Lung Neoplasms

Question 1

Which two lung cancers are chromogranin +ve?

Answer 1

-small cell lung ca, and

-bronchial carcinoid tumor

Question 2

Which lung cancers are tumors of neuroendocrine cells?

Answer 2

-small cell lung ca (NE Kulchitsky cells)

-large cell ca (pleomorphic giant cells)

-bronchial carcinoid tumor

Question 3

___ and ___ types of lung cancers are central in location.

Answer 3

SCLC and SCC.

MN: SCLC and SCC are Sentral!

Question 4

___ lung ca is a/w hypercalcemia d/t ___.

Answer 4

SCC;
d/t production of PTHrP by the squamous cancer cells.

Question 5

___ is the most common lung cancer overall.

Answer 5

adenocarcinoma

Question 6

___ is the most common lung cancer in females.

Answer 6

adenocarcinoma

Question 7

___ is the most common lung ca in non-smokers.

Answer 7

adenocarcinoma.

Question 8

Activating mutations of KRAS, EGFR, and ALK translocation are a/w ___ lung carcinoma.

Answer 8

adenocarcinoma.

Question 9

Lung ca often metastasize to ___ organs.

Answer 9

MN: Lungs to LABB!

Liver, adrenals, brain, and bone.

Question 10

What are the criteria for low malignancy risk in a solitary lung nodule?

Answer 10

Low risk
-size: < 8 mm
-Age < 45 years
-No smoking history
-smoking cessation since > 15 yrs.
-smooth nodule
-Central/uniform/popcorn calcification.

Question 11

What are the criteria for INTERMEDIATE malignancy risk in a solitary lung nodule?

Answer 11

INTERMEDIATE risk
-size: 8-20 mm
-Age: 45-60 years
-H/o smoking
-smoking cessation since 5- 15 yrs.
-nodule: scalloped

Question 12

What are the criteria for HIGH malignancy risk in a solitary lung nodule?

Answer 12

HIGH risk
-size: ≥ 20 mm
-Age > 60 years
-H/o smoking history
-smoking cessation since < 5 yrs.
-nodule: corona radiata or spiculated.
-absent/irregular calcification

Question 13

Pancoast tumors are ___ (explain).

Answer 13

are superior sulcus tumors (located at the apex of the lung adjacent to the subclavian vessels and nerve plexi.

Question 14

The most common initial symptom in a patient with a Pancoast tumor is ___.

Answer 14

shoulder pain +/- arm pain
d/t compression of the brachial plexus (C8-T2 radicular pain).

Question 15

Compression of the paravertebral sympathetic chain and inferior cervical ganglion (stellate) by a superior sulcus tumor causes the presentation of __.

Answer 15

horners syndrome

Question 16

SVC syndrome is characterized by __.

Answer 16

engorgement of the supraclavicular venous vessels and facial swelling d/t compression of the same by a pan coast tumor of the lung.

Question 17

Diagnostic testing via ___ procedure is indicated for suspected peripheral malignant lung lesions, and __ for suspected central lung lesions.

Answer 17

FNAC (CT-guided) for peripheral;

Bronchoscopy (biopsy/brushing) for central lesions.

Question 18

___ is indicated for the staging of lung cancers.

Answer 18

PET/CT.

Question 19

Dermatomyositis as a paraneoplastic syndrome is a/w which lung cancer?

Answer 19

All lung cancers

Question 20

Migratory thrombophlebitis and non-bacterial endocarditis are a/w which lung cancer?

Answer 20

adenocarcinoma

Question 21

Hypertrophic pulmonary osteoarthropathy including digital clubbing is a/w ___ lung ca.

Answer 21

all non-SCLCs

Question 22

The mainstay m/m of SCLC is ___.

Answer 22

chemotherapy (faster response).

SCLS is highly aggressive so patients usually present in advanced stages where surgical m/m may not yield curative results.

Question 23

What are some endocrine paraneoplastic syndromes a/w lung cancers? Which type of lung cancers are they a/w?

Answer 23

SCLC:
-Cushing syndrome (ACTH)
-SIADH –> HypoNa+
-peripheral neuropathy
-Lambert-Eaton syndrome
-SACD

SCC:
-Hypercalcemia (PTHrP)

LCLC:
-Gynecomastia

Question 24

Hypertrophic pulmonary osteoarthropathy is a skeletal paraneoplastic syndrome a/w ___ lung cancer.

Answer 24

NSCLC.

Question 25

___ and ___ systems are involved in paraneoplastic manifestations of all lung cancers.

Answer 25

Hematologic:
-anemia
-DIC
-Eosinophilia
-thrombocytosis
-hypercoagulability

Cutaneous:
Acanthosis nigricans