Tumors of Lung

Question 1

How many years after smoking do your cancer risk return to control levels?

Answer 1

10 years

Question 2

What potential carcinogens are in tobacco smoke?

Answer 2

initiator (benzopyrene)

promoter (phenol derivatives)

Question 3

What asbestos + smoking cancer risk?

Answer 3

50 to 90 times greater risk than gen. pop.

Question 4

What indoor air pollution may be responsible for non-smokers lung cancer?

Answer 4

radon exposure -ubiquitous radioactive gas

Question 5

What oncogenes are associated with small cell carcinoma?

Answer 5

c-myc

Question 6

What oncogenes are associated with adenocarcinoma?

Answer 6

K-ras
EGFR
EML4-ALK

Question 7

What does benzopyrene cause DNA damage at what codon?

Answer 7

same codons of p53 gene as seen in mutations in clinical lung cancers

Question 8

What is a pancoast tumor?

Answer 8

tumor at extreme apex of lung
SVC syndrome
or honrers

Question 9

What are the types of non small cell carcinoma

Answer 9

squamous cell carcinoma
adenocarcinoma
-glandular
-papillary
-solid
-bronchioloaveolar
Large cell carcinoma
adenosquamous carcinoma

Question 10

What is small cell carcinoma vs non small cell carcinoma?

Answer 10

treatment decisions
small cell very responsive to chemotherapy but surgery doesnt work

non small cell carcinoma treat with resection and chemo

Question 11

What is contraindicated in squamous cell carcinoma?

Answer 11

bevacuzimab; toxicity can cause hemorrhage

Question 12

What is the mutations that lead to response to erlotinib and gefitinib?

Answer 12

EGFR mutation

Question 13

What cause resistance to erlotinib and gefitinib?

Answer 13

KRAS mutation

Question 14

What is pemextrexed used to treat?

Answer 14

non squamous cell carcinoma

Question 15

What are the morphology of squamous cell carcinoma?

Answer 15

central cavitary necrosis
males common
arise centrall; usually endobronchial, polypoid growth

Question 16

What is the histology of squamous cell carcinoma?

Answer 16

keratin formation, intercellular bridges, atypia and invasion

large groups and nests of round, oval and polyhedral cells; squamous pearls

Question 17

What is adenocarcinoma morphology?

Answer 17

most common type in women and non-smokers

peripheral with pleural retratction or puckering associated with scarring

slow growing with metastasize
asymptomatic

Question 18

What is bronchioalveolar carcinoma?

Answer 18

subset of adenocarcinoma

single peripheral nodule or multiple nodules or diffuse pneumonia

Question 19

What is the histology of bronchioalveolar carcinoma?

Answer 19

lepidic spread-spread along alveolar septa
nonmucinous (clara cells, type II pneumocytes)
mucinous(tal columnar mucinous cells)

Question 20

What are the small cell carcinoma details?

Answer 20

predominant in males, smokers,
central location
highly malignant, median survival
submucosal/circumferential infiltration; rare endobronchial polypoid growth

extensive necrosis, secretory granules of neuroendocrine type
paraneoplastic syndrome

Question 21

How does small cell carcinoma appear on histology?

Answer 21

lymphocytic appearance

Question 22

What does large cell carcinoma appearance

Answer 22

large cells without differentiation

ultrastrucutral evidence of glandular or squamous differntiation

Question 23

What is giant cell carcinoma?

Answer 23

highly malignant

mostly peripheral

Question 24

Where do bronchogenic carcinoma metastasize?

Answer 24

hilar lymph nodes
adrenal glands
liver
brain
bone

Question 25

What are the classification of small cell carcinoma

Answer 25

``` limited disase (hemithorax with/without LN involvement) Extensive disease (contralateral lung, distant metastasis) ```

Question 26

What are the staging of non small cell carcinoma?

Answer 26

TNM Tumor size Node involvmenet mtastasis

Question 27

What is paraneoplastic syndrome?

Answer 27

symptom complexes that occur in pt with cancer that cannot be explained by spread or elaboration of horomones by tumor cell

Question 28

What is the importance of paraneoplastic syndrome

Answer 28

earliest manifestation of occult neoplasm signficant problems may mimic metastaes and be difficult to treat

Question 29

What are the small cell carcinoma associated paraneoplasms?

Answer 29

cushings (ACTH) hyponatremia (innappropiate ADH secretion) Carcinoid syndrome (serotonin) Myasthenic syndrome (eaton-lambert syndrome)

Question 30

What are the paraneoplasms associated with squamous cell carcinoma?

Answer 30

hypercalcemia (parathoromone)

Question 31

What is the microscopic appearance of a carcinoid tumor?

Answer 31

nests/cords/masses uniform cells with round nuclei salt and pepper chromatin IHC: NSE, chromogranin, synaptophysin +

Question 32

What are the clinical course and prognosis of carcinoid tumors?

Answer 32

hemoptysis, cough, obstructive symptoms (intraluminal growth) --infections, bronchiectasis, atelactasis or emphysema carcinoid syndrome -intermittent diarrhea, flushing nad cyanosis metastases rare benign course and amendable to resection