Flashcards in 08.26 - Lung Cancer (Nichols) - Questions Deck (80):
1
What percentage of heavy smokers get lung cancer
11%
2
What percentages of lung cancer do the 3 most common make?
Adeno 40%, Squamous 20%, Small Cell 15%
3
Location of Adeno, Squamous, and Small Cell
Peripheral, Central, Central
4
Which is most commonly associated with paraneoplastic?
Small Cell
5
Which is most associated with post-obstructive pneumonia
Squamous
6
Which is most associated with hypercalcemia
Squamous
7
Median age at presenation for all
70
8
In which types is cough more common
Squamous and Small Cell because central
9
Small Cell is typically treated by
Chemotherapy, unless limited to chest and mediastinal lymph nodes (add radiation)
10
__ for EGFR mutation
Erlotinib
11
Erlotinib
EGFR mutation
12
Crizotinib
Translocated ALK
13
Targets translocated ALK
Crizotinib
14
70% of nonsmokers with lung cancer have
Adenocarcinoma
15
In Adenocarcinoma, often mutations in ___ in never-smokers and ___ in smokers
EGFR-dependent pathway in never-smokers, KRAS-dependent pathway in smokers
16
KRAS mutations confer resistance to
Erlotinib
17
Type most likely to be responsive to targeted therapy
Adenocarcinoma
18
4 Gross Path features of Adeno
Peripheral, Solitary, Infiltrate pleura, Spiculated
19
Most common micro type of Adeno
Acinar
20
Adeno types with poor prognosis
Micropapillary, Solid
21
Adeno types with good prognosis
Lepidic
22
Treatment for Adenocarcinoma
Surgery if low stage, Targeted (Erlotinib, Crizotinib), Radiation + Double Chemo if inoperable
23
Adenocarcinomas are more likely to have ___ mutations and almost never have __ mutations
EGFR, KRAS
24
Adeno in Situ is characterized by
Non-destructive growth along intact alveolar septa (lepidic growth)
25
2 Types of Adeno In Situ and Pathogenesis
Non-mucinous from terminal respiratory unit cells (EGFR); Mucinous from Bronchiolar Epithelium (KRAS)
26
Gross Path of Adeno In Situ
Single or Multifocal Nodules, or pneumonia-like consolidation
27
Micro Path of Adeno In Situ
Replaces alveolar lining
28
Symptoms and Signs of Adeno In Situ
majority have none
29
Tx of Adeno In Situ
Surgery; Erlotinib or Crizotinib if applicable; Chemo
30
Two defining features of Squamous Cell
Keratinization and/or Intracellular Bridges
31
Pathogenesis of Squamous Cell
Squamous metaplasia of bronchial mucosa
32
Hypercalcemia
Squamous Cell
33
Paraneoplastic Syndrome
Small Cell
34
Gross Path of Squamous Cell
Central, Endobronchial (obstructive), Commonly met to local lymph nodes at presentation
35
Keratin Pearls
Squamous Cell
36
4 key features of Squamous Cell
Central, Endobronchial, Cavitating, Hemorrhage (Hemoptysis)
37
3 most common mutations in Small Cell
RB, RASSF1, Telomerase
38
Most aggressive type of lung cancer
Small Cell
39
Gross Path of Small Cells (4 features)
Central, Parabronchial, Already mets, Multifocal necrosis
40
1 common sign and symptom of small cell
Weight Loss, Edema
41
Tx of Small Cell
Chemo with platin + etoposide, usually with radiation
42
3 important concept points about Small Cell
Met at presentation, Responsive to chemo, rapidly fatal despite being responsive
43
3 most common primary sites of lung mets
Breast, Colon, Stomach
44
__ tend to met to lungs because spread hematogenously
Sarcomas
45
Size of mets vs primary in lungs
Smaller, rounder, more rapidly growing
46
Location of mets vs primary in lungs
Peripheral, less endobronchial, more rapidly growing
47
Lymphangitic Carcinomatosis
Mets can fill lymphatics and infiltrate interstitium with mass lesion
48
Micro Path of Mets
Adenocarcinoma
49
Treatment of Lung Mets
Cytotoxic Chemo, Targeteds
50
Carcinoid tumors are low-grade malignant ___ neoplasms
Neuroendocrine epithelial
51
Symptoms of Carcinoid
Persistent Cough, Hemoptysis
52
Epidemiology of Carcinoid Tumors
Under age 40, up to 40% nonsmokers
53
Gross Path of Carcinoid Tumors
Endobronchial polypoid mass or peripheral nodule
54
Pathogenesis of Mesothelioma
Deletion of CDKN2A/INK4A
55
Gross path of Mesothelioma
Soft, gelatinous, grayish tumor - Large pleural effusion
56
Signs of Mesothelioma
Unilateral dullness to percussion at base, decr breath sounds, asymmetric chest wall expansion
57
Chest pain is usually a sign of
chest wall involvement. And/or parietal pleura involvement.
58
Cancer most associated with smoking
Small Cell
59
Pattern of Adenocarcinoma that makes glands, with desmoplastic reaction
Acinar
60
Desmoplastic Reaction =
Fibrous tissue between glands
61
In clinical scenario of non-resolving pneumonia, think
adenocarcinoma in situ (resembles consolidation of pneumonia)
62
2/3 of squamous cell arise from
big central bronchi
63
Why does squamous cell cause obstructive symptoms
Endobronchial
64
Most likely to cavitate
Squamous
65
Commonly associated with post-obstructive pneumonia, abscess, bronchiectasis, mucus plugging, and atelectasis
Squamous Cell
66
3 things that cavitate
Squamous Cell, TB, Wegener's
67
50% of patients with metastatic lung cancer will have met in
adrenal glands
68
Central lesion on radiology =
Squamous Cell
69
Peripheral lesion on radiology =
Adenocarcinoma
70
Central lesion on radiology, but lesion small compared to adenopathy =
Small Cell
71
Cavitation =>
Squamous Cell
72
Salt and Pepper Nucleus
Small Cell Carcinoma
73
Fastest growing type
Small Cell
74
Which stages can be surgically resected
1 and 2
75
What is Stage 3
Nodes involved and/or locally really bad
76
Stage 4 means
mets
77
Treatment for Stage 3
Combined Chemo + Radiation
78
Structures that look like glands but aren't
Carcinoid Tumor
79
3 sites of mets to lungs per muthiah
Breast, Colon, Kidney
80