609 - 610 - Lung Cancer

Question 1

How does lung cancer present?

Answer 1

1. cough
2. hemoptysis
3. wheezing
4. bronchial obstruction
5. pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT

Question 2

Are primary neoplasms or metastases more common in the lungs?

Answer 2

metastases

Question 3

What are the common sites of metastasis from lung cancer?

Answer 3

1. Adrenals
2. Brain
3. Bone (→ pathologic fracture)
4. Liver (→ jaundice, hepatomegaly)

Question 4

What are the complications of lung cancer?

Answer 4

SPHERE of complications:
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)

Question 5

What is the only type of lung cancer that is not associated with smoking?

Answer 5

bronchial carcinoid

Question 6

Which lung cancers are centrally located?

Answer 6

Squamous and Small cell carcinomas are “Sentral”

Question 7

What is the most common lung cancer in nonsmokers and overall (except for metastases)?

Answer 7

Adenocarcinoma

Question 8

What mutations lead to adenocarcinoma?

Answer 8

activating mutations including k-ras, EGFR, adn ALK

Question 9

What is the fancy medical term for clubbing?

Answer 9

hypertrophic osteoarthropathy

Question 10

What does chest x-ray show in the bornchioloalveolar subtype of adenocarcinoma (adenocarcinoma in situ)?

Answer 10

hazy infiltrates similar to pneumonia

Question 11

What is the prognosis of bronchioloalveolar subtype adenocarcinoma (in situ)?

Answer 11

Excellent

Question 12

How does bronchioloalveolar subtype adenocarcinoma look histologically?

Answer 12

grows along alveolar septa → apparent “thickening” of alveolar walls

Question 13

Is adenocarcinoma central or peripheral?

Answer 13

peripheral

Question 14

How does squamous cell carcinoma present?

Answer 14

Central: hilar mass arising from bronchus
Cavitation
hyperCalcemia (produces PTHrP)
Cigarette smokers

Question 15

What does squamous cell carcinoma look like hisotologically?

Answer 15

Keratin pearls
Intercellular bridges (made of desmosomes connecting the squamous cells)

Question 16

What is the prognosis of small cell carcinoma?

Answer 16

very aggressive (b/c undifferentiated)

Question 17

What type of cells comprise small cell carcinoma?

Answer 17

poorly differentiated neuroendocrine cells aka Kluchitsky cells which stain dark blue

Question 18

How does small cell carcinoma look histologically?

Answer 18

Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and “salt and pepper” neuroendocrine-type chromatin

Question 19

What are some gene products/amplifications that can be present in small cell carcinoma?

Answer 19

ACTH
ADH
Antibodies against Ca2+ channels (LEMS)
Amplification of myc oncogenes common

Question 20

What is the treatment for small cell carcinoma?

Answer 20

Chemotherapy – surgery is not an option

Question 21

Describe large cell carcinoma histologically

Answer 21

Highly anaplastic undifferentiated tumor with pleomorphic giant cells

Question 22

What is the prognosis and treatment of large cell carcinoma?

Answer 22

Poor; less responsive to chemotherapy, remove surgically

Question 23

What is the prognosis and rate of metastasis of bronchial carcinoid tumors?

Answer 23

Excellent; rarely metastasizes

Question 24

What causes symptoms of bronchial carcinoid tumors?

Answer 24

1. Symptoms usually due to mass effect

2. Carcinoid syndrome (5-HT secretion → flushing, diarrhea, wheezing) occasionally

Question 25

What does a broncial carcinoid tumor look like histologically?

Answer 25

Nests of well differentiated neuroendocrine cells [pathoma: classically form polyp-like mass in bronchus]

Question 26

What stain can be used to identify bronchial carcinoid tumors?

Answer 26

chromogranin A

Question 27

What is mesothelioma and what classically causes it?

Answer 27

Malignancy of the pleura associated with asbestos

Question 28

What are some complications of mesothelioma?

Answer 28

Hemorrhagic pleural effusions | Pleural thickening

Question 29

What histological finding is present in mesothelioma?

Answer 29

psammoma bodies

Question 30

What is a pancoast tumor?

Answer 30

A carcinoma that occurs in the apex of the lung

Question 31

What syndromes/symptoms are associated with pancoast tumors?

Answer 31

1. Horner syndrome (due to damage of cervical sympathetic plexus) 2. SVC syndrome 3. Sensorimotor deficits 4. Hoarseness

Question 32

What is the superior vena cava syndrome?

Answer 32

Obstruction of the SVC → impairs blood drainage from the head ("facial plethora"), neck (JVD), and upper extremities (edema)

Question 33

What is a major cause of SVC syndrome other than malignancy (pancoast tumor)?

Answer 33

thrombosis from indwelling catheters

Question 34

What is the medical urgency level in SVC syndrome?

Answer 34

Emergency

Question 35

What are the complications of SVC syndrome?

Answer 35

↑ intracranial pressure (if obstruction severe) → headaches, dizziness, and ↑ risk of aneurism/rupture of intracranial arteries