Flashcards in 609 - 610 - Lung Cancer Deck (35)
How does lung cancer present?
4. bronchial obstruction
5. pneumonic "coin" lesion on x-ray film or noncalcified nodule on CT
Are primary neoplasms or metastases more common in the lungs?
What are the common sites of metastasis from lung cancer?
3. Bone (→ pathologic fracture)
4. Liver (→ jaundice, hepatomegaly)
What are the complications of lung cancer?
SPHERE of complications:
Superior vena cava syndrome
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)
What is the only type of lung cancer that is not associated with smoking?
Which lung cancers are centrally located?
Squamous and Small cell carcinomas are "Sentral"
What is the most common lung cancer in nonsmokers and overall (except for metastases)?
What mutations lead to adenocarcinoma?
activating mutations including k-ras, EGFR, adn ALK
What is the fancy medical term for clubbing?
What does chest x-ray show in the bornchioloalveolar subtype of adenocarcinoma (adenocarcinoma in situ)?
hazy infiltrates similar to pneumonia
What is the prognosis of bronchioloalveolar subtype adenocarcinoma (in situ)?
How does bronchioloalveolar subtype adenocarcinoma look histologically?
grows along alveolar septa → apparent "thickening" of alveolar walls
Is adenocarcinoma central or peripheral?
How does squamous cell carcinoma present?
Central: hilar mass arising from bronchus
hyperCalcemia (produces PTHrP)
What does squamous cell carcinoma look like hisotologically?
Intercellular bridges (made of desmosomes connecting the squamous cells)
What is the prognosis of small cell carcinoma?
very aggressive (b/c undifferentiated)
What type of cells comprise small cell carcinoma?
poorly differentiated neuroendocrine cells aka Kluchitsky cells which stain dark blue
How does small cell carcinoma look histologically?
Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and "salt and pepper" neuroendocrine-type chromatin
What are some gene products/amplifications that can be present in small cell carcinoma?
Antibodies against Ca2+ channels (LEMS)
Amplification of myc oncogenes common
What is the treatment for small cell carcinoma?
Chemotherapy -- surgery is not an option
Describe large cell carcinoma histologically
Highly anaplastic undifferentiated tumor with pleomorphic giant cells
What is the prognosis and treatment of large cell carcinoma?
Poor; less responsive to chemotherapy, remove surgically
What is the prognosis and rate of metastasis of bronchial carcinoid tumors?
Excellent; rarely metastasizes
What causes symptoms of bronchial carcinoid tumors?
1. Symptoms usually due to mass effect
2. Carcinoid syndrome (5-HT secretion → flushing, diarrhea, wheezing) occasionally
What does a broncial carcinoid tumor look like histologically?
Nests of well differentiated neuroendocrine cells [pathoma: classically form polyp-like mass in bronchus]
What stain can be used to identify bronchial carcinoid tumors?
What is mesothelioma and what classically causes it?
Malignancy of the pleura associated with asbestos
What are some complications of mesothelioma?
Hemorrhagic pleural effusions
What histological finding is present in mesothelioma?
What is a pancoast tumor?
A carcinoma that occurs in the apex of the lung
What syndromes/symptoms are associated with pancoast tumors?
1. Horner syndrome (due to damage of cervical sympathetic plexus)
2. SVC syndrome
3. Sensorimotor deficits
What is the superior vena cava syndrome?
Obstruction of the SVC → impairs blood drainage from the head ("facial plethora"), neck (JVD), and upper extremities (edema)
What is a major cause of SVC syndrome other than malignancy (pancoast tumor)?
thrombosis from indwelling catheters
What is the medical urgency level in SVC syndrome?