Term
| T/F Lung cancer is the most frequently diagnosed cancer in the world. |
|
Definition
| true 215,000 cases and 162,000 deaths in US in 2008 |
|
|
Term
| What percent of lung tumors are carcinomas? |
|
Definition
|
|
Term
| What percent of lung tumors are carcinoids? |
|
Definition
|
|
Term
| What percent of lung tumors are mesenchymal/miscellaneous? |
|
Definition
|
|
Term
| What are the characteristics of small cell carcinoma that distinguish it from non small cell? |
|
Definition
| likely to be metastatic at presentation, responds to chemotherapy (at least initially), treatment is not surgical |
|
|
Term
| What are the characteristics of non-small cell tumors that distinguish them from small cell lung tumors? |
|
Definition
| less likely to be metastatic at initial presentation, less responsive to chemotherapy, surgery is tx if surgical candidate, chemotherapy and radiation are used in conjunction |
|
|
Term
| What are the characteristics of squamous cell carcinoma? |
|
Definition
| strong association with smoking, more common in men, most commonly arise centrally, P53 mutations, long pre-neoplastic period |
|
|
Term
| What are the preneoplastic changes associated with squamous cell carcinoma? |
|
Definition
| squamous metaplasia (reversible), dysplasia (reversible), carcinoma in situ (cureable) |
|
|
Term
| What are the 5 histological features of squamous cell carcinoma of the lung? |
|
Definition
| keratinization, intercellular bridges, "squamous pearls", high mitotic rate, necrosis |
|
|
Term
| What genetic factors contribute to squamous cell carcinoma of the lung? |
|
Definition
| p53, Rb1, and EGFR (epidermal growth factor receptor overexpression) |
|
|
Term
| About 15% of squamous cell carcinomas lose expression of which gene? |
|
Definition
|
|
Term
| Which lung cancer has the highest frequency mutation of all lung cancers? |
|
Definition
| squamous cell carcinoma oncogenetics |
|
|
Term
| What do you call a malignant epithelial tumor with glandular differentiation and/or mucin production in the lung? |
|
Definition
|
|
Term
| What is the most common type of lung cancer found in women and nonsmokers? |
|
Definition
|
|
Term
| Where in the lung is adenocarcinoma found? |
|
Definition
|
|
Term
| What two markers help to confirm that a lung malignancy is adenocarcinoma? |
|
Definition
|
|
Term
| What is a "scar carcinoma"? |
|
Definition
| adenocarcinoma that causes scaring (not the other way around!) |
|
|
Term
| Which mutations occur in adenocarcinoma? |
|
Definition
| KRAS mutations mainly (poorer outcome) and EGFR (pts benefit from EGFR inhibition therapy), P53, RB1 and p16 |
|
|
Term
| Bronchioalveolar carcioma is a type of _______ and accounts for ___% of lung cancer. |
|
Definition
|
|
Term
| Where does bronchioalveolar carcinoma occur? |
|
Definition
| terminal bronchioalveolar regions; almost ALWAYS PERIPHERAL |
|
|
Term
| What type of lung cancer grows along existing structures without destruction of alveolar architecture and no evidence of stromal, vascular, or pleural invasion? |
|
Definition
| bronchioalveolar carcinoma |
|
|
Term
| What is the most aggressive of all lung cancers? |
|
Definition
|
|
Term
| Which lung cancer is a "neuroendocrine" malignancy arising from neuroendocrine progenitor cells lining the bronchial epithelium? |
|
Definition
|
|
Term
| What mutations are involved in small cell carcinoma? Does this have an association with smoking? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where is small cell typically located? |
|
Definition
| "central" tumor often submucosal |
|
|
Term
| What is the most common lung cancer associated with paraneoplastic syndromes? |
|
Definition
|
|
Term
|
Definition
| approx 3x size of lymphocyte |
|
|
Term
| What are the morphological characteristics of small cell carcinoma? |
|
Definition
| small, scant cytoplasm, ill-defined cell borders, dense, dark nuclei, finely granular chromatin, inconspicuous nucleoli, nuclear molding, high mitotic count, prominent necrosis |
|
|
Term
| What structures on EM help identify small cell carcinoma? |
|
Definition
| dense core neurosecretory granules (100nm by EM) |
|
|
Term
| What are the neuroendocrine markers used to identify small cell? |
|
Definition
| chromogranin, synaptophysin, CD57 |
|
|
Term
| How long does a pt with small cell live without treatment? |
|
Definition
|
|
Term
| What's the potential cure rate for limited/localized small cell? |
|
Definition
|
|
Term
| What is the median survival time of pts with small cell? |
|
Definition
|
|
Term
| What is a large cell carcinoma? |
|
Definition
| undifferentiated malignant epithelial tumor that lacks the cytologic features of small cell carcinoma as well as glandular or squamous differentiation |
|
|
Term
| T/F All non small cell carcinomas are by definition large cell carcinomas. |
|
Definition
|
|
Term
| What percent of lung cancers is combined carcinoma? |
|
Definition
|
|
Term
| What is large cell neuroendocrine carcinoma? |
|
Definition
| a type of combined carcinoma that may be squamous/small or adeno/small |
|
|
Term
| What are four big contributors to causing lung cancer? |
|
Definition
| tobacco smoking, industrial hazards, air pollution, molecular genetics |
|
|
Term
| What percent of lung cancers occur in smokers? |
|
Definition
|
|
Term
| The average smoker has a ___ risk of having lung cancer compared to non smokers. |
|
Definition
| 10x, heavy smokers can have up to 60x! |
|
|
Term
| How long do you have to quit smoking to reduce your risk of lung cancer? |
|
Definition
| 10 yrs (never get to baseline tho) |
|
|
Term
| T/F Smoking increases your risk of having cancer of the mouth, pharynx, larynx, esophagus, pancreas, uterus, cervix, kidney, and urinary blader. |
|
Definition
|
|
Term
| What increased risk do miners inhaling radioactive uranium have of getting lung cancer? |
|
Definition
| 4x for nonsmokers, 10x for smokers |
|
|
Term
| How does asbestos exposure affect your chance of lung cancer? How long is the latent period |
|
Definition
5x risk in nonsmokers, 50-90x in smokers
10-30 yr latent period |
|
|
Term
| T/F Radon and formaldehyde can contribute to causing lung cancer. |
|
Definition
|
|
Term
| _____ genetic mutations have occured by tht time a tumor is clinically apparent. |
|
Definition
|
|
Term
| Name the oncogenes frequently involved in lung cancer. |
|
Definition
| c-MYC, KRAS, EGFR, c-MET and C-kit |
|
|
Term
| Name the commonly deleted or inactivated tumor suppressor genes that contribute to lung cancer. |
|
Definition
|
|
Term
| What's so special about chromosome 3p? |
|
Definition
| there are numerous candidate tumor suppressor genes, such as FHIT, RASSF1A, and others |
|
|
Term
| What is the feild effect? |
|
Definition
| smoking and other mutagens cause alterations in the mucosa that can predispose you to getting a lung cancer (feild cancerization) |
|
|
Term
| What % of lung cancers WORLDWIDE occur in nonsmokers? |
|
Definition
|
|
Term
| What are the genetic mutations that characterize lung cancer not caused by smoking? |
|
Definition
| EGFR but almost never has KRAS and also p53 are less common |
|
|
Term
| What are the precursor lesions for squamous cell carcinoma? |
|
Definition
| squamous metaplasia, dysplasia, CIS |
|
|
Term
| What are the precursor lesions for adenocarcinoma? |
|
Definition
| atypical adenomatous hyperplasia |
|
|
Term
| What are the precursor lesions for small cell carcinoma? |
|
Definition
| diffuse idiopathic pulmonary neuroendocrine cell hyperplasia |
|
|
Term
| What are the paraneoplastic syndromes associated with lung cancer? |
|
Definition
| hyponatremia (ADH), cushings (adrenocorticotropic hormone), hypercalcemia (PTH), calcitonin (hypocalcemia), gynecomastia, carcinoid syndrome (seratonin and bradykinin) |
|
|
Term
| What are some systemic manifestations of lung cancer? |
|
Definition
| lambert-eaton myasthenic syndrome, acanthosis nigricans, peripheral neuropathy, hypertrophic osteoarthropathy, clubbing of fingers |
|
|
Term
| What is lambert eaton myasthenic syndrome? |
|
Definition
| weakness caused by autoantibodies against neuronal calcium channel |
|
|
Term
| What are some localized manifestations of lung cancer? |
|
Definition
| tumor mass obstructs bronchus, distal atelectasis, poast obstructive pneumonia/infection, ,may infiltrate bronchus and/or mediastinum, hemorrhage/necrosis/cavitation, pleural extension/effusion/seeding, compression of superior vena cava with venous congestion and edema of head and arm, metastasis |
|
|
Term
| What is a pancoast tumor? |
|
Definition
tumor at the apex of the lung- can cause honer's syndrome or compression of brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, or vagus nerve
also, severe pain in distribution of ulnar nerve |
|
|
Term
| What's the overall 5yr survival of all lung cancers? |
|
Definition
|
|
Term
| What's the survival if lung cancer is localized via lobectomy/pneumonectomy? |
|
Definition
|
|
Term
| What are carcinoid tumors? |
|
Definition
|
|
Term
| What patient population is typically affected by carcinoid tumors? |
|
Definition
| less than 40 yoa and males same as females |
|
|
Term
| Where are most carcinoid tumors found? |
|
Definition
| in the main stem bronchus, submucosal |
|
|
Term
| How big are carcinoid tumors? |
|
Definition
|
|
Term
| What is the morphology of carcinoid tumors? |
|
Definition
| regular, round cells with uniform nuclei. Moderate amount of eosinophilic cytoplasm, organoid architecture with delicate fibrovascular stroma |
|
|
Term
| What's the difference between typical and atypical carcinoid tumor? |
|
Definition
typical= has < 2 mitosis/10 hpf, no necrosis
atypical= 2-10 mitosis/10 hpf and/or necrosis |
|
|
Term
| Carcinoid syndrome is characterized by what symptoms? |
|
Definition
| flushing, diarrhea, cyanosis |
|
|
Term
| What is the prognosis for a typical carcinoid? |
|
Definition
| 87% at 5 yrs, 87% at 10 years |
|
|
Term
| What is the prognosis for atypical carcinoid? |
|
Definition
| 56% at 5 year, 35% at 10 yrs |
|
|
Term
| What is the prognosis for large cell neuroendocrine carcinoma? |
|
Definition
| 5 year 27%, 10 year is 9% |
|
|
Term
| What is the prognosis for small cell carcinoma? |
|
Definition
| 5 year is 9%, 10 year is 5% |
|
|
Term
| T/F THe lung is among the most common sites of metastatic spread. |
|
Definition
|
|
Term
| What are the tumors of the superior mediastinum? |
|
Definition
| lymphoma, thymoma, thyroid lesions, metastatic carcinoma, parathyroid tumors |
|
|
Term
| What are the tumors of the anterior mediastinum? |
|
Definition
| thymoma, teratoma, lymphoma, thyroid lesion, parathyroid tumors |
|
|
Term
| What are the tumors of the posterior mediastinum? |
|
Definition
| neurogenic tumors (schwannoma, neurofibroma), lymphoma, gastroenteric hernia |
|
|
Term
| What are the tumors of the middle mediastinum? |
|
Definition
| bronchogenic cyst, pericardial cyst, lymphoma |
|
|
Term
| Primary disorders of the pleura include... |
|
Definition
| primary intrapleural bacterial infections and primary neoplasm of the pleura (mesothelioma) |
|
|
Term
| What physiologic effects does a pleural effusion cause: |
|
Definition
| increased hydrostatic pressure (like CHF), increased vascular permeability (pneumonia), decreased osmotic pressure (nephrotic), increased intrapleural negative pressure (like atelectasis),decreased lymphatic drainage (like mediastinal carcinomatosis) |
|
|
Term
| What are the different types of pleuritis? |
|
Definition
| serous, serofirinous and fibrinous (call essentially caused by the same process) |
|
|
Term
| What is remarkable about a pleural effusion with a fibrinous exudate? |
|
Definition
| reflects a later, more severe exudative reaction that, in an earlier developmental phase might have presented as a serous or serofibrinous exudate |
|
|
Term
| What are common causes of pleuritis? |
|
Definition
inflammatory disease such as TB, pneumonia, lung infarcts, lung abscess, and bronchiectasis
also, RA, disseminated SLE, uremia, diffuse systemic infections, other systemic d/o's, and metastatic involvement of the pleura |
|
|
Term
| What do you call a pleural effusion with purulent exudate? |
|
Definition
|
|
Term
| What do you call pleural effusion with blood? |
|
Definition
|
|
Term
| What causes hemorrhagic pleuritis? |
|
Definition
| hemorrhagic diathesis, rickettsial dzs, neoplastic involvement of the pleural cavity |
|
|
Term
| When you encounter hemorrhagic pleuritis, it is important to carefully search for... |
|
Definition
| exfoliated tumor cells in the exudate |
|
|
Term
|
Definition
| noninflammatory collections of serous fluid within the pleural cavities. Clear/straw colored fluid |
|
|
Term
| What's the most common cause of hydrothorax? |
|
Definition
cardiac failure (usually accompanied by pulmonary congestion and edema)
--also renal failure and cirrhosis of the liver can cause it |
|
|
Term
| Hemothorax is caused by... |
|
Definition
| ruptured aortic aneurysm or vascular trauma or post operatively |
|
|
Term
| How do you identify hemothorax? |
|
Definition
| there will be large clots that accompnay the fluid componenet of blood |
|
|
Term
|
Definition
| accumulation of milky fluid usually of lymphatic origin in the pleural cavity. Chyle is milky white because it contains finely emulsified fats |
|
|
Term
|
Definition
| thoracic duct trauma or obstruction that secondarily causes rupture of major lymphatic ducts (due to malignancy |
|
|
Term
| What are the sources of metastatic tumors to the pleura? |
|
Definition
| lung, breast, ovary, others |
|
|
Term
| What are alternative names for "benign mesothelioma"? |
|
Definition
| solitary fibrous tumor, benign mesothelioma, benign fibrous mesothelioma, fibroma |
|
|
Term
| What percent of mesotheliomas are asbestos related? |
|
Definition
|
|
Term
| What is the latent period of mesothelioma? |
|
Definition
|
|
Term
| What is the increased risk of mesothelioma due to asbestos if the pt also smokes? |
|
Definition
| smoking doesn't increase your risk of mesothelioma (smoking + asbestos increases your risk of lung carcinoma however) |
|
|
Term
| What is the histology of malignant mesothelioma? |
|
Definition
| epitheloid, sarcomatoid, mixed |
|
|
Term
| What are the markers used for malignant mesothelioma? |
|
Definition
| positive ofr acid muchopolysaccharide, negative for CEA, positive for CK and long microvilli on EM |
|
|
Term
| What is the prognosis of malignant mesothelioma? |
|
Definition
| 50% 12 month survival rate; very low 2 year survival rate |
|
|
Term
| What is peritoneal mesothelioma? |
|
Definition
| mesothelioma in the abdominal cavity that is very strongly related to asbestos exposure, 50% remain confined to the abdominal cavity |
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