SFP: Lung Cancers

Question 1

What percentage of lung tumors are carcinomas?

Answer 1

95%

Question 2

Where do lung cancers fall on the ranking of cancer-related deaths?

Answer 2

1

Question 3

What percentage of people with lung cancers are active or former smokers?

Answer 3

90%

Question 4

Does secondhand smoke put you at risk for lung cancer?

Answer 4

Yes, by about 2-fold

Question 5

What gene involvement is an early event with most lung cancers?

Answer 5

3p tumor suppressor gene deletion

Question 6

What genes are involved in many non-small cell lung cancers aka adenocarcinoma?

Answer 6

KRAS and EGFR

Question 7

What is the significance of P450 in lung cancers?

Answer 7

It activates some carcinogens

Question 8

What tumors are associated with smoking?

Answer 8

Small cell and squamous cell

Question 9

Describe the origin of carcinoid tumors.

Answer 9

They are not caused by smoking and are neuroendocrine tumors

Question 10

Describe a typical carcinoid tumor.

Answer 10

There are few mitoses and no necrosis; very rarely metastasizes

Question 11

Describe atypical carcinoid tumors.

Answer 11

More mitoses and some necrosis; not as malignant as carcinomas but around half metastasize

Question 12

Where do we tend to see carcinoids in the lung?

Answer 12

In or around the bronchi

Question 13

What stains can be used to identify carcinoid tumors?

Answer 13

Synaptophysin and chromogranin

Question 14

Briefly describe origins of small cell carcinoma.

Answer 14

They have a strong relationship to smoking and are neuroendocrine tumors

Question 15

Where do we normally see small cell carcinoma in the lung?

Answer 15

The hilar region

Question 16

Describe the gross and microscopic morphology of small cell carcinoma.

Answer 16

They’re big, fast-growing tumors that involve lymph nodes. They have many mitoses, sparse cytoplasm

Question 17

With which tumors are paraneoplastic syndromes common?

Answer 17

Small cell

Question 18

What are paraneoplastic syndromes?

Answer 18

Syndromes a patient can exhibit resulting from hormone production by a tumor

Question 19

What hormones from small cell carcinoma are often involved in paraneoplastic syndromes? What develops from them?

Answer 19

1. ACTH: manifestation of Cushing’s disease
2. ADH: SIDAH

Question 20

What hormone is produced by squamous cell carcinomas? What develops as a result?

Answer 20

Parathyroid hormone protein resulting in hypercalcemia

Question 21

When do we call something non-small cell carcinoma?

Answer 21

When we cannot fully tell the histologic type but know it is not small cell

Question 22

What is the 5-year survival like in NSCLC?

Answer 22

If it is small and confined, it is about 50%. If it is big or has spread or nodes, it is around 30%

Question 23

Where do we find squamous cell carcinoma in the lung?

Answer 23

Hilar region

Question 24

Describe gross morphology of squamous cell carcinoma.

Answer 24

Big tumor with necrosis

Question 25

Describe histology of squamous cell carcinoma.

Answer 25

Big cells with a lot of cytoplasm with squamous features such as keratin pearls and intercellular bridges

Question 26

What is squamous cell carcinoma in-situ?

Answer 26

It is limited to the epithelial lining of the lung and does not pass the basement membrane

Question 27

Where in the lung do we usually see adenocarcinoma?

Answer 27

Peripherally

Question 28

What is the most common lung cancer in non-smokers and women?

Answer 28

Adenocarcinoma

Question 29

What gene mutation occurs in about 1/5th of adenocarcinomas?

Answer 29

EGFR

Question 30

What is the origin of adenocarcinoma?

Answer 30

Epithelial cells

Question 31

Describe the histology of adenocarcinoma.

Answer 31

Abundant cytoplasm, Nuclei with big nucleoli, malignant gland formation

Question 32

What is characteristic about adenocarcinoma?

Answer 32

They produce mucin

Question 33

Describe adenocarcinoma in situ.

Answer 33

They use the alveolar walls as scaffolding to grow on; it does not invade the basement membrane and uses alveolar capillaries for blood supply

Question 34

Briefly describe large cell carcinoma.

Answer 34

They’re undifferentiated and don’t have features that clearly tell us what the tumor is, and they may have giant cells. They usually metastasize.

Question 35

What do mitotic figures look like in large cell carcinoma?

Answer 35

Usually very abnormal; the nuclei look different as well