275 - Lung Cancer Flashcards

1
Q

Lung tumors can cause hoarseness by compressing which structure?

A

Laryngeal nerve

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2
Q

Describe the following for Adenocarcinoma of the lung

  • Location:
  • Biopsy finding:
  • Smoking Hx:
A
  • Location: Anywhere (Central or peripheral)
  • Biopsy finding: glandular structures
  • seen in smokers and non-smokers
    • Most common histology in never-smokers

Type of Non small cell lung cancer

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3
Q

What is the leading cause of cancer death in America?

A

Lung cancer

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4
Q

What stages of lung cancer can be treated with curative intent?

A

I - III

Late stage III and stage IV shoudl be treated with palliative intent

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5
Q

At what stage of lung cancer do patients often present?

A

Late stages (IV)

Early stages are often asymptomatic

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6
Q

In general, how do PDL1-inhibitors work?

A

Tumors that produce PDL1 turn off T-cells, which prevents them from fighting the tumor

PDL1 inhibitors block the tumor’s signaling, allowing T-cells to become activated against the tumor

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7
Q

What exposure is associated with mesothelioma?

A

Asbestos

Disease of the pleura

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8
Q

What kind of lung cancer is this?

A

Adenocarcinoma

Most common histology of NSCLC

A for Adeno - A lot (most common), Anyone (smokers and non-smokers), and Anywhere (central or peripheral)

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9
Q

In lung cancer, most paraneoplastic syndromes are associated with small cell lung cancer

What is one hormone NOT produced by SCLC? Which tumor produces it?

A

PTHrp

Squamous cell lung cancer (A type of NSCLC) produces PTHrp

Results in hypercalcemia without lytic bone lesions

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10
Q

Which type of lung cancer is most prevalent in the USA?

A

Non-small cell lung cancer

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11
Q

List 3 possible symptoms of a Pancoast tumor

A
  • Shoulder pain
  • Brachial plexopathy
  • Horner syndrome –> Ptosis, miosis, absence of facial sweating

Caused by nerve impingement

  • Note: Pancoast tumor refers to location in the apex of the lung, not a specific histological subtype*
  • Compare to SVC syndrome, which will have more signs of vascular compression: dilated collateral veins, facial plethora, extremity edema, headaches*
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12
Q

Wha is the most common type of lung cancer seen in never smokers?

A

Adenocarinoma

  • A type of NSCLC
  • Bronchioalviolar carcinoma is a subtype of adenocarcinoma
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13
Q

List 3 types of non-small cell lung cancer

A
  • Adenocarcinoma
    • Bronchioalviolar is a subtype of adenocarcinoma
  • Squamous cell
  • Large cell
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14
Q

List 5 common sites of metastases from lung cancer

A
  • Pleura
  • Bone
  • Brain/spine
  • Adrenals
  • Liver
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15
Q

List 3 substances that may be ectopically produced by SCLC

A

Paraneoplastic Syndromes:

  • ADH -> hyponatremia
  • ACTH -> Cushing syndrome (high cortisol)
  • Antibodies against pre-synpatic Ca2+ channel
  • > Lambert Eaton
    • Proximal muscle weakness, improves with stimulation
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16
Q

What is the difference between limited and extensive stage?

A

Limited = 1 hemithorax, all disease encompassed in a single radiation port

Extensive = larger than this

17
Q

Describe the following for Squamous cell lung cancer

  • Location:
  • Biopsy finding:
  • Smoking Hx:
A
  • Location: Central
  • Biopsy finding: Keratin pearls
  • Smoking Hx: Smokers (Rare in never-smokers)

**Associated with hypercalcemia - May secrete PTHrp**

Type of NSCLC

18
Q

Which type of lung cancer is most often associated with paraneoplastic syndromes?

A

Small cell lung cancer

19
Q

What kind of lung cancer is this?

A

Squamous cell carcinoma

C for Squamous cell - (bc the curve of the q looks like a c)

“Central, Cavitary, Calcium, Keratin”

20
Q

Describe the following for Small cell lung cancer

  • Location:
  • Biopsy finding:
  • Smoking Hx:
A
  • Location: Central
  • Biopsy finding: Small blue cells
  • Smoking Hx: Smokers (rare in never smokers)

**Associated with paraneoplastic syndromes**

21
Q

What kind of lung cancer is this?

A

Small cell lung cancer

S for Small cell - smokers, central, small blue cells, syndromes, agressive

Neuroendocrine cells are small and blue

22
Q

When working up a patient with suspected lung cancer, what is the most appropriate site to biopsy?

A

First, firgure out if there might be distant/metastatic disease

If so, biopsy that site

A biopsy from a metastatic site allows you to both diagnose and stage lung cancer

23
Q

List 4 symptoms of SVC syndrome

A
  • Facial plethora
  • Dilated collateral veins along the chest
  • Extremity edema
  • Headaches due to vascular congestion

Vs. Pancoast tumor, caused by nerve impingement, will likely have shoulder pain, nerve symptoms, and possible Horner syndrome

24
Q

What locations of the body are affected by mesothelioma?

A

Sites of pleura:

  • Peritoneal cavity
  • Tunica vaginalis
  • Pericardium

Associated with asbestos exposure

25
Q

If a patient presents with hypercalcemia without bone metastases, which ligand is most likely responsible?

A

PTRrp (Parathyroid hormone related peptide)

Produced by squamous cell lung cancer

26
Q

What are paraneoplastic syndromes?

A

Paraneoplastic syndromes can occur due to:

  • ectopic production of hormone (ADH, ACTH)
  • Development of antibodies (immune system producing antibodies against the tumor, but can attack healthy self tissue)
    • Ex) Lambert Eaton