Resp - Path (Lung cancer & Superior vena cava syndrome) Flashcards
Pg. 609-610 in First Aid 2014 Sections include: -Lung cancer -Mesothelioma -Pancoast tumor -Superior vena cava syndrome
What is the leading cause of cancer death?
Lung cancer is the leading cause of cancer death.
What is the physical presentation of lung cancer?
Presentation: cough, hemoptysis, bronchial obstruction, wheezing
How does lung cancer present on imaging?
pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT.
In the lung, is metastases or primary neoplasms more common?
In the lung, metastases (usually multiple) lesions are more common than primary neoplasms
What are the 4 most common cancers that metastasize to lung?
Most often from breast, colon, prostate, and bladder cancer
What are the 4 sites of metastases from lung cancer?
Sites of metastases from lung cancer - adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatosplenomegaly)
How might lung cancer metastases to the bone present? How about to the liver?
bone (pathologic fracture), liver (jaundice, hepatosplenomegaly)
What are 6 complications associated with lung cancer?
SPHERE of complications: (1) Superior vena cava syndrome (2) Pancoast tumor (3) Horner syndrome (4) Endocrine (paraneoplastic) (5) Recurrent laryngeal symptoms (hoarseness) (6) Effusions (pleural or pericardial)
Which lung cancer types are associated with smoking?
All lung cancer types except bronchial carcinoid are associated with smoking
Which lung cancers are located centrally?
Squamous and Small cell carcinoma are Sentral (central)
What are 5 types of lung cancer?
(1) Adenocarcinoma (2) Squamous cell carcinoma (3) Small cell (oat cell) carcinoma (4) Large cell carcinoma (5) Bronchial carcinoid tumor
What is the location of Adenocarcinoma in the lung?
Peripheral
What is the most common lung cancer in nonsmokers? What is the most common lung cancer overall?
Adenocarcinoma = Most common lung cancer in nonsmokers and overall (except for metastases)
Name 3 activating mutations for Adenocarcinoma of the lung.
Activating mutations include k-ras, EGFR, and ALK.
With what condition is Adenocarcinoma of the lung associated?
Associated with hypertrophic osteoarthropathy (clubbing).
What is another name for Bronchioloalverolar subtype of Adenocarcinoma of the lung? What is often seen on CXR in this case?
Bronchioalveolar subtype (adenocarcinoma in situ): CXR often shows hazy infiltrates similar to pneumonia
How is the prognosis for Bronchioloalveolar subtype of Adenocarcinoma of lung?
Excellent prognosis
What is seen on histology in Bronchioloalveolar subtype of Adenocarcinoma of the lung?
Bronchioloalveolar subtype: grows along alveolar septa –> apparent “thickening” of alveolar walls
Where is Squamous cell carcinoma of the lung located?
Central
What kind of mass occurs in Squamous cell carcinoma of the lung, and where?
Hilar mass arising from bronchus
What are 3 associations with Squamous cell carcinoma of the lung?
Cavitation; Cigarettes; hyperCalcemia (produces PTHrP)
What is seen on histology of Squamous cell carcinoma of the lung?
Keratin pearls (dark pink) and intercellular bridges; Sheets of large dysplastic squamous cells surrounding dark, pink keratin pearls
What is another name for Small cell carcinoma? What is its location?
Small cell (oat cell) carcinoma; Central
What is the differentiation of small cell carcinoma? How aggressive is it?
Undifferentiated –> very aggresive
What are 3 products that may result from Small cell (oat cell) carcinoma? Which of these is associated with a particular syndrome, and what is that syndrome?
May produce ACTH, ADH, or Antibodies against presynaptic Ca2+ channel (Lambert-Eaton myasthenic syndrome)
Amplification of which genes is common is small cell (oat cell) carcinoma?
Amplification of myc oncogenes common.
Is small cell (oat cell) carcinoma operable? How is it treated?
Inoperable; Treat with chemotherapy
What is the histology of small cell (oat cell) carcinoma?
Neoplasm of neuroendocrine Kulchitsky cells –> small dark blue cells; Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and “salt and pepper” neuroendocrine-type chromatin
Where is Large cell carcinoma of the lung located?
Peripheral
Describe the differentiation and prognosis of Large cell carcinoma of the lung.
Highly anaplastic undifferentiated tumor; poor prognosis
How is Large cell carcinoma of the lung treated/managed?
Less responsive to chemotherapy; removed surgically
What kind of prognosis does Bronchial carcinoid tumor have?
Excellent prognosis
How common is metastasis in Bronchial carcinoid tumor?
Metastasis rare
What usually causes symptoms in Bronchial carcinoid tumor? What is an occasional symptom of which to be aware? What happens in this syndrome?
Symptoms usually due to mass effect; occasionally carcinoid syndrome (5-HT secretion –> flushing, diarrhea, wheezing)
What is the histology of Bronchial carcinoid tumor?
Nests of neuroendocrine cells; chromogranin A (+)
What is Mesothelioma, and with what is it associated?
Malignancy of the pleura associated with asbestosis
What results from Mesothelioma?
Results in hemorrhagic pleural effusions and pleural thickening
What is seen on histology in Mesothelioma?
Psammoma bodies seen on histology
Describe the phenomena of Pancoast tumor and its possible effects.
Carcinoma that occurs in apex of lung may affect cervical sympathetic plexus, causing Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis), SVC syndrome, sensorimotor deficits, and hoarseness.
What is superior vena cava syndrome, and what are its associated symptoms?
An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”), neck (jugular venous distention), and upper extremities (edema).
What are 2 common causes of superior vena cava syndrome?
Commonly caused by malignancy and thrombosis from indwelling catheters.
In general, what is the clinical approach to superior vena cava syndrome, and why?
Medical emergency. Can raise intracranial pressure (if obstruction severe) –> headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries.
