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Oncology > 15 & 16 - Lung Cancer > Flashcards

15 & 16 - Lung Cancer Flashcards

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1
Q

Second most common type of cancer in each men and women

A

Lung Cancer

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2
Q

Leading cause of cancer death

A

Lung Cancer

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3
Q

Screening - CT vs CXR

A

CT catches more, catches them earlier, helps more people survive

More false positives!! (noncalcified granulomas or benign intrapulmonary LN)

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4
Q

Cytology specimens

A

Fine needle aspiration

An assortment of cells

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5
Q

Core biopsy

A

Tissue in context!

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6
Q

Minimally invasive procedures

A

CT guided biopsy - FNA & Core, only peripheral

EBUS - EndoBronchial Ultrasound-Guided Something - FNA, but not Core. Central only. Can stage.

Electromagnetic navigational bronchoscopy - FNA & Core, Peripheral & Central, can’t stage, though

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7
Q

Classifications of Tumors in the Lung

A 
Epithelial
Mesenchymal
Lymphohistiocytic
Ectopic origin
Metastatic
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8
Q

Mesenchymal Tumors

A

Not epithelial cells

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9
Q

Most common Mesenchymal Tumor in Lungs

A

Hamartoma

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10
Q

Hamartoma

A

Tissue elements normally found in lung but occurring as disorganized proliferation
Benign

“Coin lesions” with popcorn calcifications
Well-circumscribed
Slow-growing

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11
Q

Hamartoma - Morphology

A

Varying amounts of mesenchymal elements (Cartilage, fat, connective tissue, bone)
Entrapped respiratory epithelium

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12
Q

Categories of Epithelial Tumors of the Lung

A

Neuroendocrine Tumors
XXX
XXX

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13
Q

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH

A 
Proliferation of neuroendocrine cells
Confined to mucos aof airways
Invade locally to form tumorlets
Develop into carcinoids
Rarely associated with small cell carcinoma and large cell neuroendocrine carcinoma
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14
Q

Neuroendocrine Tumors - Low-intermediate grade

A

Typical carcinoid

Atypical carcinoid

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15
Q

Neuroendocrine Tumors - High Grade

A

Small cell carcinoma

Large cell neuroendocrine carcinoma

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16
Q

Neuroendocrine - Typical Carcinoid

A

Central Airways > Peripheral
Well-circumscribed
Fill bronchial lumens

Morphology:
Monomorphic
Fine “salt and pepper” chromafin

Immunostains:
Synaptophysin
Chromogranin
CD56

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17
Q

Neuroendocrine - Small Cell Lung Cancer

A

Large central mass with bulky mediastinal adenopathy

Morphology:
Scant cytoplasm
Inconspicuous/Absent nucleoli
Nuclear molding
Crush artifact
Numerous mitoses
Immunostains:
Neuroendocrine markers
Synaptophysin
Chromogranin
CD56
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18
Q

Squamous Cell Carcinoma

A

Preinvasive: Squamous cell carcinoma in situ

Invasive: Keratinizing, Non-Keratinizing, Basaloid squamous cell carcinoma

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19
Q

Adenocarcinoma

A

Preinvasive: Atypical adenomatous hyperplasia (AAH), Adenocarcinoma in situ

Invasive: Adenocarcinoma, classification based on predominant subtype:
Lepidic, acinar, papillary, micropapillary, solid

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20
Q

Squamous Cell Carcinoma - Life cycle

A

Early:
Normal - Ciliated epithelium
Hyperplasia
Squamous metaplasia

Intermediate:
Dysplasia

Late:
Carcinoma in situ
Invasive carcinoma

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21
Q

Squamous Cell Carcinoma - Histo

A

Morphology:
Keratinization
Intercellular bridges

Immunostains:
P40
P63
CK5/6

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22
Q

Adenocarcinoma - Life Cycle

A

Pre-invasive:
Atypical Adenomatous Hyperplasia (AAH) (less than .5cm)
Adenocarcinoma in Situ (less than 3cm)

Invasive:
Minimally invasive adenocarcinoma

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23
Q

Adenocarcinoma - Histo

A

Morphology:
Glands/acini
(micro)papillae
Mucin

Immunostains
TIF-1
Napsin A

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24
Q

Which two molecular tests do you do on an adenocarcinoma?

Study These Flashcards
A

EGFR Mutation

ALK rearrangement

25
Large Cell Carcinoma
Non-small cell carcinoma Lacks cytological architectural and immunohistochemical features of small cell carcinoma, adenocarcinoma and squamous cell carcinoma Catch-all
26
Sarcomatoid Carcinoma
Pleomorphic Carcinoma | Non-small cell carcinoma, with at least 10% spindle and/or giant cells
27
Lung Metastases - Presentation
Single or multiple Lymphangitic Lung parenchyma or pleura>endobronchial mass
28
Lung Metastases - Common sites
``` Breast Prostate GI tract Gynecological Head & Neck ```
29
Lung Metastases - Pathological Diagnosis
Clinical Morphological Immunohistochemical
30
Lung Cancer Presentation - Local Symptoms
``` Cough Dyspnea Hemoptysis Chest pain Hoarseness (recurrent laryngeal nerve) SVC Syndrome Wheezing ```
31
Lung Cancer Presentation - Systemic Symptoms
Constitutional: Weight loss Malaise Skeletal: Clubbing Hypertrophic Pulmonary Osteoarthropathy Endocrine: SIADH (SCLC) Hypercalcemia (Squamous) Cushings Syndrome (SCLC) Neurologic: Horner's Syndrome Eaton-Lambert Syndrome (SCLC) Vascular: Hypercoagulable state of malignancy Thrombophlebitis DIC
32
NSCLC Staging - Determination
Size Invasion of adjacent structures Separate nodules with the same morphology
33
Lung Cancer - Clinical Staging
PET scan | MRI
34
TNM - Nodes N1 vs N2
``` N1 = Double Digit Station (more peripheral) N2 = Single Digit Station (more central) ```
35
Dr. Bosl's Rules of Cancer
It's not cancer until proven to be cancer If it's cancer, it's curable until proven otherwise If it's not curable, the cancer is treatable until proven otherwise Even if the cancer is not treatable, the patient is always treatable.
36
Definitive Management - Early Stage Disease
Surgery Anatomical resections: Pneumonectomy - High M&M, especially a right pneumonectomy. MAJOR functional consequences (60% function loss) Lobectomy - Preferred surgical option for most patients Lung-preserving surgery: Wedge Resection - Least morbidity, commonly done, but recurrence rate higher. Can be safe in patients with limited lung function. First surgical step if pathology is unclear. Techniques: Conventional open VATS (Video-Assisted Thoracoscopic Surgery) Robotic
37
Adjuvant Treatment
Given after surgery to decrease risk of recurrence Chemotherapy (eliminate micrometastatic disease) Radiotherapy (eliminate localized disease at resection margins/mediastinal nodes) Curative intent, but no guarantee
38
Lung Cancer - Adjuvant Treatment (Stage I - II)
Platinum Doublet No major difference in efficacy between various chemotherapy doublets in advanced disease ``` Cisplatin with: Premetrexed Docetaxel Gemcitabine Etc ``` 4cm cutoff for adjuvant chemotherapy
39
Lung Cancer - Adjuvant Treatment (Stage III)
Involves local and distant therapy Surgery → Adjuvant chemo → PORT Neoadjuvant Chemo → Surgery → +/- PORT Chemo + XRT → Surgery Chemo + XRT
40
PORT
Post-Operative RT When you discover mid-surgery that there is N2 lymph node involvement, causing them to be a higher stage than you thought. PORT has not been shown to improve survival Increases mortality in N0 and N1
41
Stage IIIB
Involvement of the contralateral lymph nodes Prognosis poor They are essentially at stage 4, so only treat with chemo & XRT or XRT alone. No surgery.
42
Platinum Doublets for Stage IIIB treatment
Cisplatin and Paclitaxel Cisplatin and Gemcitabine Cisplatin and Docetaxel Carboplatin and Paclitaxel Which platinum doublet is best? THEY ARE ALL THE SAME
43
Cisplatin - Mechanism
Platinum agent | Inhibits DNA synthesis by the formation of DNA cross-links, disrupts DNA function
44
Cisplatin - Side effects
``` Neurotoxicity Nausea/vomiting Ototoxicity Nephrotoxicity (must hydrate) Electrolyte disturbances ```
45
Paclitaxel - Mechanism
It's a taxane | Disrupts microtubule function (stabilizer), cell cycle arrest & apoptosis
46
Paclitaxel - Side Effects
``` Alopecia Decreased blood count Neuropathy Hypersensitivity reaction Arthralgias/myalgias Fatigue Nail changes ```
47
Pemetrexed - Mechanism of Action
Antimetabolite Inhibits folate-dependent enzymes involved in purine & pyrimidine synthesis: Thymidylate Synthase (TS) Dihydrofolate Reductase (DHFR) Glycinamide Ribonucleotide Formyltransferase (GARFT) Multi-targeted folate analogue Adenocarcinoma does better with this than other drugs
48
Premetrexed - Side Effects
``` Well tolerated, for the most part Decreased blood counts Nausea Fatigue Rash Supplementation with B12 and folic acid to reduce side effects. ```
49
EGFR Pathway
Member of the HER family of cell surface TKRs Downstream signaling via RAS/MAPK, PI3K/AKT pathways Inappropriate signaling leads to: Increased/uncontrolled cell proliferation Decreased apoptosis Enhanced cancer cell motility Angiogenesis
50
Lung cancer with an EGFR mutation
Predictive AND prognostic Better prognosis Responds well to an EGFR TKI
51
Give an EGFR TKI to Lung Cancer with EGFR mutation
Higher response rates in: Females Never smokers Asians
52
ALK+ NSCLC - Treatment
Crizotinib (WAY BETTER THAN CHEMO)
53
Small Cell Lung Cancer - Staging
Limited Vs Extensive stage disease based on radiation fields ``` Limited: 40% of patients 14 - 20 months median survival 40% 2-year survival 10 - 20% long-term survival ``` ``` Extensive: 60% of patients 8 - 12 months median survival 5 - 10% 2-year survival Very few long-term survivors ```
54
Limited Stage Small Cell Lung Cancer - Treatment
``` Surgery is rarely an option Standard of care: Chemo & XRT Chemo = Platinum + Etoposide (4 - 6 cycles) Concurrent > Sequential BID may be more effective than daily RT? ```
55
Limited Stage Small Cell Lung Cancer - During Remission
Give Prophylactic Cranial Irradiation (PCI) 10 - 30% of patients entering complete remission relapse with isolated CNS mets PCI (20 - 40 Gy) improves survival Long-term neuropsychiatric defects commonly noted
56
Extensive Stage SCLC
Very poor outcome 9 - 12 months medical survival Standard treatment is chemo (4 - 6 treatments of platinum/etoposide) 60 - 80% response rate Patients quickly relapse 2nd line chemotherapies provide only short-term benefits
57
Etoposide - Mechanism of action
Topoisomerase inhibitor Forms complex with DNA andtopoisomerase II Prevents re-ligation of DNA strands causing breakage
58
Etoposide - Side effects
``` Alopecia Nausea Decreased blood counts Fatigue Secondary leukemia ```

Oncology (23 decks)

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