Tumors of Lung Flashcards
How many years after smoking do your cancer risk return to control levels?
10 years
What potential carcinogens are in tobacco smoke?
initiator (benzopyrene)
promoter (phenol derivatives)
What asbestos + smoking cancer risk?
50 to 90 times greater risk than gen. pop.
What indoor air pollution may be responsible for non-smokers lung cancer?
radon exposure -ubiquitous radioactive gas
What oncogenes are associated with small cell carcinoma?
c-myc
What oncogenes are associated with adenocarcinoma?
K-ras
EGFR
EML4-ALK
What does benzopyrene cause DNA damage at what codon?
same codons of p53 gene as seen in mutations in clinical lung cancers
What is a pancoast tumor?
tumor at extreme apex of lung
SVC syndrome
or honrers
What are the types of non small cell carcinoma
squamous cell carcinoma adenocarcinoma -glandular -papillary -solid -bronchioloaveolar Large cell carcinoma adenosquamous carcinoma
What is small cell carcinoma vs non small cell carcinoma?
treatment decisions
small cell very responsive to chemotherapy but surgery doesnt work
non small cell carcinoma treat with resection and chemo
What is contraindicated in squamous cell carcinoma?
bevacuzimab; toxicity can cause hemorrhage
What is the mutations that lead to response to erlotinib and gefitinib?
EGFR mutation
What cause resistance to erlotinib and gefitinib?
KRAS mutation
What is pemextrexed used to treat?
non squamous cell carcinoma
What are the morphology of squamous cell carcinoma?
central cavitary necrosis
males common
arise centrall; usually endobronchial, polypoid growth
What is the histology of squamous cell carcinoma?
keratin formation, intercellular bridges, atypia and invasion
large groups and nests of round, oval and polyhedral cells; squamous pearls
What is adenocarcinoma morphology?
most common type in women and non-smokers
peripheral with pleural retratction or puckering associated with scarring
slow growing with metastasize
asymptomatic
What is bronchioalveolar carcinoma?
subset of adenocarcinoma
single peripheral nodule or multiple nodules or diffuse pneumonia
What is the histology of bronchioalveolar carcinoma?
lepidic spread-spread along alveolar septa
nonmucinous (clara cells, type II pneumocytes)
mucinous(tal columnar mucinous cells)
What are the small cell carcinoma details?
predominant in males, smokers,
central location
highly malignant, median survival
submucosal/circumferential infiltration; rare endobronchial polypoid growth
extensive necrosis, secretory granules of neuroendocrine type
paraneoplastic syndrome
How does small cell carcinoma appear on histology?
lymphocytic appearance
What does large cell carcinoma appearance
large cells without differentiation
ultrastrucutral evidence of glandular or squamous differntiation
What is giant cell carcinoma?
highly malignant
mostly peripheral
Where do bronchogenic carcinoma metastasize?
hilar lymph nodes adrenal glands liver brain bone
What are the classification of small cell carcinoma
limited disase (hemithorax with/without LN involvement) Extensive disease (contralateral lung, distant metastasis)
What are the staging of non small cell carcinoma?
TNM
Tumor size
Node involvmenet
mtastasis
What is paraneoplastic syndrome?
symptom complexes that occur in pt with cancer that cannot be explained by spread or elaboration of horomones by tumor cell
What is the importance of paraneoplastic syndrome
earliest manifestation of occult neoplasm
signficant problems
may mimic metastaes and be difficult to treat
What are the small cell carcinoma associated paraneoplasms?
cushings (ACTH)
hyponatremia (innappropiate ADH secretion)
Carcinoid syndrome (serotonin)
Myasthenic syndrome (eaton-lambert syndrome)
What are the paraneoplasms associated with squamous cell carcinoma?
hypercalcemia (parathoromone)
What is the microscopic appearance of a carcinoid tumor?
nests/cords/masses
uniform cells with round nuclei
salt and pepper chromatin
IHC: NSE, chromogranin, synaptophysin +
What are the clinical course and prognosis of carcinoid tumors?
hemoptysis, cough, obstructive symptoms (intraluminal growth) –infections, bronchiectasis, atelactasis or emphysema
carcinoid syndrome -intermittent diarrhea, flushing nad cyanosis
metastases rare
benign course and amendable to resection
