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Nichols: Lung Cancers Flashcards

(104 cards)

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1
Q

In general, lung cancers are more common and fatal in what sex/race? less common less fatal?

A

black males > asians and hispanics

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2
Q

3 major types of lung cancer

A

adenocarcinoma
squamous cell
small cell

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3
Q

assc with inapproprate ADH expression

A

small cell

–> leads to hyponatremia

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4
Q

more commonly peripherial

A

adenocarinomas

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5
Q

assc with Easton-Lambert syndrome

A

small cell

*due to autoantibodies against P/Q type voltage-gated calcium channels

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6
Q

commonly causes hypercalcemia

A

squamous cell carcinomas

**due to the production of a substance resembling parathyroid hormone

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7
Q

commonly metastatic at presentation

A

small cell

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8
Q

causes post-obstructive pneumonia

A

squamous cell carcinoma

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9
Q

more commonly central

A

small cell

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10
Q

commonly causes cavitation

A

squamous cell

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11
Q

assc with cushing syndrome

A

small cell

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12
Q

more common in women, asians, and never smokers

A

adenocarcinomas

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13
Q

common symptoms assc with lung cancer

A

cough (60%) > dyspnea > weight loss, hemoptysis > chest pain > horeseness (10%)

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14
Q

common signs assc with lung cancer

A

none

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15
Q

How is lung cancer Dx?

A
  1. discover via radiology (screen 55-80 y/o with 30+ pack-years Hx)
  2. biopsy
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16
Q

What type of lung cancer is tx with sugery

A

early stage squamous and adenocarcinoma (aka non-small cell)

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17
Q

treatment for non-small cell carcinoma

A

early stages: surgery

later stages: chemo (carboplatin + docataxel)

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18
Q

drug target for mutated ALK

A

crizotinib

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19
Q

WHat is the prognosis of lung caner as a whole?

A

5 year survival of 17%

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20
Q

malignant epithelial tumor of lung with glandular features such as making glands or mucin

A

adenocarcinoma (lung primary adenocarcinoma)

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21
Q

70% of never smokers with lung cancer have

A

adenocarcinoma

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22
Q

role of filtered cigarettes in the increased of adenocarcinoma

A

filter removed large particles = increased particle deposition in small airways

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23
Q

other causes of adenocarcinoma other than cigarette smoke

A

radon gas from ground
radiation
asbestos

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24
Q

Mutation common in adenocarcinomas of never smokers

A

EGFR

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25
Mutation common in adenocarcinomas of smokers
KRAS
26
KRAS mutation confers resistance to what drug?
erlotinib
27
EGFR mutations confers responsiveness to what drug?
gefitinib and erlotinib
28
crizotinib effectiveness requires what mutation?
EML4-ALK translocation fusion oncogene | *it is an ALK inhibitor
29
What mutations are seen in adenocarcinoms?
``` EFGR KRAS EML4-ALK p53 c-MET NKX2-1 PIK3CA BRAF ```
30
Tx for inoperable adenocarcinomas
pemetrexed
31
antifolate metabolite inhibitor of thymidylate synthetase, inhibiting the formation of precursor purine and pyrimidine nucleotides, preventing the formation of DNA and RNA
pemetrexed
32
anti-vascular endothelial growth factor (VEGF) monoclonal antibody
bevacizumab
33
What microscopic pathologies of adenocarcinoma are assc with a good prognosis? bad?
good: lepidic (without invasion) = spreading within alveoli bad: micopapillary, solid
34
Tx options for adenocarcinomas
erlotinib, pemetrexed, bevacizumab
35
prognosis for adenocarcinomas
determined by stage: early stage live about 20 months on average late stage about 13 months **no KRAS = + 5 mos **EML4-ALK translocation fusion oncogene + 5 mos
36
Describe the common pathology of adenocarcinomas
peripheral, subpleural, solitary, lobulated or spiculated
37
non-invasive neoplasm characterized by non-destructive growth along intact alveolar septa
adenocarcinoma in situ
38
involves type II pneumocytes and Clara cells
non-mucinous adenocarcinoma in situ
39
metaplasia of bronchilar epithelium
municnous adenocarcinoma in situ
40
can become mulitfocal from tumor spread via airways and the mucocilliary escalator
municnous adenocarcinoma in situ
41
CK20 negative and TTF-1 positive
non-mucinous adenocarcinoma in situ
42
KRAS + and EGFR –
municnous adenocarcinoma in situ
43
CK20 postitive and TTF-1 negative
municnous adenocarcinoma in situ
44
KRAS – and EGFR +
non-mucinous adenocarcinoma in situ
45
size difference between lesions of adenocarcinoma in situ and lung primary adenocarcinoma
in situ: < 2 cm | primary: > 4 cm
46
Tx for adenocarcinoma in situ
Surgical resection Inoperable: - erlotinib for EGFR + - crizotinib for ALK+ - paclitaxel for EGFR – (mitotic inhibitor)
47
mucinous or non-mucinous adenocarcinoma in situ has a better prognosis
non-mucinous
48
desmoplastic reaction
lung primary adenocarcinoma * occurs around glandular structures * *makes it very firm to palpation
49
anthroacotic pigment
lung primary adenocarcinoma
50
lepidic growth
adenocarcinoma in situ | = non destructive growth long intact alveolar septa
51
large endobronchial mass
squamous cell carcinoma
52
Where do squamous cell carcinomas typically arise
2/3 from main, lobar, or segmental | 1/3 from small periph bronchi
53
What tx is contraindicated in squamous cell carcinoma
bevacizumab bc it was assc with hemorrhaging
54
Optimal Tx for squamous cell carcinoma
surgical resection | radiation is suboptimal
55
Tx for small cell carcinoma
cisplatin or carboplatin + etopside + radiation
56
topoisomerase inhibitor that forms a complex with DNA and the enzyme, preventing re-ligation of DNA strands, causing them to break
etopside
57
are primary lung tumors or pulmonary mets more common | Why?
pulm mets 1. receive entire RT heart blood flow with every heart beat 2. densest capillary bed in body 3. 1st capillary bed met by venous return from every other organ 4. 1st capillary bed met by lymphatic drainage after being dumped into SVC by thoracic duct 5. lots of O2!
58
WHat are the primary sites of lung mets?
``` Breast Colon Stomach Melanoma Prostate Liver Thyroid ``` Little Boys Prefer To Meet Silly Cunts
59
______ tend to metastasize to lungs because they tend to spread by vein (hematogenously) rather than by lymphatic channels (characteristic of ________)
sarcomas carcinomas
60
Lymphangitic carcinomatosis
metastatic disease can fill lymphatics and infiltrate interstitium without creating mass lesions
61
CK7 and TTF-1 positive and CK20 and CDX2 negative
lung primary tumor
62
CK20 and CDX2 positive and CK7 and TTF-1 negative
colon primary
63
CK7 positive and CK20, CDX2 and TTF-1 negative
breast primary
64
How do lung mets appear compared than primaries
Smaller and rounder
65
Lung mets usually appear in what area of the lung
Lower/base
66
The bigger lung mets are usually in what area of the lung
Lower/base
67
acinar type
Lung primary adenocarcinoma
68
Intracellular bridges
Squamous cell carcinoma
69
Invades submucosal space
Small cell
70
Most likelt to cause hemoptysis
Squamous cell carcinoma
71
Keratin pearls
Squamous cell carcinoma
72
replacing alveolar lining
Adenocarcinoma in situ
73
Near 100% of cell in this type are p63 positive
Squamous cell carcinoma
74
Facial, cervical, and arm edema
Small cell
75
Usually metastaic and responsive to chemo
Small cell
76
100% of cells in this type are p40 positive
Squamous cell carcinoma
77
“salt and peper” nuclear chromatin
Small cell
78
Many mitoses
Small cell
79
Extensive necrosis
Small cell
80
Assc with bronchiectasis
Squamous cell carcinoma
81
Male smoker
Small cell > Squamous cell > adenocarcinoma
82
Female smoker
Adenocarcinoma
83
keratinization
Squamous cell carcinoma
84
Telomerae mutation
Small cell
85
RASSF mutations
Small cell
86
RB1 mutation
Small cell
87
Parabronchial (without an endobronchial mass)
Small cell
88
Central, endobronchial, cavitiating, hemoptysis
Squamous cell carcinoma
89
Large central tumor + extensive metastases
Small cell | **usually to nearby LN first
90
peripheral, subpleural, solitary, lobulated or speculated lung lesion
adenocarcinoma
91
Causes atelectasis
Squamous cell carcinoma
92
pancytokeratin positive
Small cell
93
Bcl-2 assc with
Small cell
94
FHIT assc with
small cell
95
Most likely to cause a paraneoplastic syndrome
Small cell
96
Spiculation
Squamous cell carcinoma | = central hemorrhage
97
Pemberton’s sign
Small cell | = development of facial flushing
98
Most aggressive type of lung cancer
Small cell
99
Most responsive to chemo
Small cell
100
Neuroendocrine carcinoma
Small cell
101
pneumonia-like area of consolidation
Adenocarcinoma in situ
102
Smooth pick eosinophillic cytoplasm
Squamous cell carcinoma
103
SVC syndrome
Small cell
104
Inspiratory stridor when pts raise both arm above head
Small cell

Pulmonary (31 decks)

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