SM 183 Lung Cancer

Question 1

Which type of lung cancer involves keratin pearls?

Answer 1

Squamous cell carcinoma

Question 2

How does early stage Lung Cancer present and how is it detected?

Answer 2

Early stage Lung Cancer is often asymptomatic and detected incidentally or via Lung Cancer screening

Question 3

What are the traits of Adenocarcinoma, with respect to cellular origin, location, and relationship to smoking?

Answer 3

Derived from gland cells, may be found centrally or peripherally, and seen in both smokers and non-smokers

Question 4

Which type of lung cancer involves densely packed blue cells?

Answer 4

Small Cell Carcinoma

Question 5

What are the traits of Small Cell Lung Cancer, with respect to cellular origin, location, and relationship to smoking?

Answer 5

Aggressive neuroendocrine tumors, found centrally and occur in smokers, associated with most paraneoplastic syndromes

Question 6

What is a Pancoast tumor?

Answer 6

An apical tumor that causes nerve impingement, with symptoms varying by site of involvement

Question 7

What is extensive Small Cell Lung Cancer?

Answer 7

Extensive Small Cell lung cancer extends beyond a single hemithorax and anything outside of the chest, cannot be cured

Question 8

What is Mesothelioma?

Answer 8

A pleural cancer that occurs due to Asbestos exposure

Question 9

What are the two large categories of Lung Cancer?

Answer 9

Small cell lung cancer and non-small cell lung cancer

Question 10

Which tumors are central?

Answer 10

Small cell and Squamous Cell (smoking related)

Question 11

Can biopsies prove stage of disease?

Answer 11

Yes

Question 12

What questions should be asked when treating a patient for Lung Cancer?

Answer 12

What stage is the patient? Is the disease curable or not curable? What can the patient tolerate?

Question 13

Which tumors are peripheral?

Answer 13

Adenocarcinoma (smokers and non-smokers) as well as Large Cell

Question 14

What type of Lung Cancer are paraneoplastic syndromes associated with?

Answer 14

Small cell lung cancer, except for PTHrp, which is associated with Squamous cell lung cancer

Question 15

What causes horseness in Lung Cancer?

Answer 15

Compression of the recurrent Laryngeal nerve by a Lung Cancer

Question 16

Where can Lung Cancer metastasize to?

Answer 16

Lung Cancer can spread to the pleura, bone, brain/spine, and liver

Question 17

What should be done if metastatic disease is suspected?

Answer 17

A biopsy of a distant site should be done if metastatic disease is suspected to confirm diagnosis and stage

Question 18

What is Miosis?

Answer 18

Constricted pupils due to a mass effect from an apical Lung Cancer on a stellate ganglion, seen in Horner’s Syndrome

Question 19

What is HOA?

Answer 19

A paraneoplastic syndrome associated with Lung Cancer that presents as a triad of distal clubbing, arthralgias, and large finger nails

Question 20

What type of lesion does Lung Cancer produce?

Answer 20

A “coin lesion”, but it can look like anything

Question 21

What information is obtained from a lung cancer biopsy?

Answer 21

Histology (cell of origin), Molecular Analysis (what is driving the tumor), and PDL1 Analysis (tumor interaction with the immune system)

Question 22

What type of Lung Cancer is this and why?

Answer 22

Adenocarcinoma, due to lots of gland cells

Question 23

What is required to diagnose Lung Cancer?

Answer 23

Tissue sampling is required to diagnose Lung Cancer

Question 24

How do paraneoplastic syndrome’s manifest in Lung Cancer?

Answer 24

Paraneoplastic syndromes in lung cancer involve the ectopic production of hormones, such as ADH, ACT, and PHTrp

Question 25

At what stage will most patients present with Lung Cancer?

Answer 25

Most patients with lung cancer present with advanced disease

Question 26

What is the leading cause of cancer related mortality in the US?

Answer 26

Lung cancer, the second most commonly diagnosed cancer in men and women

Question 27

What type of Lung Cancer is this and why?

Answer 27

Squamous Cell Carcinoma, due to Keratin Pearl

Question 28

What is limited Small Cell Lung Cancer?

Answer 28

Limited Small Cell lung cancer is confined to a single hemithorax

Question 29

What is Small Cell Lung Cancer associated with?

Answer 29

Smokers, rapid/aggressive growth, paraneoplastic syndromes (except PTHrp), staged as Limited or Extensive

Question 30

What can paraneoplastic syndromes in Lung Cancer result in?

Answer 30

Ectopic production of Hormones and Development of Antibodies

Question 31

What is SVC Syndrome?

Answer 31

Occurs when a Lung Cancer obstructs the SVC, leading to facial redness and dilated collateral veins along the chest

Question 32

What paraneoplastic syndrome is Squamous Cell Carcinoma associated with?

Answer 32

PTHrp = Parathyroid Hormone related protein, which causes hypercalcemia and hypophosphatasia

Question 33

What are the main risk factors for Lung Cancer?

Answer 33

Tobacco, though environmental factors like asbestos and radiation therapy also plays a role

Question 34

How do we prevent lung cancer?

Answer 34

Smoking cessation

Question 35

What is Horner's Syndrome?

Answer 35

Horner's Syndrome occurs when a Lung Cancer compresses a Stellate Ganglion, leading to constricted pupils, drooping of the upper eyelid, and absence of sweating

Question 36

Where is Adenocarcinoma found?

Answer 36

Both centrally and peripherally

Question 37

What are the signs and symptoms of late stage Lung Cancer?

Answer 37

Cough, Weight Loss, Dyspnea, Chest Pain, Hemoptysis

Question 38

What type of lung cancer is this and why?

Answer 38

Small cell lung cancer, due to small densely packed blue cells

Question 39

What is Anhidrosis?

Answer 39

Absence of sweating in the face, due to a mass effect from an apical Lung Cancer on a stellate ganglion, as seen in Horner's Syndrome

Question 40

What is a Paraneoplastic syndrome?

Answer 40

A paraneoplastic syndrome is a syndrome mediated by humoral factors secreted by a tumor itself, or the immune response against a tumor

Question 41

What are the traits of Squamous Cell Carcinoma, with respect to cellular origin, location, and relationship to smoking?

Answer 41

Occurs in squamous cells, found centrally near hilum, and occurs primarily in smokers

Question 42

What are the subtypes of non-small cell lung cancer?

Answer 42

Adenocarcinoma, squamous cell carcinoma, and large cell carcinoma

Question 43

What are Carcinoid tumors?

Answer 43

Neuroendocrine tumors that can overproduce Serotonin

Question 44

How does Lung Cancer cause Lambert Eaton?

Answer 44

Lung Cancer causes the production of antibodies against presynaptic Cav channels in the synapse, which prevent the release of ACh, as a result of a paraneoplastic syndrome

Question 45

Do all patients with Lung Cancer smoke?

Answer 45

Nope, you can get Lung Cancer without ever smoking

Question 46

Is Adenocarcinoma found in smokers or non-smokers?

Answer 46

Adenocarcinoma is found in both smokers and non-smokers

Question 47

What paraneoplastic syndromes are found in Small Cell Lung Cancer?

Answer 47

All of them, except for PTHrp, which occurs in Squamous Cell Carcinoma

Question 48

What is Ptosis?

Answer 48

Ptosis is drooping of the upper eyelid due to a mass effect from an apical Lung Cancer on a stellate ganglion, as seen in Horner's Syndrome

Question 49

What symptoms can a Pancoast tumor cause, and what determines the symptoms?

Answer 49

Pancoast tumors can cause shoulder pain, brachial plexus, and Horner's syndrome