Lung Tumors- Rao

Question 1

What is the most common lung tumor?

Answer 1

Bronchogenic carcinoma

Question 2

How common is lung cancer? How deadly is it?

Answer 2

Most common visceral cancer in males, rising incidence in women
Most frequent fatal malignancy in both genders

Question 3

How does smoking change your risk of bronchogenic carcinoma?

Answer 3

Smokers have a 10-fold increase
Heavy smokers have a 20-fold increase

Risk levels return to normal 10 years after quitting

Question 4

How is a smoking habit quantified?

Answer 4

Pack-years

of packs/day * # of years

Question 5

What about tobacco smoke causes cancer?

Answer 5

Smoke contains initiator (match) and promoters (fuse)

Question 6

What are industrial hazards that can contribute to cancer risk?

Answer 6

Asbestos, Uranium, Radiation, Nickel, Mustard gases, etc

Question 7

How does asbestos exposure change your lung cancer risk?

Answer 7

5-fold increase if non-smoker

50-90-fold increase if smoker

Question 8

What is the most likely cause of lung cancer in non-smokers? Where would they be exposed to this?

Answer 8

Radon

Indoor-air pollution, some areas have naturally high levels

Question 9

Which lung cancers are the following oncogene mutations associated with?
c-myc
K-ras
EGFR
EML4-ALK

Answer 9

c-myc-small cell carcinoma
K-ras- adenocarcinoma
EGFR- adenocarcinoma
EML4-ALK- adenocarcinoma

Question 10

What is a “scar cancer”? Which came first, the scar or the cancer?

Answer 10

A cancer associated with a scar

variable, sometimes the scar forms in response to the cancer, sometimes it is there first

Question 11

What type of cancer is typically seen in scar cancers?

Answer 11

usually adenocarcinoma

Question 12

What is the clinical picture of a bronchogenic carcinoma?

Answer 12

patient is in their 50s
presents with cough, weight loss, chest pain, dyspnea
increase in sputum

Question 13

What is a pancoast tumor? What are sequelae often seen with them?

Answer 13

Tumor at the apex of the lung

Can cause miosis, anhydrosis, and ptosis because of sympathetic ganglion interference

Question 14

What are some less common problems that can be seen in lung tumors?

Answer 14

atelectasis- tumor blockage of brochioles
hoarseness- recurrent laryngeal nerve invasion
diaphragm paraylsis- phrenic nerve invasion
dysphagia- esophagela invasion
pericardial tamponade- pericardial invasion
SVC syndrom- impingement of superior vena cava

Question 15

How are bronchogenic carcinomas grouped?

Answer 15

Grouped according to chemotherapy response
Small cell carcinomas
Non-small cell carcinomas

Question 16

How common is squamous cell carcinoma? What does the typical patient look like?

Answer 16

25-40% of cancers

typical patient is male smoker

Question 17

What are some physical traits of a squamous cell bronchogenic carcinoma?

Answer 17

Keratinized
intracellular bridges
usually central (main/lobar bronchi)
polypoid growth

Question 18

What cancer are females most likely to get?

What cancer are non-smokers most likely to get?

Answer 18

adenocarcinoma for both

HOWEVER the typical adenocarcinoma patient is a smoker

Question 19

How common is adenocarcinoma?

Answer 19

25-40%, most common lung cancer in the US

Question 20

What does the progression of adenocarcinoma look like?

Answer 20

Slow-growing
Typically presents at more advanced stage
More likely to metastasize

Question 21

What are the four subtypes of adenocarcinoma?

Answer 21

glandular
solid
papillary
bronchioloalveolar

Question 22

What are the two subtypes of bronchioloalveolar adenocarcinomas? Which one has a better prognosis?

Answer 22

nonmucinous- affects clara cells, type 2 pneumocytes

mucinous- worse prognosis

Question 23

How common is small cell carcinoma? What does the typical patient look like?

Answer 23

20-25% of cancers

typical patient is male, smoker with a central tumor

Question 24

What does small cell carcinoma look like clinically?

Answer 24

presents at advanced stage (70% metastasis)
extensive necrosis
paraneoplastic syndrome 
excellent chemo response 
median survival is 4 months

Question 25

What does large cell carcinoma look like clinically?

Answer 25

large, undifferentiated cells
peripheral lung cancer
poor survival (6% 5-year; >10 months)

Question 26

What does an adenosquamous cancer look like clinically?

Answer 26

present with scar
peripheral tumor
typical patient is a smoker

Question 27

Where is lung cancer most likely to metastasize?

Answer 27

Adrenal glands, Brain, and Liver

may metastasize to bone, hilar lymph nodes as well

Question 28

What is the most important determining factor in tumor survival?

Answer 28

Stage at presentation, followed by type

Question 29

What is paraneoplastic syndrome? What can be released?

Answer 29

hormone overproduction seen in 1-10% of cancers

ACTH, ADH, Serotonin, parathyroid hormone, etc

Question 30

What are carcinoid tumors?

Answer 30

a rare (1-5%) tumor that is seen in people under 40, largely benign (low-grade malignant), with a very high survival rate

Question 31

What are some symptoms of a carcinoid tumor?

Answer 31

Hemoptysis, cough, atelectasis

carcinois syndrome- diarrhea, flushing, cyanosis