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MCC > Wk 6 Lung Cancer > Flashcards

Wk 6 Lung Cancer Flashcards

1
Q

What % of lung cancers occurs in smokers?

A

85%

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2
Q

What are 2 primary mutagenic components of cigarette smoke?

A
  1. polycyclic aromatic hydrocarbons
  2. arsenic (increases risk of squamous cell carcinoma in lung)
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3
Q

Major cause of mesothelioma

A

asbestos

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4
Q

2 major types of lung cancer

A
  1. small cell carcinoma (SCLC)
  2. non-small cell lung cancer (NSCLC) - 85%
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5
Q

3 types of NSCLC

A
  1. adenocarcinoma - most common
  2. squamous cell carcinoma
  3. large cell carcinoma (less common)
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6
Q

What is the most common lung cancer of non-smokers?

A

adenocarcinoma 40-50% of lung cancers
-most common lung cancer in women (women>men)
-still associated w/ smoking
-peripheral

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7
Q

What mutations are seen in adenocarcinomas?

A

EGFR
KRAS
ALK

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8
Q

What are the 4 C’s for squamous cell carcinoma?

A

Centrally located
Cigarettes
Cavitary
Calcium abnormalities

Must have:
1. “squamous/keratin pearls”
-best prognosis
2. intercellular bridges (desmosomes)

-may produce PTHrP

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9
Q

What lung cancer has the worst prognosis?

A

Small cell carcinoma

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10
Q

S’s of small cell carcinoma

A

“Sentrally” located
Smoking
Suck - worst px
Syndromes (paraneoplastic like Lambert-Eaton syndrome, Cushing, SIADH)
Simple Staging
-often presents w/ something different - quickly invades lymphatics, BVs
-metastatic to brain, bone, liver

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11
Q

Clinic presentation for SCC

A

pulm symptoms
incidental finding on imaging
metastatic lesion complications - nausea, weakness
-paraneoplastic syndromes

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12
Q

acronym for SCC

A

SPHERE:
SVC syndrome
Pancoast tumor
Horner’s syndrome
Endocrine abnormalities
Recurrent laryngeal nerve dysfxn -> hoarseness
Effusions

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13
Q

Endocrine abnormalities and associated lung cancers

A
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14
Q

Most common adenocarcinoma mutation

A

EGFR

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15
Q

Genetic mutations in lung cancer

A

Dominant oncogenes: Ras, HER2/neu, C-myc, C-fos

Tumor Suppressor genes: p53, Rb, p16

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16
Q

What are 3 risks of lung cancer screening?

A
  1. false positives
  2. potential overdx for findings that may not have caused problems
  3. radiation exposure from repeated LDCT tests
17
Q

What are the 5 main types of lung cancer?

A
  1. small cell carcinoma
  2. adenocarcinoma (NSCLC)
  3. squamous cell carcinoma (NSCLC)
  4. large cell carcinoma (NSCLC)
  5. Carcinoid tumor (NSCLC)
18
Q

What is a pro-carcinogen?

A

Must be metabolized to become a carcinogen

19
Q

What is a ferrugenous body?

A

Asbestos fiber w/ macrophages on it
seen in mesothelioma

20
Q

What cancer is associated w/ asbestos?

A

Lung cancer first, mesothelioma second

21
Q

What is needed for dx of lung cancer?

A

biopsy

22
Q

What are 2 benign lung lesions?

A
  1. granuloma - can present as a coin lesion, often due to TB or fungus
  2. bronchial hamartoma (tissue that belongs in that area but is disorganized) - contains lung tissue and cartilage, often calcified on imaging
23
Q

Distinguishing differences b/w tx of small cell carcinoma and NSCC

A
  1. small cell - surgical resection does not work, but does for NSCC
  2. small cell tx w/ chemotherapy, NSCC usually does not respond well to chemo
24
Q

What are 2 key histological indicators of adenocarcinoma?

A
  1. glands
  2. mucin production
25
Q

2 key histological findings for squamous cell carcinoma

A
  1. keratin pearls
  2. intercellular bridges
26
Q

Characteristics of large cell carcinoma

A

Smoking
-poorly differentiated large cells
-central or peripheral
-poor px

27
Q

Characteristics of bronchioalveolar carcinoma

A

-columnar cells that grow along preexisting bronchioles and alveoli
-arise from Clara cells
- not related to smoking
- peripheral
- can present like pneumonia-like consolidation
- excellent px

28
Q

Characteristics of carcinoid tumor

A

Well differentiated neuroendocrine cells (compare to SCC, which is poorly differentiated neuroendocrine tumor)
-chromogranin positive
-not related to smoking
-often polyp-like mass in bronchus, central or peripheral
-low-grade malignancy
-rarely, but can cause carcinoid syndrome

29
Q

Describe histology of carcinoid tumor

A
30
Q

What does chromogranin + look like w/ carcinoid tumor?

A

Stains positive b/c it’s a neuroendocrine type tumor

31
Q

What are the most common types of metastasis to the lung?

A

breast and colon carcinoma

32
Q

What does metastasis to the lungs look like?

A

multiple cannonball nodules on imaging
-more common than primary tumor

33
Q

How is lung staging done?

A

TNM:
T: size and local extension of tumor
N: spread ot regional lymph nodes (hilar or mediastinal)
M: unique site of distant spread is the adrenal gland
-overall, 15% 5 yr survival

34
Q

What are 4 local complications w/ lung cancer?

A
  1. pleural involvement
  2. SVC obstruction (SVC syndrome)
  3. involvement of laryngeal (hoarseness) or phrenic nerve (diaphragmatic paralysis)
  4. compression of sympathetic chain (ptosis, meiosis, anhidrosis - Horner’s Syndrome) - esp w/ Pancos tumor (at the apex of the lung)
35
Q

What cells line the visceral and parietal pleura?

A

mesothelial cells - produce fluid in pleural space

36
Q

Characteristics of mesothelioma

A

=malignant neoplasm of mesothelial cells in pleural space
-assoc w/ asbestos exposure
-presents w/ recurrent pleural effusions, dyspnea, and chest pain
-tumor encases the lung

37
Q

Label the cancers

A

A. carcinoid tumor
B. squamous cell carcinoma
C. small cell carcinoma
D. adenocarcinoma

MCC (44 decks)

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