Lung malignancy

Question 1

Most common cancer and cancer death in both males and female

Answer 1

LUNG cancer

Question 2

Risk Factors of Lung cancer

Answer 2

SMOKING

one gentic mutation is induced for every 15 cigarettes smoked

Question 3

The best known risk factor in developing ANY cancer

Answer 3

AGE

Question 4

High associated with lung cancer and mesothelioma

Answer 4

Asbestos

Question 5

Cancer development

Answer 5

Genetic and Environmental factors

Question 6

Polymorphic variations in the genes…

Answer 6

p53 and retinoblastoma suppressor gene expression

Question 7

The process when carcinogen confers a genetic change on the normal cell

Answer 7

Initiation

Question 8

Happens when those genetic changes confers a growth advantage on the cell over its neighboriing cells

Answer 8

Promotion

Question 9

Lung cancer gene mutations

Answer 9

EGFR - cancer susceptibility to never smokers

P450 enzyme system specifically CYP1A1

RB

p53 *Li-Fraumeni syndrome) - 1st degree relatives of lung CA

Question 10

Hallmarks of Cancer

Answer 10

Self sufficiency in growth signals

Insensitivity to antigrowth signals

Tissue invasion and metastasis

Limitless replicative potential

Sustained angiogenesis

Evading apoptosis

Avoidance of host immune system

Tumor promoting inflammation involved

Develop ability to deregulate cellular energetics

Develop genomic instability

Question 11

Epithelial tumors of the lung counts for 90% of epithelial tumors of the lung counts for 90% of epithelial tumors

Answer 11

Bronchogenic carcinoma

Question 12

NSCLC type

Answer 12

Adenocarcinoma
SQCCA
Large cell CA

Account for 90% of all epithelial cancers

Question 13

Squamous cell lung CA

Answer 13

Typically central and close to carina
Frequently presenting with bronchial obstruction and hemoptysis

Highly associated with cigarette smoking

More common in men than in women

areas of squamous metaplasia

Question 14

MOST frequent histologic subtype of NSCLC

Answer 14

Adenocarcinoma

Question 15

Contains sheet of cells rather than 3D group of cells as with the case of adenocarcinoma

Answer 15

Squamous cell carcinoma

Question 16

Possess a glandular differentiation or mucin production

Typically peripheral, sometimes originating in areas of pre-existing lung scarring

Answer 16

Adenocarcinoma

Question 17

Most common histology found in never smokers, and also in women

Answer 17

Adenocarcinoma

Question 18

Adenocarcinoma may manifest as:

Answer 18

Adenocarcinoma in situ

Minimally invasive

Invasive

Question 19

Main histological patterns of adenocarcinoma

Answer 19

Acinar - gland like spaces

Papillary - leaf like thin septa

Solid carcinoma with mucin production - Poorly differentiated

Lepidic mixed subtype tumors with non-mucinous bronchioalveolar CA

Micropapillary

Question 20

Marker for adenocarcinoma

Answer 20

TTF 1 or napsin A

Question 21

marker for squamous CA

Answer 21

p40 or p63 and/or mucin stains

Question 22

Lung adenocarcinomas can arise when tumorrs express this mutant gene

Answer 22

EGFR

Question 23

What type of cells have the capacity to give rise to adenocarcinoma

Answer 23

Type II epithelial cells

Question 24

LArge malignant cells without evidence of squamous of glandular differentiation

Answer 24

Large cell CA

Question 25

Macroscopic features of large ccell CA

Answer 25

Peripheral | maybe central

Question 26

Histological features of large CA

Answer 26

Large malignant cells that lack the cytologic and architectural features of small cell CA and glandular or squamous differentiation

Question 27

Undifferentiated/oat cell Carcinoma

Answer 27

Squamous cell CA

Question 28

Histological characteristic of small cell CA

Answer 28

salt and pepper pattern (Very scant cytoplasm, small, hyperchromatic nuclei with a fine chromatin pattern and absent/inconspicuous nucleoli

Question 29

Cell of origin for small cell carcinoma

Answer 29

Kulchitsky cells

Question 30

Type of cancer that secrets a lot of polypeptide hormones such as ACTH, AVP, ANF, and GRP

Answer 30

Small cell Carcinoma

Question 31

Lung cancer associated with a lot of paraneoplastic syndromes

Answer 31

small cell CA

Question 32

Clinical signs of lung malignancy

Answer 32

``` Cough (80%) Hemoptysis (70%) Dyspnea (60%) Chest pain (40%) Recurrent or slowly resolving pneumonia Constitutional signs Cachexia Supraclavicular or axillary LAD Tender ribs ```

Question 33

Signs of Mediastinal compression

Answer 33

SVC syndrome - facial edema, NVE, plethora, dysphagia, dyspnea ``` Facial edema Telagiectasia Hypotension latter part Flushing Neck vein engorgement ```

Question 34

A tumor that occupies the apex of the lung might affect the nerve specifically ulnar nerve which can result to arm pain

Answer 34

Pancoast Tumor C8, T1 and T2

Question 35

Metastatic signs and symptoms

Answer 35

Bone Pain and tenderness hepatomegaly and jaundice Confsuion and neurologic signs Nausea, vomiting, headache

Question 36

Hypertrophic Pulmonary Osteoarthropathy

Answer 36

Clubbing Periostitis commonly found in small cell lung CA swelling pain

Question 37

Hypercalcemia (PNPS)

Answer 37

most common oncologic emergency Increase PTH

Question 38

Paraneoplastic syndrome

Answer 38

``` hypercalcemia Cushing's syndrome Carcinoid syndrome Gynecomastia Hypoglycemia ```

Question 39

Carcinoid syndrome (serotonin)

Answer 39

``` Irregular mottled blushing Flat angiomas of the skin Acquired tricuspid and pulmonary stenosis Diarrhea Bronchial Spasm Mental aberratiion Excretion of large quantities of 5-HIAA ```

Question 40

Neurological syndrome found in small lung CA

Answer 40

Eaton-lambert syndrome

Question 41

Progressive proximal muscle weakness in the absence of dermatomyositis

Answer 41

Eaton-Lambert Syndrome

Question 42

Migrating venous thrombophlebitis

Answer 42

Trousseau syndrome

Question 43

Establishes a cytologic and/or histologic diagnosis in 80-85% of centrally located lesions

Answer 43

Bronchoscopy

Question 44

Four types of specimens

Answer 44

Bronchial brush Bronchial washing Bronchoalveolar lavage transbronchial FNAB - most sensitive

Question 45

May diagnose up to 90% of peripheral lung cancers

Answer 45

CT guided transthoracic needle biopsy

Question 46

Provides not only histologic dx but also important staging information

Answer 46

Mediastinoscopy

Question 47

Scan good for staging

Answer 47

PET Scan

Question 48

Checks for the level of glucose metabolism by cells

Answer 48

PET - uses FDG 18 - uses scorring called standardized Uptake Values

Question 49

Tumor component (2018)

Answer 49

``` < = 1 cm =T1a >1-2 cm = T1b >2-3cm = T1c >3-4 cm = T2a >4-5cm = T2b >5-7 cm = T3 >7 cm = T4 ```

Question 50

M component (2018)

Answer 50

Within the thoracic = M1a Single extrathoracic = M1b Multiple extrathoracic = M1c

Question 51

Node invovlement

Answer 51

``` N0 = no nodes N1 = ipisilateral bronchopulmonary N2 = Ipsilateral or subcarinal N3 = contralateral hilar/mediatinal and ipsilateral ```

Question 52

Treatment for Lung CA

Answer 52

I - Cure II - Cure III and IV - Control of local disease and increase length of survival

Question 53

Surgical treatment

Answer 53

Wedge resection - not form small cell CA Lobectomy - small tumors Pneumonectomy - large tumors

Question 54

Backbone of CRx treatment

Answer 54

Cisplatin/Carboplatin

Question 55

Anti EGFR

Answer 55

Gefitiib - forst approved tyrosine kinase inhibitor Erlotinib - 1st-3rd line tx of metastatic NSCLC Afatinib - 2nd generation tyrosine kinase inhibitor Ceftuximab

Question 56

ALK inhibitors

Answer 56

Crizotinib - targets EML4/ALK fusion protein Ceritinib Alectinib

Question 57

Bevacizumab

Answer 57

VEGF inhibitor

Question 58

Immunotherapy

Answer 58

PD-1/PD-L1 interaction -mediates inhibition of T cell mediated tumor cell killing and inhibition of T cell activation nivolumab, pembrolizumab