Flashcards in 609 - 610 - Lung Cancer Deck (35):
1
How does lung cancer present?
1. cough
2. hemoptysis
3. wheezing
4. bronchial obstruction
5. pneumonic "coin" lesion on x-ray film or noncalcified nodule on CT
2
Are primary neoplasms or metastases more common in the lungs?
metastases
3
What are the common sites of metastasis from lung cancer?
1. Adrenals
2. Brain
3. Bone (→ pathologic fracture)
4. Liver (→ jaundice, hepatomegaly)
4
What are the complications of lung cancer?
SPHERE of complications:
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)
5
What is the only type of lung cancer that is not associated with smoking?
bronchial carcinoid
6
Which lung cancers are centrally located?
Squamous and Small cell carcinomas are "Sentral"
7
What is the most common lung cancer in nonsmokers and overall (except for metastases)?
Adenocarcinoma
8
What mutations lead to adenocarcinoma?
activating mutations including k-ras, EGFR, adn ALK
9
What is the fancy medical term for clubbing?
hypertrophic osteoarthropathy
10
What does chest x-ray show in the bornchioloalveolar subtype of adenocarcinoma (adenocarcinoma in situ)?
hazy infiltrates similar to pneumonia
11
What is the prognosis of bronchioloalveolar subtype adenocarcinoma (in situ)?
Excellent
12
How does bronchioloalveolar subtype adenocarcinoma look histologically?
grows along alveolar septa → apparent "thickening" of alveolar walls
13
Is adenocarcinoma central or peripheral?
peripheral
14
How does squamous cell carcinoma present?
Central: hilar mass arising from bronchus
Cavitation
hyperCalcemia (produces PTHrP)
Cigarette smokers
15
What does squamous cell carcinoma look like hisotologically?
Keratin pearls
Intercellular bridges (made of desmosomes connecting the squamous cells)
16
What is the prognosis of small cell carcinoma?
very aggressive (b/c undifferentiated)
17
What type of cells comprise small cell carcinoma?
poorly differentiated neuroendocrine cells aka Kluchitsky cells which stain dark blue
18
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
19
What are some gene products/amplifications that can be present in small cell carcinoma?
ACTH
ADH
Antibodies against Ca2+ channels (LEMS)
Amplification of myc oncogenes common
20
What is the treatment for small cell carcinoma?
Chemotherapy -- surgery is not an option
21
Describe large cell carcinoma histologically
Highly anaplastic undifferentiated tumor with pleomorphic giant cells
22
What is the prognosis and treatment of large cell carcinoma?
Poor; less responsive to chemotherapy, remove surgically
23
What is the prognosis and rate of metastasis of bronchial carcinoid tumors?
Excellent; rarely metastasizes
24
What causes symptoms of bronchial carcinoid tumors?
1. Symptoms usually due to mass effect
2. Carcinoid syndrome (5-HT secretion → flushing, diarrhea, wheezing) occasionally
25
What does a broncial carcinoid tumor look like histologically?
Nests of well differentiated neuroendocrine cells [pathoma: classically form polyp-like mass in bronchus]
26
What stain can be used to identify bronchial carcinoid tumors?
chromogranin A
27
What is mesothelioma and what classically causes it?
Malignancy of the pleura associated with asbestos
28
What are some complications of mesothelioma?
Hemorrhagic pleural effusions
Pleural thickening
29
What histological finding is present in mesothelioma?
psammoma bodies
30
What is a pancoast tumor?
A carcinoma that occurs in the apex of the lung
31
What syndromes/symptoms are associated with pancoast tumors?
1. Horner syndrome (due to damage of cervical sympathetic plexus)
2. SVC syndrome
3. Sensorimotor deficits
4. Hoarseness
32
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)
33
What is a major cause of SVC syndrome other than malignancy (pancoast tumor)?
thrombosis from indwelling catheters
34
What is the medical urgency level in SVC syndrome?
Emergency
35