN MASS
- MASS LOCATED AT PERIPHERY
14
Q
MICROSCOPIC OF ADENOCARCINOMA
A
- 5 MALIGNANT FEATURES
- MALIGNANT CELLS ARRANGED IN GLANDULAR FORMATION OR NESTS, MUCIN PRODUCTION
15
Q
MACROSCOPIC OF SQUAMOUS CELL CARCINOMA
A
- PALE WHITE TO TAN FIRM MASS
- MASS LOCATED AT CENTRALLY
- CAVITY IN THE TUMOUR
- CONSOLIDATION DISTAL TO TUMOUR
16
Q
MICROSCOPIC OF SQUAMOUS CELL CARCINOMA
A
- INTERCELLULAR BRIDGES
- 5 MALIGNANT FEATURES
- KERATIN PEARL
17
Q
DESC OF LARGE CELL CA.
A
- NON SMALL CELL LUNG CA
- DOES NOT DISPLAY SQ OR GLANDULAR DIFFERENTIATION
- MAY BE CENTRAL OR PERIPHERAL
18
Q
PRESENTING FEATURES OF LUNG CA
A
- ASYMPTOMATIC
- MAJOR:
1. COUGH +/- HAEMOPTYSIS
2. LOW
3. CHEST PAIN
4. DYSPNOEA - COMPLICATIONS:
1. HAEMATOGENOUS (BONE FRACTURE)
2. LYMPHATIC SPREAD (ENLARGED SUPRACLAVICULAR LN)
3. LOCAL SPREAD TO NEARBY STRUCTURE
4. PARANEOPLASTIC SYNDROME - SYSTEMIC FEATURES: LOA,LOW, LETARGY, FEVER
19
Q
EXAMPLES OF PARANEOPLASTIC SYNDROME
A
- HYPERCALCEMIA
- CAUSED BY SECRETION OF THE PTH RELATED PEPTIDE - CUSHING SYNDROME
- INCREASED THE PRODUCTION OF THE ADRENOCOTROPIC HORMONE - SIADH
- NEUROMUSCULAR SYNDROME
- MG
- PERIPHERAL NEUROPATHY
- POLYMYOSITIS - CLUBBING OF THE FINGERS AND HYPERTROPHIC PULMONARY OSTEOARTHYROPATHY
- COAGULATION ABNORMALITIES
- MIGRATORY THROMBOPHLEBITIS
- NON BACTERIAL ENDOCARDITIS
- DIC
20
Q
INVESTIGATION FOR LUNG CA
A
- CHEST RADIOGRAPHY
- CT SCAN
- CYTOLOGY:
1. SPUTUM
2. BAL
3. FNA
4. PLEURAL EFFUSION - BIOPSY
1. LUNG: TRANSBRONCHIAL, CT GUIDED TRUCUT
2. PLEURA
21
Q
SMALL CELL CARCINOMA IS THE WORST/ BEST PROGNOSIS
A
WORST
22
Q
DESC METASTATIC TUMOUR IN THE LUNG
A
- MORE FREQUENT THAN PRIMARY CARCINOMA OF THE LUNG
- BREAST, COLON, STOMACH, PANCREAS, KIDNEY, MELANOMA, PROSTATE, LIVER
- GROSS: MULTIPLE NODULES IN MULTIPLE LOBE (CANNONBALL LESION)
23
Q
DESC NASOPHARYNGEAL CA
A
- TUMOUR OF THE NASOPAHRYNX
- AGE: BTWN 50 TO 60
- SEX: MALE»_space;>
- HIGH FREQUENCY IN CHINESE
- CLOSELY LINK WITH EBV
- EBV OCCUR AFTER TUMOUR DEV.
- AB TO VIRAL CAPSID AG ARE GREATLY ELEVATED AND IN ENDEMIC AREAS, PT DEV IGA BEFORE TUMOUR
24
Q
CLINCAL COURSE OF NASOPHARYNGEAL CARCINOMA
A
- PAINLESS, SWELLING OR LUMP IN THE NECK
-BLOCKED NOSE @ NOSE BLEED - CHANGES IN HEARING, RINGING IN THE EAR (TINNITUS)
- INVADE LOCALLY, SPREAD TO CERVICAL LN, THEN METASTASIZE TO DISTANT AREA
- TEND TO BE RADIOSENSITIVE
- RESPONSE TO IMMUNE CP INHIBITORS
25
Q
MICROSCOPIC OF NASOPHARYNGEAL CA.
A
- MOSTLY SQ CELL CA
- HISTOLOGY SUBTYPES:
1. KERATINISING SQ CELL CA (TYPE1) - LEAST RADIOSENSITIVE
2. NON KERATINISING SQ CELL CA (TYPE 2)
2. UNDIFFERENTIATED CA (TYPE 3)- MOST RADIOSENSITIVE - SPRINKLE OF LYMPHOCYTE WITHIN TUMOUR CLUSTERS
26
Q
DESC CARCINOMA OF THE LARYNX
A
- COMMONLY OCCUR AFTER 40 YRS OF AGE
- MORE COMMON IN MEN
- ENVIRONMENTAL INFLUENCE:
1. SMOKERS
2. ALCOHOL AND ASBESTOS - HUMAN PAPILLOMAVIRUS: USUALLY HAVE BETTER PROGNOSIS
- 95% ARE WELL DIFFERENTIATED SQ CELL CARCINOMA
- SITE
1. GLOTTIC TUMOUR (MOST COMMON) - DIRECTLY AT VOCAL CORD
2. SUPRAGLOTTIC: ABOVE THE CORD
3. SUBGLOTTIC: BELOW THE CORD
27
Q
CLINICAL COURSE OF CA OF THE LARYNX
A
- PERSISTENT HOARSENESS
- 90% OF GLOTTIC TUMOUR ARE CONFINED TO THE LARYNX ONLY
- GLOTTIC REGION HAS A SPARSE LYMPHATIC
- WITH SURGERY, RADIATION THERAPY, OR COMBINATION T(X), MANY PT CAN BE CURED
- MAY BE COMPLICATE WITH PULM INFX
