42. Lung cancer Flashcards Preview

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Flashcards in 42. Lung cancer Deck (99):
1

leading cause of cancer death

lung cancer

2

MC lung cancer

metastasis

3

lung metastasis is most often from

1. breast 2. colon 3. prostate 4. bladder

4

sites of metastasis from lung cancer

1. adrenals 2. Brain 3. bone 4. liiver

5

lung cancer metastasis to liver - manifestation

1. jaundice
2. hepatomegaly

6

lung cancer - presentation

1. cough
2. hemoptysis
3. bronchial obstruction
4. wheezing
5. loss of weight
6. anorexia
7. noncalcidied nodule on CT

7

Complication

mnemonic : SPHERE + dysphagia + phrenic nerve paresis - heart or pericardial invasion + pleural invasion
1. Superior vena cava
2. Pancoast tumor
3. Horner syndrome
4. Endocrine ( paraneoplastic)
5. recurrent laryngeal nerve compression (hoarse ness)
6. effusions ( pleural or pericardial)

8

Risk factors

1.smoking,
2.secondhand smoke,
3.radon,
4.asbestos,
5.family history
6. silicosis
8.coal

9

primary lung cancer is divided to

1. small cell caecinoma
2. Non- small cell

10

primary lung cancer - types ( small or non small?)

-Small cell (oat cell) carcinoma
- Non small cell

1. Adenocarcinoma
2.Squamous cell carcinoma
3. Large cell carcinoma
4. Bronchial carcinoid tumor

11

Location - Small cell (oat cell) carcinoma

central

12

Location -Adenocarcinoma

peripheral

13

Location - Squamous cell carcinoma

central

14

Location - Large cell carcinoma

peripheral

15

lung metastasis on image

usually multiple lession

16

bronchial carcinoid tumor - location

central or peripheral

17

Small cell (oat cell) carcinoma may cayse / produce

1. ACTH (Cushing syndrome),
2.SIADH, or
3.Antibodies against presynaptic Ca2+ channels (Lambert- Eaton myasthenic syndrome)
4. or neurons (paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration).

18

Small cell (oat cell) carcinoma - mangement

inoperable
treat with chemotherapy +/- radiation

19

Small cell (oat cell) carcinoma - gene amplification

myc oncogenes common

20

Small cell (oat cell) carcinoma - aggressiveness

very aggresive

21

Small cell (oat cell) carcinoma is also called

oat cell

22

Small cell (oat cell) carcinoma - histology

1. neoplasm of neuroendocrine Kultchitsky cells ( small dark blue cells(
2. chromogranin A positive
3. undifferentiated ( very aggreesive)
4. neuron specific enolase positive

23

Small cell (oat cell) carcinoma - histology positive to

chromonogranin A
Neuron specific enolase

24

Kultchitsky cells apperance

small dark blue cells

25

lung squamous cell carcinoma - histology

keratin pearls and intercellular bridges

26

lung squamous cell carcinoma - may cause/ produce

1. cavitation
2. hypercalcemia ( produce PTHrP)

27

lung squamous cell carcinoma - CXR

Hilar mass arising from bronchus

28

Bronchial carcinoid tumor - histology

nest of neuroendocrine cells
chromogranin A positive

29

chromogranin A positive lung tumors

1. bronchial carcinoid tumor
2. lung small cell (oat cell) carcinoma

30

Bronchial carcinoid tumor - prognosis

excellent

31

Bronchial carcinoid tumor - metastasis

rare

32

Bronchial carcinoid tumor - presentation . symptoms

1. symptoms due to mass effect
2. carcinoid syndrome ( flashing, diarrhea, wheezing)

33

Large cell carcinoma can secrete

β- hcG

34

Large cell carcinoma - histology

1. β-hCG secretion
2. pleomorphic giant cells
3. highly anaplastic undifferentiated tumor

35

Large cell carcinoma -prognosis

poor

36

Large cell carcinoma - treatment

1. less responsive to chemotheapy
2. remove surfically

37

MC primary lung cancer

adenocarcinoma

38

MC lung cancer in non smokers

adenocarcinoma

39

lung adenocarcinoma

1. KRAS
2. EGFR
3. ALK

40

lung adenocarcinoma is associated with ( paraneoplastic)

hypertrophic osteorathropathy (clubbing)

41

lung adenocarcinoma -histology

1. glandular pattern
2. often stains mucom (+)

42

adenocarcinoma in situ

bronchioarveolar subtype

43

bronchioarveolar subtype - CXR

1. g;amdural pattern
2 often stain mucin (+)

44

bronchioarveolar subtype - prognosis

excellent

45

bronchioarveolar subtype - histology

hazy infiltrates similar pneumonia

46

excellent prognosis lung tumors

1. bronchioalveolar subtype
2. Bronchial carcinoid tumor

47

lung tumor - c myc

small cell carcinoma

48

lung rumor - clubbing

adenocarcinoma

49

lung tumor less responsive to chemotherapy

Large cell carcinoma

50

Small cell carcinoma on nervous system

Antibodies against presynaptic Ca2+ channels (Lambert-
Eaton myasthenic syndrome) or neurons (paraneoplastic
myelitis, encephalitis, subacute cerebellar degeneration)

51

lung tumor - similar to pneumonia CXR

bronchioalveolar subtype

52

lung tumor - β-hCG secretion

Large cell carcinoma

53

lung tumor - nests of neuroendocrine cells

Bronchial carcinoid tumor

54

Mc tumor in male smokers

swuamous cell lung

55

lung small cell carcinoma epidimiology

male smokers

56

lung squamous cell carcinoma epidemiology

male smokers

57

MC tumor in female smokers

lung adenocarcinoma

58

large cell carcinoma - epidimiology

smokers

59

bronchioalveolar subtype - smoking

no relation ship

60

bronchial carcinoid tumor - smoking

no relationship

61

Lung Ca - MC symptom

cough (75%)

62

Lung Ca - proportion of cough / hemoptysis /dyspnea

cough --> 75%
hemoptysis --> 35%
dyspnea ---> 60%

63

Lung Ca - single most common area of metastasis

brain

64

lung ca - metastasis to bone - labs

1. increased ALP
2. hypercalcemia

65

Lung Cs in CXR

pneumonic coin lession

66

lung Ca in CT

noncalcified nodule

67

Lung cancer - effusions

1. Pleural
2. Pericardial

68

primary lung cancers that have lesser association with smoking

1. Bronchial carcinoid
2. Bronchioalveolar

69

• What type of cancer is the leading cause of cancer death?

Lung cancer

70

• A patient with a history of smoking has a cough and hemoptysis. Exam shows decreased breath sounds and wheezing. What do you suspect?

Lung cancer (a common clinical presentation is cough, bronchial obstruction, hemoptysis, and wheezing)

71

• Name four common sites of metastases from primary lung cancer.

Brain, bone, liver, and adrenals

72

• In association with a primary lung cancer, what finding suggests bone metastases?

Pathologic fractures

73

• A patient is diagnosed with the leading cause of cancer death. What two findings on physical exam might suggest liver metastases?

Jaundice and hepatomegaly (this is likely lung cancer, the leading cause of cancer death)

74

• Metastases occur ____ (more/less) frequently than primary neoplasms when it comes to lung cancer.


More

75

• A patient is found to have multiple pulmonary tumors. If these are metastatic, name the most common sites they would have originated from.

Breast, colon, prostate, bladder

76

• What are the common complications of lung cancer?

SVC syndrome, Pancoast tumor, Horner syndrome, Endocrine (paraneoplasia), Recurrent laryngeal nerve symptoms, Effusions (SPHERE)

77

• A patient with lung cancer experiences unexpected voice changes. How is it changing, and why might this be happening?


It can become hoarse, due to compression of the recurrent laryngeal nerve

78

• Which potential spaces can develop effusions as a result of lung cancer?

Pleural and pericardial spaceσ

79

• List two forms of bronchogenic carcinoma that tend to arise peripherally in the lungs.

Adenocarcinoma and large cell carcinoma

80

• List risk factors that lead to lung cancer.

Asbestos exposure, family history, radon, smoking, secondhand smoke

81

• A patient is diagnosed with an oat cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?

Centrally (small cell [oat cell] cancer is a very aggressive type of lung cancer)

82

• Name three possible products of neoplastic neuroendocrine cells in small cell carcinoma.

ACTH, SIADH, and Antibodies against presynaptic calcium channels or neurons

83

• An elderly smoker with hemoptysis and known lung cancer develops muscle weakness that improves with activity. What is the diagnosis?

Lambert-Eaton syndrome (a paraneoplastic syndrome associated with small cell carcinoma of the lung)

84

• What is the treatment of small cell lung cancer?

This inoperable cancer is treated with chemotherapy

85

• A smoker is newly diagnosed with lung cancer, which has myc amplification, and chromogranin A positivity on histology. Treatment?

Treat with chemotherapy, as it is usually inoperable (this patient has small cell [oat cell] cancer)

86

• Name the non-small cell lung cancers.


Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, bronchial carcinoid tumor

87

• A patient is diagnosed with lung cancer that is the most common nonsmoker subtype. In which area of the lungs does this typically arise?

Peripherally (this is adenocarcinoma of the lung)

88

• What is the most common type of lung cancer in nonsmokers and women?

Adenocarcinoma

89

• Adenocarcinoma has mutations in the ____ oncogenes. Small cell carcinoma has mutations in ____ oncogenes.





KRAS, EGFR, ALK; myc

90

• What lung cancer is associated with hypertrophic osteoarthropathy?

Adenocarcinoma

91

• A nonsmoker has cough, clubbing, and joint pain. Chest x-ray shows hazy infiltrates, suggesting cancer. Where is growth most likely to be?

Along alveolar septa giving an appearance of wall thickening (the patient has bronchoalveolar cancer [excellent prognosis])

92

• Bronchioloalveolar adenocarcinoma can present similarly to what other noncancerous pathological lung disease?

Pneumonia

93

• A woman has chest pain, dyspnea, and hemoptysis. Histology shows a glandular pattern and mucin (image). Did this woman smoke?

Unlikely, as this is adenocarcinoma, which classically arises in nonsmokers and women

94

• A patient is diagnosed with a squamous cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?

Centrally

95

• A patient with lung cancer has elevated calcium. Is the causative malignancy typically found centrally or peripherally?



Centrally, as this is squamous cell cancer, with release of parathyroid hormone–related peptide causing hypercalcemia

96

• What are the 3Cs of squamous cell carcinoma?

Cavitation, Cigarettes, and hypercalcemia (from parathyroid hormone–related protein)

97

• A patient is diagnosed with a large cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?

Peripherally

98

• What peripherally arising form of bronchogenic carcinoma is most anaplastic or undifferentiated?

Large cell carcinoma, which has a poor prognosis

99

• What is the usual approach to the treatment of large cell carcinoma of the lung?

Surgical removal (it is poorly responsive to chemotherapy)