Term
| what are the 7 types of lung tumors and their prevalence |
|
Definition
carcinoma 95%
carcinoid 5%
mesenchuma
fibrosarcoma
leiomyoma
lymphoma
harmatoma |
|
|
Term
| harmatoma: appearance 3, composition 2, prognosis 1 |
|
Definition
coin lesion: flat, spherical, 3-4cm
fibrous tissue, vessels
most common benign lesion |
|
|
Term
| list the lung tumors least to most agressive 4 |
|
Definition
typical carcinoid
atypical carcinoid
squamous cell
small cell |
|
|
Term
| what is the number 1 cancer related death in industralized countries |
|
Definition
|
|
Term
| who is lung cancer more prevalent in |
|
Definition
|
|
Term
| what percent of lung cancer have metastasis at diagnosis, what is the survival rate |
|
Definition
>50% metastasize at diagnosis
25% have gone to local nodes
5y survival 15%
if localized its 45% |
|
|
Term
| what 3 lesions are benign but look like lung cancer on imaging, how can you distinguish them |
|
Definition
harmatoma: coin lesion soltiary nodule
granuloma: TB or fungi (histopplasmosis)
bronchial harmatoma: cartilage, calcifications
check against previous x-ray if not changed probablly benign |
|
|
Term
| what is the main way all lung cancers allow cancerous proliferation |
|
Definition
| allow passage of the cell through G1/S check point |
|
|
Term
| which cancers have late/early metastasis, what mutation is it |
|
Definition
inactivation of CH3p tumor supressor causes early metastasis
P53 and KRAS mutations cause late metastasis (adenocarcinoma) |
|
|
Term
| what mutation that causes lung cancer has a field effect, what does that mean |
|
Definition
CH3p tumors supressor inactivation (early mutation)
found in patients without cancer and is activated by a carcinogen |
|
|
Term
| lung cancer carcinogens are paracarcinogens, what does this mean |
|
Definition
require activation by P450 monoxygenase to convert them to carcinogens
people with polymorphisms in P450 have increased metabolism and cancer risk |
|
|
Term
| what is the mutagen sensitivity genotype, what does it cause |
|
Definition
| lymphocytes undergo chromosomal breaks after tobacco exposure increases cancer risk 10x |
|
|
Term
| explain the general pathogenesis of lung cancer |
|
Definition
| genetic abnormalities accumulate then are activated by a carcinogen, through different mechanisms, they allow the cell to pass through the G1/S check point |
|
|
Term
| what 2 cancers have the strongest association with smoking of all |
|
Definition
squamous cell carcinoma
small cell carcinoma |
|
|
Term
| how can we determine a smoker's cancer risk |
|
Definition
genetic mutations
linear association with packs/year smoking (60x risk for >2pk/d for 20y) |
|
|
Term
| what are the mutagenic components of tobacco 2 |
|
Definition
polyaromatic hydrocarbons
arsenic |
|
|
Term
| what is the risk of cancer in a second hand smoker, pipe/cigar smoker, former smoker |
|
Definition
passive/second hand: 2x
pipe/cigar: moderate increase
cessation: decreases risk over time but never returns to base like bronchial epithelium contains gentic change for many years |
|
|
Term
| what are environmental factors that can lead to lung cancer 8 |
|
Definition
radioactive ore (miners)
asbestos
arsenic
chromium
uranium/radon
nickel
vinyl chloride
mustard gas |
|
|
Term
| what is the risk of cancer in someone exposed to asbestos as a smoker and non smoker |
|
Definition
|
|
Term
| what are the 5 types of carcinoma lung cancers |
|
Definition
adenocarcinoma
squamous cell carcinoma
small cell carcinoma
large cell carcinoma
mixed carcinoma |
|
|
Term
| epidemology of lung adenocarcinoma 4 |
|
Definition
most common in non smoker, women, <45yo
EGFR mutation in middle eastern women |
|
|
Term
| epidemology of lung squamous cell carcinoma 2 |
|
Definition
|
|
Term
| epidemology of lung small cell carcinoma |
|
Definition
|
|
Term
| epidemology of lung large cell carcinoma |
|
Definition
|
|
Term
| cause of lung adenocarcinoma |
|
Definition
| peripherial lung injury > bronchoalveolar stem cells (BASC) replenish clara and alveolar cells > if pt has TP53, KRAS, EGFR mutation > over proliferation of clara (mucous) and alveolar cells (both columnar) due to bypass through G1/S check point |
|
|
Term
| cause of lung squamous cell carcinoma |
|
Definition
| inactivation of p16/CDKN2A allows passage through G1/S check point |
|
|
Term
| cause of lung small cell carcinoma |
|
Definition
| RB gene mutation allows passage through G1/S check point |
|
|
Term
| cause of lung large cell carcinoma |
|
Definition
| inactivation of p16/CDKN2A allows passage through G1/S check point |
|
|
Term
| what are the 3 stages of adenocarcinomas |
|
Definition
1. atypical adenomatous hyperplasia (NOT precursor lesion, already atypical)
2. adenocarcinoma in situ (AIS)
3. (true) adenocarcinoma |
|
|
Term
| atypical adenomatous hyperplasia: cell type, size, cell features 2 |
|
Definition
cuboidal epithelium
<5mm thick
central scar, well demacrated |
|
|
Term
| what are the locations in the lung of the 4 main lung carcinomas |
|
Definition
adenocarcinoma: peripheral
squamous cell: central
small cell: central
large cell: central and peripheral |
|
|
Term
| what cell features make atypical adenomatous hyperplasia atypical 2 |
|
Definition
| hyperchromasia, pleomorphism, prominent nucleoli |
|
|
Term
| adenocarcinoma in situ: size, cell features, cell type |
|
Definition
single nodule <3cm
central scar, preserves alveoli archeticture
proliferation of glands and mucous |
|
|
Term
| true adenocarcinoma: organization type, location, growth pattern |
|
Definition
novolayer
on alveolar septa
in leptic growth pattern |
|
|
Term
| what are the 4 forms of adenocarcinoma |
|
Definition
acinar: gland forming
papillary
solid: intracellular mucin
mucinous: mucinous bronchioalveolar carcinoma subtype |
|
|
Term
| mucinous bronchioalveolar carcinoma: cell type, location, CXR signs, cause, prognosis |
|
Definition
adenocarcinoma subtype
proliferation of columnar clara cells
peripherial lung, bronchioles, alveoli
CXR: pneumonia like consolidations
cause: not smoking
prognosis: excellent |
|
|
Term
| what are the 6 stages of lung squamous cell carcinoma and some characteristics of each |
|
Definition
1. squamous metaplasia/dysplasia: in major bronchi epithelium
2. CIS: symptomatic, keratin pears, intracellular bridges, central necrosis, cavitation
3. destruction of bronchial epithelium and parenchyma invasion
4. true SCC: poor differentiation
5. distal atelectus, infection, parenchyma invasion, dissemination to hilar nodes
6. dissemination out of thorax |
|
|
Term
| small cell carcinoma: cell type, 3 stages of development |
|
Definition
1. proliferation of neuroendocrine (kulchitsky) cells
2. nuclear molding: due to close opposition of tumor cells with scan cytpplasm
3. early hilar and mediastinal metastasis |
|
|
Term
| kluchitsky cells: shape, color, cell features 3, staining characteristics |
|
Definition
small, round fulsiform shape, extends into parenchyma
pale gray
scant cytoplas, fine granular chromatin, mitotic figures
fragile, fragment making crush artifact on biopsy |
|
|
Term
| large cell carcinoma: cell type, 3 cell features |
|
Definition
malignant undifferentiated completely
large nuclei, prominent nucleoli, moderate cytpplasm |
|
|
Term
| CXR signs of lung adenocarcinoma 4 |
|
Definition
butterflies on fence: due to novolayer on alveolar septa leptic growth pattern
pericardial and pleural effusions
persistent segmental atelectasis
pneumonitis |
|
|
Term
| CXR signs of lung squamous cell carcinoma 3 |
|
Definition
pericardial and pleural effusions
persistent segmental atelectasis
pneumonitis |
|
|
Term
| CXR signs of lung small cell carcinoma 3 |
|
Definition
pericardial and pleural effusions
persistent segmental atelectasis
pneumonitis |
|
|
Term
| CXR signs of lung large cell carcinoma 3 |
|
Definition
pericardial and pleural effusions
persistent segmental atelectasis
pneumonitis |
|
|
Term
| clinical symptoms of lung adenocarcinoma 7 |
|
Definition
| horseness, CP, superior vena cava syndrome, paraneoplastic coagulation (migratory thrombophlebitis, nonbacterial endocarditis, DIC) |
|
|
Term
| clinical symptoms of lung squamous cell carcinoma 3 |
|
Definition
| horseness, CP, superior vena cava syndrome |
|
|
Term
| clinical symptoms of lung small cell carcinoma 13 |
|
Definition
horseness, CP, superior vena cava syndrome
cushing syndrome: paraneoplastic ACTH
SIADH: paraneoplastic ADH
myasthenia, peripherial neuropathy, polymyositis, eaton-lambert
finger clubbing
hypertrphic pulmonary and osteoarthropathy
hypercalcemia: paraneoplastic PTH |
|
|
Term
| clinical symptoms of lung large cell carcinoma |
|
Definition
| horseness, CP, superior vena cava syndrome |
|
|
Term
| prognosis of lung adenocarcinoma |
|
Definition
if detected before metastasis or local spread cure is possible via lobectomy or pneumoectomy (better prognosis than small cell)
poor response to chemo, target specific gene products instead
generally slow growing |
|
|
Term
| prognosis of lung squamous cell carcinoma |
|
Definition
if detected before metastasis or local spread cure is possible via lobectomy or pneumoectomy (better prognosis than small cell)
poor response to chemo, target specific gene products instead |
|
|
Term
| prognosis of lung small cell carcinoma |
|
Definition
has usually metastasized by time of diagnosis even if appears small and localized
sensitive to chemo but usually reoccurs
median survival 1y |
|
|
Term
| prognosis of lung large cell carcinoma |
|
Definition
if detected before metastasis or local spread cure is possible via lobectomy or pneumoectomy (better prognosis than small cell)
poor response to chemo, target specific gene products instead |
|
|
Term
| what nodes do the 4 lung carcinomas metastisize to, which do it early and which late |
|
Definition
adenocarcinoma: non specific
squamous cell: hilar nodes (later)
small cell: hilar and mediastinal (early)
large cell: non specific |
|
|
Term
| which lung carcinoma is historically the most clinically silent |
|
Definition
|
|
Term
| how can you tell clinically a lung cancer is in earlier stages |
|
Definition
chronic cough and expectoration may signify localized disease rarley
local node metastasis is earlier: carina, mediastinum, scalenes, clavicular, virchow/subclavicular |
|
|
Term
| mixed lung carcinoma most common combination |
|
Definition
small cell carcinoma
adenocarcinoma |
|
|
Term
| mixed lung carcinoma cause |
|
Definition
| more than one cell line differentiation suggests all carcinomas of lung come from multipotential progenitor cell |
|
|
Term
| prognosis of mixed lung carcinoma |
|
Definition
if detected before metastasis or local spread cure is possible via lobectomy or pneumoectomy (better prognosis than small cell)
poor response to chemo, target specific gene products instead |
|
|
Term
| define superior vena cava syndrome |
|
Definition
| obstruction of SVC causes distension of head and neck veins with edema and blue discoloration of the arms and face |
|
|
Term
| what are signs a lung carcinoma is in later stages 5 |
|
Definition
pleural or pericardial metastasis
laryngeal nerve involved: horseness
phrenic nerve involved: diaphragm paralysis
horner syndrome: compression of sympathetic chain
distant metastasis: brain, liver, bone |
|
|
Term
| which lung carcinoma is most likley to cause pleural or pericardial metastasis and thus SVC syndrome |
|
Definition
|
|
Term
| which lung carcinoma is most likley to cause horner syndrome, why, what symptom can help you further diagnose this |
|
Definition
| pancost tumor destories 1st and 2nd ribs and thoracic vertebrae (destruction cause pain in ulnar nerve distribution) |
|
|
Term
| 3 signs of horner syndrome |
|
Definition
| sympathetic causes pitosis, miosis, anhydrosis |
|
|
Term
| bronchial carcinoid tumor: age |
|
Definition
|
|
Term
| bronchial carcinoid tumor: 2 types and their cellular characteristics |
|
Definition
typical: low grade, nests of niform cells, salt and pepper chromatin, little pleomorphism
atypical: high mitotic rate, focal necrosis, node/distant metastasis |
|
|
Term
| which causes a bronchial carcinoid tumor to be atypical |
|
Definition
| P53 mutations seen in 20-40% |
|
|
Term
| bronchial carcinoid tumor: cell type, cause, location in lung |
|
Definition
proliferation of neuroendocrine cells
central or peripheral lung bronchial mucosa
not related to smoking |
|
|
Term
| bronchial carcinoid tumor: tumor shape, composition |
|
Definition
polyploid, spherical, intraluminal mass, penetrates lung substance (possibly peribronchiolic tissue)
dense core of neurosecretory granules in cytoplasm (chromogranin positive)
well demacrated
collar button lesion: mucosa plaque penetrates wall and fans into peribronchial tree |
|
|
Term
| clinical signs of bronchial carcinoid tumor |
|
Definition
cough, hemoptysis, recurrent bronchial and pulmonary infections
peripheral tumors: asymptomatic, insidental discovery
carcinoid syndrome tumors: diarrhea, flushing, cyanosis |
|
|
Term
| bronchial carcinoid tumor: prognosis and metastasis |
|
Definition
5-15% in hilar nodes at presentation, distal metastasis rare
often resectable and curable
10y survival 85% for typical and 50% for atypical |
|
|
Term
| bronchial carcinoid tumor: associated diseases |
|
Definition
| multiple endocrine neoplasia syndrome |
|
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