9.8 Lung Cancer

Question 1

What organ is unique site of metastasis for lung cancer?

Answer 1

adrenal gland

Question 2

Polyp-like mass in the bronchus:

-what to suspect

Answer 2

Carcinoid tumor, classic presentation

Question 3

lung cancer: where does it rank among cancer deaths

Answer 3

1 cause of cancer death in USA

Question 3

Lung carcinoma:

divided into what 2 types:

Answer 3

1. small cell (15%)–use chemo, no surgery
2. non-small cell (85%)–tx with surgery upfront, does not respond well to chemo

Question 3

most common lung tumor:

1. male smokers
2. female smokers
3. nonsmokers

Answer 3

1. squamous cell carcinoma
2. adenocarcinoma
3. adenocarcinoma

Question 4

Lung cancer:

-main risk factors (3)

Answer 4

1. smoking (85% of lung cancer)
2. Radon–radioactive decay of uranium in soil. Accumulates in basements, also seen in uranium miners
3. asbestos (remember, in asbestosis more likely to get lung cancer than mesothelioma)

Question 5

Adenocarcinoma

1. histology
2. association
3. location
4. complications, comments

Answer 5

1. Glands or mucin
2. female smokers, nonsmokers
3. peripheral
4. no paraneoplastic syndrome

Question 6

What is characteristic of lung hamartoma composition?

Answer 6

combo of lung tissue and cartilage. often calcified on imaging.

Question 7

TNM staging of lung cancer:

what are 3 things to consider in the T category

Answer 7

T: Tumor size/local spread

1. pleural involvement (more likely in peripheral tumors like adenocarcinoma)
2. SVC obstruction
3. nerve involvement (recurrent laryngeal–hoarseness, phrenic–breathing paralysis)

Question 8

lung cancer:

what are 2 most common cancers that metastasize to lung?

Answer 8

1. colon
2. breast

Question 9

Non-small cell carcinoma:

-list types (5) by most common

Answer 9

1. adenocarcinoma (40%)
2. squamous cell carcinoma (30%)
3. large cell carcinoma (10%)
4. carcinoid tumor (5%)
5. bronchioloalveolar carcinoma

Question 9

Pt presents with distended head/neck veins, edema, blue arms and face.

What’s happening, and how can a lung issue cause this?

Answer 9

SVC syndrome

-lung tumor compresses superior vena cava

Question 11

what carcinogens to know in cigarettes: (2)

Answer 11

1. polycyclic aromatic hydrocarbons
2. arsenic–squamous cell carcinoma risk

Question 13

Pt with coin lesion CXR, calcified.

-think what?

Answer 13

Lung Hamartoma, calcified.

-benign, composed of lung tissue and cartilage, often calcified

Question 14

Which tumor can present with pneumonia-like consolidation on imaging?

Answer 14

Bronchioloalveolar carcinoma

Question 15

which lung tumor is most likely to cause pleural involvement? why?

Answer 15

adenocarcinoma (female smokers and nonsmokers) b/c it’s peripheral

Question 16

Which lung tumors are:

1. central
2. peripheral
3. central or peripheral

(2 each)

Answer 16

1. (‘S’) small cell, squamous cell
2. adenocarcinoma, bronchioloalveolar
3. large cell, carcinoid

Question 17

Pancoast tumor

-what can it cause, and how does it present (3 symptoms)?

Answer 17

• tumor in apex of lung
• can cause Horner’s syndrome (press on sympathetic chain)
  1. ptosis (drooping eyelid)
  2. miosis (pinpoint pupil)
  3. anhidrosis (no sweating)

Question 19

Lung cancer:

-typical symptoms (4)

Answer 19

usu nonspecific:

1. cough
2. weight loss
3. hemoptysis
4. pneumonia, postobstructive

Question 20

1. neuroendocrine cells: how to identify on staining, and why?
2. which lung tumors are neuroendocrine cells?

Answer 20

1. chromogranin positive on immunohistochemistry. (neuroendocrine secretory granules)
2. 1) small cell carcinoma (poorly differentiated)
   2) carcinoid tumor (well differentiated)

Question 21

small cell carcinoma:

1. histology
2. association
3. location
4. complications, comments

Answer 21

1. poorly differentiated small cells, mimic lymphocytes
2. smokers
3. central
4. paraneoplastic syndrome can occur (ADH, ACTH, Lambert-Eaton syndrome–Ab against presynaptic Ca channels, muscle weakness that improves with use)

Question 22

Lung tumor biopsy:

what are you looking for to categorize this tumor?

Answer 22

1. Keratin pearls, desmosome interceullar bridges: squamous cell
2. glands, mucin: adenocarcinoma
3. small cells, mimic lymphocytes: small cell
4. none of these, and poorly differentiated: large cell carcinoma
5. cartilage present, maybe calcified: hamartoma
6. granuloma: infection, or sarcoidosis/berylliosis

Question 22

How to stage lung cancer

Answer 22

TNM staging:

• Tumor size/local spread (pleura, SVC obstruction, nerve involvement)
• Nodes, lymph. (hilar, mediastinal)
• Metastasis (think adrenal for lung cancer)

Question 24

carcinoid tumor

1. histology
2. association
3. location
4. complications, comments

Answer 24

1. well-differentiated neuroendocrine tumor (chromogranin positive)
2. not assoc with smoking
3. central or peripheral; classic: Polyp-like mass in bronchus
4. rarely can cause carcinoid syndrome

Question 25

Lung cancer: - what is typically first sign on imaging? - what are your next steps?

Answer 25

1. you usu a solitary nodule ('coin lesion') 2. compare with old Xrays--if lesion existed before, same size, then more likely benign. If new or growing, maybe malignant 3. Do biopsy, necessary for cancer dx

Question 26

Pt with coin lesion on lung Xray: -what to consider other than cancer (2)

Answer 26

- 2 main types of benign lesions: 1. granuloma (often TB or fungus--think Histoplasma in Midwest!) 2. hamartoma (composed of lung tissue and cartilage, often calcified)

Question 27

bronchioloalveolar carcinoma ## Footnote 1. histology 2. association 3. location 4. complications, comments

Answer 27

1. columnar cells replace squamous cells in air sacs and bronchioles, arise from Clara cells 2. not related to smoking 3. peripheral 4. presents with pneumonia-lika consolidation, excellent prognosis

Question 28

what accumulates in closed areas like basements that is dangerous to lungs?

Answer 28

Radon--radioactive decay of uranium found in soil. -2nd leading cause of lung cancer

Question 29

What lung disorder is more common in Midwest?

Answer 29

Histoplasmosis, leading to benign granulomas in lung. Look like coin lesions

Question 30

chromogranin

Answer 30

immunohistochem stain for neuroendocrine cells. (evidence of neurosecretory granules) -positive in small cell and carcinoid lung tumors

Question 31

squamous cell carcinoma ## Footnote 1. histology 2. association 3. location 4. complications, comments

Answer 31

1. keratin pearls, or intercellular bridges (desmosomes, seen only in squamous cells) 2. smokers (most common tumor in smokers) 3. central 4. paraneoplastic syndrome (PTHrP)

Question 32

"S" mnemonic in lung cancer:

Answer 32

- Small cell carcinoma - Squamous cell carcinoma - smokers - Central - Syndrome, paraneoplastic

Question 33

What is the screening method for lung cancer?

Answer 33

No effective lung cancer screening method. cancers caught late. 15% 5 year survival