08.26 - Lung Cancer (Nichols) - Questions Flashcards Preview

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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

Soft, gelatinous, grayish

Think mesothelioma