SG 30 Lung Cancer / Pathology

Question 1

What are the ECOG scores specifically?

Answer 1

0 = no symptoms
1 = mild symptoms that don't interfere w/ daily activities
2 = limits activities more than 50% day
3 = sitting in bed more than 50% day b/c so limited 
4 = bedbound
5 = dead

Question 2

Do you need biopsy for adenocarcinoma dx?

Answer 2

YEP

Question 3

How treat these adenocarcinomas:

Stage 1-4

Answer 3

Stage 1 = resect
2 = resect + chemo
3 = chemo + radiation
4 = systemic chemo

Question 4

How does EGFR mutation lead to lung cancer?

Answer 4

Tyrosine kinase receptor always on -> cell growth + prolif

Question 5

EGFR inhibitor you know

Answer 5

Erlotinib

Question 6

What drug would you use for ALK + adenocarcinomas

Answer 6

Crizotinib

Question 7

What type of lung cancer is most likely to grow into a lumen/obscure the SVC -> SVC syndrome?

Answer 7

Small cell

Question 8

Stage small cell -> treat

Answer 8

Limited - chemo + radiation
Extensive - chemo (extensive b/c has grown outside the bounds of radiation)
+ TNM staging

Question 9

What would serum and urine Na + osmoles look like for SIADH

Answer 9

Low serum Na + osmoles

High urine Na + osmoles

Question 10

Cause + signs of Cushing’s

Answer 10

Paraneoplastic
Excess cortisol
Rounded face + abdominal obesity + striae on skin + diabetes

Question 11

Does Lambert Eaton effect pre or post synaptic Ca channels?

Answer 11

PRE-synaptic voltage gated Ca channels in NMJ

Question 12

Do you operate on pts when mediastinal nodes are positive?

Answer 12

NO
If + mediastinal LN -> locally advanced disease
Now need chemo + radiation to cure you

Question 13

If you have a resectable cancer, what would warrant adjuvant chemo?

Answer 13

Any LN involvment on path

Question 14

Atypical adenomatous hyperplasia is a precursor for what lesion? What is usually seen on scans?

Answer 14

Precursor for adenocarcinoma

See ground glass opacities

Question 15

AAH histo

Answer 15

Alveolar septal thickening

Lined by atypical type 2 pneumocytes

Question 16

What is a major difference between adenocarcinoma in situ mucinous vs non-mucinous types?

Answer 16

Mucinous are almost always multifocal aka multiple

Mucinous are worse than non

Question 17

What is the difference between adenocarcinoma in situ vs minimally invasive adenocarcinoma?

Answer 17

AIS = tumor

Question 18

What is the difference between adenomatous hyperplasia and adenocarcinoma in situ?

Answer 18

AIS more atypical and columnar

Question 19

What is the invasive counter part to non-mucinous adenocarcinoma in situ? What marker is it positive for?

Answer 19

Acinar adenocarcinoma

TTF1 +

Question 20

If a lung cancer has no LN involvement, where is it most likely to met to? What is the most common lung cancer to do this - treat?

Answer 20

To the BRAIN!
Small cell most likely - don’t excise
Most common resected type is adenocarcinoma

Question 21

What tumor is likely to grow into the lumen of the bronchus - invading through wall into lung parenchyma? Hint: see keratin in tumor.

Answer 21

Squamous carcinoma

Question 22

What are the main 2 neuro-endocrine tumors you need to know?
Markers
How tell apart

Answer 22

Both + for synaptophysin and chromograinin
Carcinoid - low Ki67
Small cells - high Ki67