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Pulmonology > Lung Cancer- Bootcamp > Flashcards

Lung Cancer- Bootcamp Flashcards

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1
Q

How common and how deadly is lung cancer?

A

Lung cancer is the most common cause of cancer death and it is the second most common cancer
* Prostate and breast cancer are more common

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1
Q

_ is a classification of lung cancers that are non-resectable and carry a worse prognosis

A

Small cell is a classification of lung cancers that are non-resectable and carry a worse prognosis

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2
Q

Non-small cell lung cancer is generally resectable and has a better prognosis; it includes three types:

A

Non-small cell lung cancer is generally resectable and has a better prognosis; it includes three types:
1. Squamous cell carcinoma
2. Adenocarcinoma
3. Carcinoid tumors

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3
Q

Lung cancer will usually show up as a small opacity on a chest x-ray called a _

A

Lung cancer will usually show up as a small opacity on a chest x-ray called a coin lesion

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4
Q

Lung cancer commonly presents with the following symptoms:

A

Lung cancer commonly presents with the following symptoms:
* Low grade fever
* Weight loss
* Cough
* Hemoptysis
* Dyspnea

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5
Q

Lung cancer on the superior sulcus of the lung is called a _ tumor

A

Lung cancer on the superior sulcus of the lung is called a pancoast tumor

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6
Q

A pancoast tumor may cause symptoms secondary to _

A

A pancoast tumor may cause symptoms secondary to neurological involvement (brachial plexus, Horner syndrome) and musculoskeletal symptoms (shoulder pain, vertebral, or rib pain)

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7
Q

_ involves ipsilateral ptosis, miosis, and anhidrosis; caused due to interruption of sympathetic nerve chain running to the head

A

Horner’s syndrome involves ipsilateral ptosis, miosis, and anhidrosis; caused due to interruption of sympathetic nerve chain running to the head
* May be secondary to a pancoast lung tumor

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8
Q

_ involves facial plethora, upper extremity edema, JVD, and headaches and may occur secondary to lung cancer

A

SVC syndrome involves facial plethora, upper extremity edema, JVD, and headaches and may occur secondary to lung cancer

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9
Q

Phrenic nerve compression due to lung cancer would involve _

A

Phrenic nerve compression due to lung cancer would involve paralysis of the diaphragm

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10
Q

The _ nerve is a branch off of the vagus nerve that when compressed can lead to hoarseness
* May be affected by lung cancer

A

The recurrent laryngeal nerve is a branch off of the vagus nerve that when compressed can lead to hoarseness
* May be affected by lung cancer

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11
Q

Lung cancer can also cause (transudative/exudative) pleural effusion

A

Lung cancer can also cause exudative pleural effusion

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12
Q

Small cell carcinoma is a malignant lung neoplasm derived from _ progenitor cells

A

Small cell carcinoma is a malignant lung neoplasm derived from neuroendocrine progenitor cells
* In other words, undifferentiated neuroendocrine cells

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13
Q

The biggest risk factor for small cell carcinoma is _

A

The biggest risk factor for small cell carcinoma is smoking
* Small cell lung cancer has the strongest association with smoking of all the lung cancers

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14
Q

SCLCs often involve upregulations in _ and _ and down regulations in _

A

SCLCs often involve upregulations in MYC and BCL2 and down regulations in tumor suppressor genes like P53 and RB

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15
Q
A

Small cell carcinoma is composed of small cells with scant cytoplasm

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16
Q

Small cell carcinoma is often derived from neuroendocrine progenitor cells; therefore the tumor cells may express markers like _ or _

A

Small cell carcinoma is often derived from neuroendocrine progenitor cells; therefore the tumor cells may express markers like chromogranin or synaptophysin

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17
Q

Small cell carcinoma will often present with metastasis to _

A

Small cell carcinoma will often present with metastasis to lymph nodes, brain, spinal cord, liver, bone, adrenal glands, skin

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18
Q

_ is a common electrolyte abnormality associated with SCLC due to the common paraneoplastic syndrome SIADH

A

Hyponatremia is a common electrolyte abnormality associated with SCLC due to the common endocrine paraneoplastic syndrome SIADH

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19
Q

Syndrome of inappropriate ADH secretion (SIADH) causes the kidney to (reabsorb/ secrete) Na+

A

Syndrome of inappropriate ADH secretion (SIADH) causes the kidney to reabsorb Na+ –> water follows –> leads to increased total body water and hyponatremia

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20
Q

Another common endocrine abnormality that can result from SCLC is Cushing syndrome, which involves over-secretion of _

A

Another common endocrine abnormality that can result from SCLC is Cushing syndrome, which involves over-secretion of ACTH –> increased cortisol –> hyperglycemia + obesity

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21
Q

Lambert-Eaton syndrome secondary to SCLC will present with _

A

Lambert-Eaton syndrome secondary to SCLC will present with muscle weakness
* Antibodies made against presynaptic Ca+ channels

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22
Q

SCLC is best diagnosed using bronchoscopy due to its _ location

A

SCLC is best diagnosed using bronchoscopy due to its central location in the thorax
* Transthoracic needle biopsy risks damage to mediastinal structures

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23
Q

Adenocarcinoma originates in _ cells

A

Adenocarcinoma originates in mucus-producing epithelial cells
* Typically effects cells lining the outer lung

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24
Adenocarcinoma can result from acquired somatic, _ mutations that speed up the growth factor receptor signaling pathways
Adenocarcinoma can result from acquired somatic, **gain-of-function** mutations that speed up the growth factor receptor signaling pathways
25
Adenocarcinoma has been associated with mutations in the tyrosine kinase genes such as _
Adenocarcinoma has been associated with mutations in the tyrosine kinase genes such as: * EGFR * ALK * ROS1 * MET
26
KRAS is another mutation associated with adenocarcinoma that affects the _ coding gene
KRAS is another mutation associated with adenocarcinoma that affects the **GTPase** coding gene
27
Squamous cell carcinoma originates in _ cells
Squamous cell carcinoma originates in **flat squamous epithelial cells** that line the inside of the lung airways
28
The most common lung cancer in non-smokers is _
The most common lung cancer in non-smokers is **adenocarcinoma**
29
TP53 gene on chromosome _ is commonly inactivated or deleted in squamous cell carcinoma (and other cancers)
TP53 gene on chromosome **17** is commonly inactivated or deleted in squamous cell carcinoma (and other cancers)
30
Retinoblastoma tumor suppressor gene, RB1 is located on chromosome _
Retinoblastoma tumor suppressor gene, RB1 is located on chromosome **13**
31
Squamous metaplasia is the first step in the progression of squamous cell carcinoma; this is followed by _ and finally _
Squamous metaplasia is the first step in the progression of squamous cell carcinoma; this is followed by **squamous dysplasia** and finally **neoplasia**
32
Neoplasia can be defined as squamous dysplasia that has progressed to _
Neoplasia can be defined as squamous dysplasia that has progressed to **full thickness of the epithelium** --> this is termed **squamous cell carcinoma in situ** * From here, it can progress to invasive squamous cell carcinoma
33
Adenocarcinomas and large cell carcinomas tend to be found in the _ region
Adenocarcinomas and large cell carcinomas tend to be found in the **lung periphery**
34
Squamous cell carcinomas are usually found in _ regions
Squamous cell carcinomas are usually found in **bronchial airways, centrally located** * Sometimes squamous cell carcinoma is confused with small cell
35
Mesotheliomas are not lung cancers but rather cancers of the _
Mesotheliomas are not lung cancers but rather cancers of the **pleura**
36
Mesothelioma is almost always associated with exposure to _
Mesothelioma is almost always associated with exposure to **asbestos** * More common in construction workers, shipyard workers, factor workers, firefighters
37
A lung tumor that comes back positive with tumor markers chromogranin and synaptophysin is likely _
A lung tumor that comes back positive with tumor markers chromogranin and synaptophysin is likely **small cell carcinoma** * Carcinoid tumor (NSCLC) will also be chromogranin +
38
Describe the pathophysiology of squamous cell carcinoma
Smoking causes damage to our normal pseudostratified columnar epithelium --> squamous metaplasia --> hyperplasia + rapid cell turnover --> squamous cell carcinoma
39
_ and _ carcinomas are strongly correlated to smoking and tend to be centrally located in the lungs
**Squamous** and **small cell** carcinomas are strongly correlated to smoking and tend to be centrally located in the lungs
40
Short blunted microvilli on EM will more likely be (adenocarcinoma/ mesothelioma)
Short blunted microvilli on EM will more likely be **Adenocarcinoma**
41
Long slender microvilli on EM will more likely be (adenocarcinoma/ mesothelioma)
Long slender microvilli on EM will more likely be **mesothelioma**
42
Mutations in EGFR, KRAS, and ALK are most associted with _
Mutations in EGFR, KRAS, and ALK are most associated with **adenocarcinoma**
43
A glandular tumor that produces mucin describes _
A glandular tumor that produces mucin describes **adenocarcinoma**
44
The most common paraneoplastic syndrome associated with squamous cell carcinoma is _
The most common paraneoplastic syndrome associated with squamous cell carcinoma is **PTH related peptide production** --> leads to **hypercalcemia**
45
Keratin pearls are associated with _
Keratin pearls are associated with **squamous cell carcinoma** * These tumors produce lots of keratin
46
"Intercellular bridges" are associated with _
"Intercellular bridges" are associated with **squamous cell carcioma** * Squamous cells have lots of *desmosomes* between cells
47
Well differentiated nests of neuroendocrine cells describe _
Well differentiated nests of neuroendocrine cells describe **carcinoid tumors** * They will be chromogranin + * Associated with carcinoid syndrome (high serotonin --> flushing and diarrhea)
48
Bronchogenic carcinoma is a _ type lung cancer; however, it is distinguished by being well differentiated
Bronchogenic carcinoma is a **small cell carcinoma**; however, it is distinguished by being well differentiated
49
Psammoma bodies on histology are indicative of _
Psammoma bodies on histology are indicative of **mesothelioma**
50
Cancer of the alveolar type II epithelial cells (pneumocytes)
Cancer of the alveolar type II epithelial cells (pneumocytes): **adenocarcinoma**
51
Cancer of the basal epithelial cells
Cancer of the basal epithelial cells: **squamous cell carcinoma**
52
Lung cancer that arises in the proximal airways of smokers and cavitates:
Lung cancer that arises in the proximal airways of smokers and cavitates: **squamous cell carcinoma**
53
Define the stages of squamous cell carcinoma invasion
**Squamous metaplasia**: bronchial epithelium goes from columnar to squamous **Squamous dysplasia**: loss of cell polarity, increased nuclear hyperchromasia, mitotic activity, etc **Squamous cell carcinoma in situ**: neoplastic stage where squamous dysplasia has progressed to involve the full thickness of the epithelium **Invasive carcinoma**: invasion of adjacent structures
54
Squamous cell metaplasia
55
Squamous cell carcinoma in situ
56
If we see keratin pearls and intercellular bridges, we are likely in _ stage
If we see keratin pearls and intercellular bridges, we are likely in **invasive squamous cell carcinoma** stage
57
Keratin pearls (squamous cell carcinoma)
58
Hypertrophic osteoarthritis and clubbing are often syndromes of _ lung cancer
Hypertrophic osteoarthritis and clubbing are often syndromes of **adenocarcinoma**
59
60
Adenocarcinoma in situ
61
Adenocarcinoma
62
Small cell
63
64
Metastatic lung cancer- multiple well circumscribed nodules
65
ARDS Berlin definition
66
ARDS is _ type of hypoxemia
ARDS is a **shunt** * There is an A-a gradient * After a while we can no longer blow off the CO2 by hyperventilating - expect CO2 to be high
67
Direct causes of ARDS
68
Indirect causes of ARDS

Pulmonology (16 decks)

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