Flashcards in 42. Lung cancer Deck (99):
leading cause of cancer death
MC lung cancer
lung metastasis is most often from
1. breast 2. colon 3. prostate 4. bladder
sites of metastasis from lung cancer
1. adrenals 2. Brain 3. bone 4. liiver
lung cancer metastasis to liver - manifestation
lung cancer - presentation
3. bronchial obstruction
5. loss of weight
7. noncalcidied nodule on CT
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)
primary lung cancer is divided to
1. small cell caecinoma
2. Non- small cell
primary lung cancer - types ( small or non small?)
-Small cell (oat cell) carcinoma
- Non small cell
2.Squamous cell carcinoma
3. Large cell carcinoma
4. Bronchial carcinoid tumor
Location - Small cell (oat cell) carcinoma
Location - Squamous cell carcinoma
Location - Large cell carcinoma
lung metastasis on image
usually multiple lession
bronchial carcinoid tumor - location
central or peripheral
Small cell (oat cell) carcinoma may cayse / produce
1. ACTH (Cushing syndrome),
3.Antibodies against presynaptic Ca2+ channels (Lambert- Eaton myasthenic syndrome)
4. or neurons (paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration).
Small cell (oat cell) carcinoma - mangement
treat with chemotherapy +/- radiation
Small cell (oat cell) carcinoma - gene amplification
myc oncogenes common
Small cell (oat cell) carcinoma - aggressiveness
Small cell (oat cell) carcinoma is also called
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
Small cell (oat cell) carcinoma - histology positive to
Neuron specific enolase
Kultchitsky cells apperance
small dark blue cells
lung squamous cell carcinoma - histology
keratin pearls and intercellular bridges
lung squamous cell carcinoma - may cause/ produce
2. hypercalcemia ( produce PTHrP)
lung squamous cell carcinoma - CXR
Hilar mass arising from bronchus
Bronchial carcinoid tumor - histology
nest of neuroendocrine cells
chromogranin A positive
chromogranin A positive lung tumors
1. bronchial carcinoid tumor
2. lung small cell (oat cell) carcinoma
Bronchial carcinoid tumor - prognosis
Bronchial carcinoid tumor - metastasis
Bronchial carcinoid tumor - presentation . symptoms
1. symptoms due to mass effect
2. carcinoid syndrome ( flashing, diarrhea, wheezing)
Large cell carcinoma can secrete
Large cell carcinoma - histology
1. β-hCG secretion
2. pleomorphic giant cells
3. highly anaplastic undifferentiated tumor
Large cell carcinoma -prognosis
Large cell carcinoma - treatment
1. less responsive to chemotheapy
2. remove surfically
MC primary lung cancer
MC lung cancer in non smokers
lung adenocarcinoma is associated with ( paraneoplastic)
hypertrophic osteorathropathy (clubbing)
lung adenocarcinoma -histology
1. glandular pattern
2. often stains mucom (+)
adenocarcinoma in situ
bronchioarveolar subtype - CXR
1. g;amdural pattern
2 often stain mucin (+)
bronchioarveolar subtype - prognosis
bronchioarveolar subtype - histology
hazy infiltrates similar pneumonia
excellent prognosis lung tumors
1. bronchioalveolar subtype
2. Bronchial carcinoid tumor
lung tumor - c myc
small cell carcinoma
lung rumor - clubbing
lung tumor less responsive to chemotherapy
Large cell carcinoma
Small cell carcinoma on nervous system
Antibodies against presynaptic Ca2+ channels (Lambert-
Eaton myasthenic syndrome) or neurons (paraneoplastic
myelitis, encephalitis, subacute cerebellar degeneration)
lung tumor - similar to pneumonia CXR
lung tumor - β-hCG secretion
Large cell carcinoma
lung tumor - nests of neuroendocrine cells
Bronchial carcinoid tumor
Mc tumor in male smokers
swuamous cell lung
lung small cell carcinoma epidimiology
lung squamous cell carcinoma epidemiology
MC tumor in female smokers
large cell carcinoma - epidimiology
bronchioalveolar subtype - smoking
no relation ship
bronchial carcinoid tumor - smoking
Lung Ca - MC symptom
Lung Ca - proportion of cough / hemoptysis /dyspnea
cough --> 75%
hemoptysis --> 35%
dyspnea ---> 60%
Lung Ca - single most common area of metastasis
lung ca - metastasis to bone - labs
1. increased ALP
Lung Cs in CXR
pneumonic coin lession
lung Ca in CT
Lung cancer - effusions
primary lung cancers that have lesser association with smoking
1. Bronchial carcinoid
• What type of cancer is the leading cause of cancer death?
• 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)
• Name four common sites of metastases from primary lung cancer.
Brain, bone, liver, and adrenals
• In association with a primary lung cancer, what finding suggests bone metastases?
• 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)
• Metastases occur ____ (more/less) frequently than primary neoplasms when it comes to lung cancer.
• 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
• What are the common complications of lung cancer?
SVC syndrome, Pancoast tumor, Horner syndrome, Endocrine (paraneoplasia), Recurrent laryngeal nerve symptoms, Effusions (SPHERE)
• 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
• Which potential spaces can develop effusions as a result of lung cancer?
Pleural and pericardial spaceσ
• List two forms of bronchogenic carcinoma that tend to arise peripherally in the lungs.
Adenocarcinoma and large cell carcinoma
• List risk factors that lead to lung cancer.
Asbestos exposure, family history, radon, smoking, secondhand smoke
• 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)
• Name three possible products of neoplastic neuroendocrine cells in small cell carcinoma.
ACTH, SIADH, and Antibodies against presynaptic calcium channels or neurons
• 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)
• What is the treatment of small cell lung cancer?
This inoperable cancer is treated with chemotherapy
• 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)
• Name the non-small cell lung cancers.
Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, bronchial carcinoid tumor
• 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)
• What is the most common type of lung cancer in nonsmokers and women?
• Adenocarcinoma has mutations in the ____ oncogenes. Small cell carcinoma has mutations in ____ oncogenes.
KRAS, EGFR, ALK; myc
• What lung cancer is associated with hypertrophic osteoarthropathy?
• 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])
• Bronchioloalveolar adenocarcinoma can present similarly to what other noncancerous pathological lung disease?
• 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
• A patient is diagnosed with a squamous cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?
• 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
• What are the 3Cs of squamous cell carcinoma?
Cavitation, Cigarettes, and hypercalcemia (from parathyroid hormone–related protein)
• A patient is diagnosed with a large cell carcinoma of the lung. In which area of the lungs does this cancer type typically arise?
• What peripherally arising form of bronchogenic carcinoma is most anaplastic or undifferentiated?
Large cell carcinoma, which has a poor prognosis