Sketchy Path: Lung Carcinoma

Question 1

Most cancers found in the lungs are actually ______________.

Answer 1

metastases (like the crab bra, the crab kidney bag, and the crab colon belt)

Question 2

Although most lung cancers are caused by smoking (like the guys smoking next to the red risky dice), there are other risk factors: __________________.

Answer 2

• Radiation (like the radioactive microwave)
• Pulmonary fibrosis (like the lung bonsai on their table)
• Workplace exposures (like the guy coughing in the crawl space)

Question 3

What age is most common for lung cancer?

Answer 3

60s (like the gray-haired old man)

Question 4

Lung cancer can cause what symptoms?

Answer 4

• Decreased appetite (old man who’s dropped his cake)
• Dyspnea (he can’t breathe)
• Weight loss (he’s really skinny)
• Chest pain (he’s clutching his chest)

Question 5

What signs are suggestive of lung cancer?

Answer 5

• Wheezing (party blower)
• Hemoptysis (bleeding ducts)
• Recurrent pneumonia (repeating bacteria party streamers)

Question 6

___________ lung cancers are more likely to cause hemoptysis.

Answer 6

Central (like how SCC and small cell are beneath the central ducts and have blood dripping in)

Question 7

_______________ occur almost exclusively in smokers.

Answer 7

SCC and small cell carcinoma (like the smoke drifting into those two cells)

Question 8

______________ is the number one lung cancer in non-smokers.

Answer 8

Adenocarcinoma (like the “No Smoking” sign in the dining DEN)

Question 9

Adenocarcinoma is most common in which demographic?

Answer 9

Women younger than 40

Question 10

Adenocarcinomas glands can appear as _____________.

Answer 10

mucinous, acinar, or papillary

Question 11

Adenocarcinoma in situ is said to have a _______________ growth pattern.

Answer 11

lepidic (meaning butterfly-like)

It forms glands that thicken the alveoli.

Question 12

Adenocarcinoma can produce __________.

Answer 12

mucus (like the guy coughing up mucus)

Question 13

In addition to being columnar, adenocarcinoma can present with ___________ cells.

Answer 13

cuboidal (like the purple jello cubes on the inmate’s plate)

Question 14

What metaplasia occurs prior to the development of squamous cell carcinoma?

Answer 14

Pseudostratified columnar to stratified squamous (like the pseudostratified columnar brick wall morphing into the stratified tile floor)

Question 15

Squamous dysplasia can present with ______________.

Answer 15

necrosis and keratin pearls (like the skull and pearls beneath the squamous tile)

Question 16

Which lung neoplasm has especially basophilic cells?

Answer 16

Small cell carcinoma (like the blue bubble wrap on the walls of the small cell)

Question 17

The chromatin pattern of small cell carcinoma is said to be __________________.

Answer 17

salt and pepper like (like the dotted granite in the small cell)

Question 18

Small cell carcinoma stains positive for ______________.

Answer 18

chromogranin (like the GRANite cell), synaptophysin (like the synapse wiring –because synaptophysin is a neuronal marker), and enolase

Question 19

Although small cell carcinoma is not amenable to surgery, it usually responds INITIALLY to ______________.

Answer 19

radiation and chemotherapy (like the nuclear window and the chemistry set in his cell)

Question 20

How does large cell carcinoma present histologically?

Answer 20

Large, anaplastic cells with prominent nucleoli (like the large man with the shining spot on his bald – anaplastic –head)

Question 21

Regional spread of lung cancers can lead to ________________.

Answer 21

• Pleural or pericardial effusions (like the guy with the wet shirt and wet briefcase)
• Pancoast tumors with Horner syndrome (like the Pancoast airline in the background and the prison horns with ganglia powering them)

Question 22

Pancoast invasion of the brachial plexus can lead to ____________.

Answer 22

pain in an ulnar distribution from invasion into C8 - T2

Question 23

What symptoms can result from mediastinal invasion?

Answer 23

• SVC syndrome (like the SVC hot air balloon above the mediastinal mast)
• Hoarseness due to impingement of the recurrent laryngeal nerve (like the horse with yellow reins)

Question 24

Small cell carcinoma can cause what two paraneoplastic syndromes?

Answer 24

• SIADH (like the spilled water jug)
• Lambert-Eaton myasthenic syndrome (guard unable to reach calcium because small cell inmate is grabbing his antibody keys)
• Antibodies against the cerebellar Purkinje cells (like the other guard removing his red turban to get the keys underneath)
• Cushing’s syndrome (like the cushion beneath the fat guard)

Question 25

LEMS presents with what kind of muscle weakness?

Answer 25

Symmetric proximal (like how the guard can’t rise from his chair)

Question 26

What paraneoplastic syndrome can adenocarcinoma cause?

Answer 26

Hypertrophic osteoarthropathy: sudden swelling and clubbing of the distal phalanges (like the guy’s swollen finger when the lunch lady hit him for trying to reach over the glass)

Question 27

What causes the hypercalcemia seen in SCC?

Answer 27

PTHrp (like the prisoner PRETENDING to be the PHd psychologist and stealing his ice cream)