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Flashcards in Nichols: Lung Cancers Deck (104):
1

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

black males > asians and hispanics

2

3 major types of lung cancer

adenocarcinoma
squamous cell
small cell

3

assc with inapproprate ADH expression

small cell
--> leads to hyponatremia

4

more commonly peripherial

adenocarinomas

5

assc with Easton-Lambert syndrome

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

6

commonly causes hypercalcemia

squamous cell carcinomas
**due to the production of a substance resembling parathyroid hormone

7

commonly metastatic at presentation

small cell

8

causes post-obstructive pneumonia

squamous cell carcinoma

9

more commonly central

small cell

10

commonly causes cavitation

squamous cell

11

assc with cushing syndrome

small cell

12

more common in women, asians, and never smokers

adenocarcinomas

13

common symptoms assc with lung cancer

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

14

common signs assc with lung cancer

none

15

How is lung cancer Dx?

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

16

What type of lung cancer is tx with sugery

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

17

treatment for non-small cell carcinoma

early stages: surgery
later stages: chemo (carboplatin + docataxel)

18

drug target for mutated ALK

crizotinib

19

WHat is the prognosis of lung caner as a whole?

5 year survival of 17%

20

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

adenocarcinoma (lung primary adenocarcinoma)

21

70% of never smokers with lung cancer have

adenocarcinoma

22

role of filtered cigarettes in the increased of adenocarcinoma

filter removed large particles = increased particle deposition in small airways

23

other causes of adenocarcinoma other than cigarette smoke

radon gas from ground
radiation
asbestos

24

Mutation common in adenocarcinomas of never smokers

EGFR

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