Wk 6 Lung Cancer

Question 1

What % of lung cancers occurs in smokers?

Answer 1

85%

Question 2

What are 2 primary mutagenic components of cigarette smoke?

Answer 2

1. polycyclic aromatic hydrocarbons
2. arsenic (increases risk of squamous cell carcinoma in lung)

Question 3

Major cause of mesothelioma

Answer 3

asbestos

Question 4

2 major types of lung cancer

Answer 4

1. small cell carcinoma (SCLC)
2. non-small cell lung cancer (NSCLC) - 85%

Question 5

3 types of NSCLC

Answer 5

1. adenocarcinoma - most common
2. squamous cell carcinoma
3. large cell carcinoma (less common)

Question 6

What is the most common lung cancer of non-smokers?

Answer 6

adenocarcinoma 40-50% of lung cancers
-most common lung cancer in women (women>men)
-still associated w/ smoking
-peripheral

Question 7

What mutations are seen in adenocarcinomas?

Answer 7

EGFR
KRAS
ALK

Question 8

What are the 4 C’s for squamous cell carcinoma?

Answer 8

Centrally located
Cigarettes
Cavitary
Calcium abnormalities

Must have:
1. “squamous/keratin pearls”
-best prognosis
2. intercellular bridges (desmosomes)

-may produce PTHrP

Question 9

What lung cancer has the worst prognosis?

Answer 9

Small cell carcinoma

Question 10

S’s of small cell carcinoma

Answer 10

“Sentrally” located
Smoking
Suck - worst px
Syndromes (paraneoplastic like Lambert-Eaton syndrome, Cushing, SIADH)
Simple Staging
-often presents w/ something different - quickly invades lymphatics, BVs
-metastatic to brain, bone, liver

Question 11

Clinic presentation for SCC

Answer 11

pulm symptoms
incidental finding on imaging
metastatic lesion complications - nausea, weakness
-paraneoplastic syndromes

Question 12

acronym for SCC

Answer 12

SPHERE:
SVC syndrome
Pancoast tumor
Horner’s syndrome
Endocrine abnormalities
Recurrent laryngeal nerve dysfxn -> hoarseness
Effusions

Question 13

Endocrine abnormalities and associated lung cancers

Answer 13

Question 14

Most common adenocarcinoma mutation

Answer 14

EGFR

Question 15

Genetic mutations in lung cancer

Answer 15

Dominant oncogenes: Ras, HER2/neu, C-myc, C-fos

Tumor Suppressor genes: p53, Rb, p16

Question 16

What are 3 risks of lung cancer screening?

Answer 16

1. false positives
2. potential overdx for findings that may not have caused problems
3. radiation exposure from repeated LDCT tests

Question 17

What are the 5 main types of lung cancer?

Answer 17

1. small cell carcinoma
2. adenocarcinoma (NSCLC)
3. squamous cell carcinoma (NSCLC)
4. large cell carcinoma (NSCLC)
5. Carcinoid tumor (NSCLC)

Question 18

What is a pro-carcinogen?

Answer 18

Must be metabolized to become a carcinogen

Question 19

What is a ferrugenous body?

Answer 19

Asbestos fiber w/ macrophages on it
seen in mesothelioma

Question 20

What cancer is associated w/ asbestos?

Answer 20

Lung cancer first, mesothelioma second

Question 21

What is needed for dx of lung cancer?

Answer 21

biopsy

Question 22

What are 2 benign lung lesions?

Answer 22

1. granuloma - can present as a coin lesion, often due to TB or fungus
2. bronchial hamartoma (tissue that belongs in that area but is disorganized) - contains lung tissue and cartilage, often calcified on imaging

Question 23

Distinguishing differences b/w tx of small cell carcinoma and NSCC

Answer 23

1. small cell - surgical resection does not work, but does for NSCC
2. small cell tx w/ chemotherapy, NSCC usually does not respond well to chemo

Question 24

What are 2 key histological indicators of adenocarcinoma?

Answer 24

1. glands
2. mucin production

Question 25

2 key histological findings for squamous cell carcinoma

Answer 25

1. keratin pearls 2. intercellular bridges

Question 26

Characteristics of large cell carcinoma

Answer 26

Smoking -poorly differentiated large cells -central or peripheral -poor px

Question 27

Characteristics of bronchioalveolar carcinoma

Answer 27

-columnar cells that grow along preexisting bronchioles and alveoli -arise from Clara cells - not related to smoking - peripheral - can present like pneumonia-like consolidation - excellent px

Question 28

Characteristics of carcinoid tumor

Answer 28

Well differentiated neuroendocrine cells (compare to SCC, which is poorly differentiated neuroendocrine tumor) -chromogranin positive -not related to smoking -often polyp-like mass in bronchus, central or peripheral -low-grade malignancy -rarely, but can cause carcinoid syndrome

Question 29

Describe histology of carcinoid tumor

Answer 29

Question 30

What does chromogranin + look like w/ carcinoid tumor?

Answer 30

Stains positive b/c it's a neuroendocrine type tumor

Question 31

What are the most common types of metastasis to the lung?

Answer 31

breast and colon carcinoma

Question 32

What does metastasis to the lungs look like?

Answer 32

multiple cannonball nodules on imaging -more common than primary tumor

Question 33

How is lung staging done?

Answer 33

TNM: T: size and local extension of tumor N: spread ot regional lymph nodes (hilar or mediastinal) M: unique site of distant spread is the adrenal gland -overall, 15% 5 yr survival

Question 34

What are 4 local complications w/ lung cancer?

Answer 34

1. pleural involvement 2. SVC obstruction (SVC syndrome) 3. involvement of laryngeal (hoarseness) or phrenic nerve (diaphragmatic paralysis) 4. compression of sympathetic chain (ptosis, meiosis, anhidrosis - Horner's Syndrome) - esp w/ Pancos tumor (at the apex of the lung)

Question 35

What cells line the visceral and parietal pleura?

Answer 35

mesothelial cells - produce fluid in pleural space

Question 36

Characteristics of mesothelioma

Answer 36

=malignant neoplasm of mesothelial cells in pleural space -assoc w/ asbestos exposure -presents w/ recurrent pleural effusions, dyspnea, and chest pain -tumor encases the lung

Question 37

Label the cancers

Answer 37

A. carcinoid tumor B. squamous cell carcinoma C. small cell carcinoma D. adenocarcinoma