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PATH STORE > Respiratory IV - Neoplasms > Flashcards

Respiratory IV - Neoplasms Flashcards

1
Q

Bronchogenic carcinomas are derived from …

A

endoderm or a derivative (neuroendocrine)

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2
Q

What is the difference in treatment between small cell carcinomas and non-small cell carcinomas?

A

Small cell - not resectable, but sensitive to chemo

Non-small cell - resectable, but less responsive to chemo

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3
Q

Tobacco smoking is related to bronchogenic carcinoma.
What % of lung cancers are in smokers?
What other cancers are smokers at risk for?
What changes are seen in respiratory epithelium?
Why is smoking related?

A

80% of lung cancer in smokers
Other risk: lip, tongue, floor of mouth, pharynx, esophagus, urinary bladder, pancreas

Histologic changes in lining epithelium

  • -squamous metaplasia / atypia in central airways
  • -goblet (glandular) metaplasia in peripheral airways

Smoke contains polycyclic aromatic hydrocarbons, phnol derivates, contaminants

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4
Q

What industrial and environmental hazards pose a risk of bronchogenic carcinoma?

A
  • Asbestos
  • Radiation (miners, accidental, war)
  • Nickel, chromates, coal, mustard gas, arsenic, beryllium, iron
  • Air pollution
  • Radon – bulk of cancers in nonsmokers
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5
Q

There is also a genetic component involved in bronchogenic carcinoma. What genes are involved?

A

C-myc – small cell

K-ras – adenocarcinoma

p53

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6
Q

We don’t really know the association, but it seems that previous injury is associated with a certain cancer. Which cancer?

A

Scarring is usually associated with adenocarinoma

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7
Q

Bronchogenic carcinoma morphology

  • -where does it originate?
  • -what is the tissue like?
  • -how does it metastasize? where to?
A

3/4 take origin from 1st, 2nd, or 3rd order bronchi

  • -tissue is gray-white and firm
  • -two paths: fungate into lumen or infiltrate along wall
  • -extension to pleural surface, mediastinum, pericardium, regional lymph nodes
  • -early metastasis through both lymphatic and hematogenous routes
  • -most common sites: ADRENALS; liver, brain, bone
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8
Q

What secondary pathologies can develop as a result of bronchogenic carcinoma?

A
  • -partial obstruction - focal emphysema
  • -total obstruction - atelectasis
  • -impaired drainage - severe suppurative or ulcerative bronchitis, bronchiolitis, bronchiectasis
  • -pulmonary abscesses
  • -superior vena cava syndrome
  • -pleuritis, pleural effusions, pericarditis

(secondary pathologies are related anatomic changes distal to bronchial involvement)

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9
Q

What are the types of bronchogenic carcinomas?

A
  1. Squamous cell carcinoma (40%)
  2. Adenocarcinoma (35%)
  3. Small cell carcinoma (25%)
  • -Large cell carcinoma
  • -Bronchioalveolar carcinoma
  • -Carcinoid tumor
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10
Q

Squamous cell carcinoma

  • -correlated with?
  • -what histologic features are seen?
  • -where do they arise?
  • -spread?
  • -what paraneoplastic syndrome is this associated with?
A

–closely correlated with a smoking history

  • -production of keratin and intercellular bridges in well- differentiated forms
  • -less well-differentiated tumors merge with large cell tumors

–arises in larger, more central bronchi

  • -tends to spread locally
  • -metastasizes somewhat later but grows more rapidly

–associated with hypercalcemia syndrome

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11
Q

Adenocarcinoma

  • -derived from?
  • -common in who?
  • -located where?
  • -histology?
  • -growth?
A
  • -bronchial-derived adenocarcinoma (glandular metaplasia in small airways)
  • -most common type in women and non-smokers
  • -more peripherally located, smaller
  • -vary histologically from well-differentiated to papillary lesions to solid masses
  • -80% contain mucin
  • -grow more slowly
  • -may be associated with scarring; less frequently associated with smoking
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12
Q

Large cell carcinoma

  • -what kind of tumor?
  • -histology?
A
  • -anaplastic with larger, more polygonal cells and vesicular nuclei
  • -probably undifferentiated squamous cell carcinomas and adenocarcinomas
  • -intracellular mucin, multinucleate giant cells
  • -also “clear cell” and “spindle cell” types
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13
Q

Small cell carcinoma

  • -malignant?
  • -what do the cells look like?
  • -how do the cells grow?
A

–highly malignant tumor

  • -cells are small with little cytoplasm; round or oval
    • –lymphocyte-like, but twice the size of lymphocytes “oat cells”
    • –some others spindle-shaped or polygonal
  • -resemble Kulchitsky’s neuroendocrine cells seen along bronchial epithelium in fetus and neonate
    • –on EM, dense-core neurosecretory granules

–grow in clusters without glandular or squamous organization

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14
Q

Small cell carcinoma

  • -associated with?
  • -most often where?
  • -can it be cured?
A
  • -associated with paraneoplastic syndromes
    • –ADH - hyponatremia
    • –ACTH - cushings
  • -strong relationship to cigarette smoking - only 1% occur in nonsmokers
  • -most often hilar or central; most aggressive; metastasize widely
  • -virtually incurable
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15
Q

Small cell carcinomas can metastasize easily. Explain how being derived from neuroendocrine cells affects this.

A

Neuroendocrine cells don’t grow with other cells, so they already have the advantage of being able to spread without having to detach from each other

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16
Q

Staging of bronchogenic carcinoma

A

Stage I - localized disease

Stage II - local disease plus ipsilateral nodes

Stage III - extension or contralateral nodes

Stage IV - distant metastasis

17
Q

Bronchogenic carcinomas are of the most insidious and aggressive neoplasms. Why?

A

Discovered in 6th decade generally after secondary spread

Presenting complaints: cough, weight loss, chest pain, dyspnea, increased sputum production

Patients die very quickly after diagnosis

18
Q

Bronchogenic carcinoma

  • -prognosis
  • -can the tumors be resected easily
  • -difference in small cell and localized solitary tumor in terms of survival rate
A

overall 5-year survival approx. 10%; mean survival 1 year

  • -not more than 20-30% permit resection
  • -adenocarcinoma and squamous cell remain localized longer
  • -surgical resection of small cell ineffective, but sensitive to chemotherapy; potential cure rates of 15-25% for limited disease
  • -localized solitary tumor < 4 cm: 30-40% 5-year survival
19
Q

Which neoplasm is associated with hypercalcemia?

A

Squamous cell carcinoma

20
Q

Lambert-eaton myasthenic syndrome

A

autoimmune antibodies to neuronal calcium channel; muscle weakness

associated with small cell carcinoma

21
Q

Pancoast’s tumor

A

apical tumors invading neural structures including cervial sympathetic plexus

  • – 95% NSCC
  • – 50% squamous; 25% large cell; 25% adenocacarcinoma
22
Q

Bronchoalveolar / bronchioalveolar carcinoma

  • -prognosis?
  • -what are the cells like?
  • -where do these tumors form?
  • -tx?
A

rare (90% at 5 years)
–3rd decade to advanced years; M=F

  • -distinctive tall, columnar to cuboidal epithelial cells that line up along alveolar septa
  • -abundant mucinous secretions

–peripheral lung, project into alveolar spaces; papillary formations

–solitary lesions resectable; metastasize late

23
Q

Bronchial carcinoid tumor

  • -originates from?
  • -what % of tumors? malignant?
  • -invasive?
  • -course? survival?
  • -patient demographic
A

tumor of neuroendocrine origin; similar to GI counterpart

  • -represent 1-5% of all lung tumors
  • -malignant, but not as aggressive as small cell carcinoma
  • -often locally invasive and capable of metastasis (rare)
  • -usually benign course with 50-95% 5-10 year survival
  • -most patients <40 years; M=F
  • -no known relationship to smoking or other environmental factors
24
Q

There are two forms of bronchial carcinoid tumor. What are they?

  • -where are they found?
  • -histology
  • -associated with carcinoid syndrome of the heart?
A

1) intraluminal polypoid masses
2) penetrate bronchial wall

  • -confined to main-stem bronchus; rarely exceed 3-4 cm
  • -symptoms from intraluminal growth
  • -nests, cords, and masses of cells similar to lymphocytes; infrequent mitoses
  • -dense-core neurosecretory granules
  • -few secrete vasoactive amines (diarrhea, flushing, cyanosis)

–not associated with carcinoid syndrome of the heart

25
Q

Metastatic cancer

–usually spread how?

A

hematogenous

26
Q

What is ht most common cause of heart failure with bronchogenic carcinoma?

A

Hydrothorax (pleural effusion in pulmonary edema)

27
Q

What is Meig’s syndrome

A

Isolated R sided hydrothorax

28
Q

What is the difference between spontaneous idiopathic pneumothorax and tension pneumothorax?

A

spontaneous idiopathic pneumothorax

  • -rupture of small, peripheral, usually apical subpleural blebs
  • -mediastinal shift towards collapsed lung

tension pneumothorax

  • -ball-valve or flap mechanism - build up of pressurized air in the thorax
  • -compression of mediastinal structures toward contralateral lung
29
Q

Pleural neoplasms - secondary or metastatic tumors

A

far more common than primary tumors

  • -most frequent from lung (Stage III) and breast
  • -direct extension or lymphatic spread
  • -also ovarian carcinomas
    • –Meig’s syndrome – ovarian fibroma with right- sided pleural effusion

–most associated with serosanguinous effusion that contains desquamated tumor cells

30
Q

Benign mesothelioma

A
  • -localized growth attached to pleural surface (1-2 cm)
  • -remains confined to surface of the lung
  • -no pleural effusion
  • -?fibromas
  • -no relationship to asbestos exposure
31
Q

Malignant mesothelioma

A
  • -uncommon, but associated with asbestos exposure
  • -latent period of 25 - 45 years
  • -NOT associated with smoking
32
Q

Morphology of mesothelioma

  • -descrive the lesion and spread
  • -cell types
  • -other features
A
  • -diffuse lesion that spreads widely in pleural space
  • -affected lung ensheathed by a thick layer of soft, gelatinous, grayish-pink tumor
  • -two cell types
    • –mesenchymal component resembling fibrosarcoma
    • –epithelial component forming tubular and papillary structures

–other features: positive staining mucopolysaccharide; lack of CEA, staining for keratin proteins

33
Q

Clinical features of mesothelioma

A

–presenting complaints: chest pain, dyspnea, recurrent pleural effusions

–50% die within 12 months

  • -lung invaded directly with metastatic spread to hilar lymph nodes
  • -also peritoneal mesotheliomas

PATH STORE (24 decks)

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