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FA - Respiratory > Resp - Path (Lung cancer & Superior vena cava syndrome) > Flashcards

Resp - Path (Lung cancer & Superior vena cava syndrome) Flashcards

Pg. 609-610 in First Aid 2014 Sections include: -Lung cancer -Mesothelioma -Pancoast tumor -Superior vena cava syndrome

1
Q

What is the leading cause of cancer death?

A

Lung cancer is the leading cause of cancer death.

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2
Q

What is the physical presentation of lung cancer?

A

Presentation: cough, hemoptysis, bronchial obstruction, wheezing

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3
Q

How does lung cancer present on imaging?

A

pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT.

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4
Q

In the lung, is metastases or primary neoplasms more common?

A

In the lung, metastases (usually multiple) lesions are more common than primary neoplasms

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5
Q

What are the 4 most common cancers that metastasize to lung?

A

Most often from breast, colon, prostate, and bladder cancer

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6
Q

What are the 4 sites of metastases from lung cancer?

A

Sites of metastases from lung cancer - adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatosplenomegaly)

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7
Q

How might lung cancer metastases to the bone present? How about to the liver?

A

bone (pathologic fracture), liver (jaundice, hepatosplenomegaly)

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8
Q

What are 6 complications associated with lung cancer?

A

SPHERE of complications: (1) Superior vena cava syndrome (2) Pancoast tumor (3) Horner syndrome (4) Endocrine (paraneoplastic) (5) Recurrent laryngeal symptoms (hoarseness) (6) Effusions (pleural or pericardial)

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9
Q

Which lung cancer types are associated with smoking?

A

All lung cancer types except bronchial carcinoid are associated with smoking

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10
Q

Which lung cancers are located centrally?

A

Squamous and Small cell carcinoma are Sentral (central)

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11
Q

What are 5 types of lung cancer?

A

(1) Adenocarcinoma (2) Squamous cell carcinoma (3) Small cell (oat cell) carcinoma (4) Large cell carcinoma (5) Bronchial carcinoid tumor

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12
Q

What is the location of Adenocarcinoma in the lung?

A

Peripheral

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13
Q

What is the most common lung cancer in nonsmokers? What is the most common lung cancer overall?

A

Adenocarcinoma = Most common lung cancer in nonsmokers and overall (except for metastases)

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14
Q

Name 3 activating mutations for Adenocarcinoma of the lung.

A

Activating mutations include k-ras, EGFR, and ALK.

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15
Q

With what condition is Adenocarcinoma of the lung associated?

A

Associated with hypertrophic osteoarthropathy (clubbing).

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16
Q

What is another name for Bronchioloalverolar subtype of Adenocarcinoma of the lung? What is often seen on CXR in this case?

A

Bronchioalveolar subtype (adenocarcinoma in situ): CXR often shows hazy infiltrates similar to pneumonia

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17
Q

How is the prognosis for Bronchioloalveolar subtype of Adenocarcinoma of lung?

A

Excellent prognosis

18
Q

What is seen on histology in Bronchioloalveolar subtype of Adenocarcinoma of the lung?

A

Bronchioloalveolar subtype: grows along alveolar septa –> apparent “thickening” of alveolar walls

19
Q

Where is Squamous cell carcinoma of the lung located?

A

Central

20
Q

What kind of mass occurs in Squamous cell carcinoma of the lung, and where?

A

Hilar mass arising from bronchus

21
Q

What are 3 associations with Squamous cell carcinoma of the lung?

A

Cavitation; Cigarettes; hyperCalcemia (produces PTHrP)

22
Q

What is seen on histology of Squamous cell carcinoma of the lung?

A

Keratin pearls (dark pink) and intercellular bridges; Sheets of large dysplastic squamous cells surrounding dark, pink keratin pearls

23
Q

What is another name for Small cell carcinoma? What is its location?

A

Small cell (oat cell) carcinoma; Central

24
Q

What is the differentiation of small cell carcinoma? How aggressive is it?

A

Undifferentiated –> very aggresive

25
Q

What are 3 products that may result from Small cell (oat cell) carcinoma? Which of these is associated with a particular syndrome, and what is that syndrome?

A

May produce ACTH, ADH, or Antibodies against presynaptic Ca2+ channel (Lambert-Eaton myasthenic syndrome)

26
Q

Amplification of which genes is common is small cell (oat cell) carcinoma?

A

Amplification of myc oncogenes common.

27
Q

Is small cell (oat cell) carcinoma operable? How is it treated?

A

Inoperable; Treat with chemotherapy

28
Q

What is the histology of small cell (oat cell) carcinoma?

A

Neoplasm of neuroendocrine Kulchitsky cells –> small dark blue cells; Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and “salt and pepper” neuroendocrine-type chromatin

29
Q

Where is Large cell carcinoma of the lung located?

A

Peripheral

30
Q

Describe the differentiation and prognosis of Large cell carcinoma of the lung.

A

Highly anaplastic undifferentiated tumor; poor prognosis

31
Q

How is Large cell carcinoma of the lung treated/managed?

A

Less responsive to chemotherapy; removed surgically

32
Q

What kind of prognosis does Bronchial carcinoid tumor have?

A

Excellent prognosis

33
Q

How common is metastasis in Bronchial carcinoid tumor?

A

Metastasis rare

34
Q

What usually causes symptoms in Bronchial carcinoid tumor? What is an occasional symptom of which to be aware? What happens in this syndrome?

A

Symptoms usually due to mass effect; occasionally carcinoid syndrome (5-HT secretion –> flushing, diarrhea, wheezing)

35
Q

What is the histology of Bronchial carcinoid tumor?

A

Nests of neuroendocrine cells; chromogranin A (+)

36
Q

What is Mesothelioma, and with what is it associated?

A

Malignancy of the pleura associated with asbestosis

37
Q

What results from Mesothelioma?

A

Results in hemorrhagic pleural effusions and pleural thickening

38
Q

What is seen on histology in Mesothelioma?

A

Psammoma bodies seen on histology

39
Q

Describe the phenomena of Pancoast tumor and its possible effects.

A

Carcinoma that occurs in apex of lung may affect cervical sympathetic plexus, causing Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis), SVC syndrome, sensorimotor deficits, and hoarseness.

40
Q

What is superior vena cava syndrome, and what are its associated symptoms?

A

An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”), neck (jugular venous distention), and upper extremities (edema).

41
Q

What are 2 common causes of superior vena cava syndrome?

A

Commonly caused by malignancy and thrombosis from indwelling catheters.

42
Q

In general, what is the clinical approach to superior vena cava syndrome, and why?

A

Medical emergency. Can raise intracranial pressure (if obstruction severe) –> headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries.

FA - Respiratory (13 decks)

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