Crr Week 6: Neoplastic Diseases Of The Lung And Pleura (Sawh)

Front 1

What is a malignant tumor of epithelial cells called?

Back 1

Carcinoma

Front 2

What is a malignant tumor of squamous cells called?

Back 2

Squamous cell carcinoma

Front 3

What is a malignant tumor of glandular cells called?

Back 3

Adenocarcinoma

Front 4

What is a benign tumor composed of haphazardly arranged tissues typical of that location called?

Back 4

Hamartoma

Front 5

Are lung cancers more common in men or women?

Back 5

Men
(2.7 : 1 ratio)

Front 6

In U.S. men, what is the most frequent form of lung cancer?

Back 6

Adenocarcinoma

Front 7

Describe the decrease in lung cancer risk after smoking cessation.

Back 7

After 5 years cessation --> risk sharply decreases

After 20 years cessation --> risk approaches that of those who have never smoked

Front 8

Which lung cancers are correlated to tobacco smoke?

Back 8

Squamous cell carcinoma > small cell carcinoma > adenocarcinoma

Front 9

Why is there a higher rate of lung cancer in US blacks than other ethnicities?

Back 9

Probably due to increased tobacco consumption

Front 10

By how much does second-hand smoke increase the risk of lung cancer?

Back 10

20-25%

Front 11

List 5 of the most important occupational carcinogens that can lead to lung cancer

Back 11

1. Asbestos
2. Crystalline silica
3. Radon
4. Polycyclic aromatic hydrocarbons
5. Heavy metals

Front 12

List 3 common genetic changes that result in lung cancer

Back 12

1. TP53 gene mutation
2. Inactivation of pathway controlling RB1
3. Loss of heterozygosity (LOH) on chromosome 3p

Front 13

Where is the retinoblastoma gene located?

Back 13

13q11

Front 14

Inactivation of RB1 pathway accounts for 80 - 100% of _____________ carcinomas

Back 14

Small cell carcinomas

Front 15

Loss of heterozygosity on chromosome 3p accounts for ~80% of ____________ carcinomas

Back 15

Non-small cell carcinomas

Front 16

During the development of small cell lung carcinoma, which comes first-- inactivation of RB or TP53 mutation?

Back 16

1. Inactivation of RB
2. TP53 mutation

Front 17

Does TP53 mutation occur sooner during the development of NSCLC or SCLC?

Back 17

NSCLC

Front 18

What are the 2 types of benign epithelial tumors of the lung?

Are these common or uncommon?

Back 18

1. Papilloma
2. Adenoma

*These are uncommon

Front 19

What are the 4 types of malignant epithelial tumors of the lung?

Are these common or uncommon?

Back 19

1. Squamous cell carcinoma
2. Adenocarcinoma
3. Large cell carcinoma
4. Small cell carcinoma

These are common

Front 20

A malignant epithelial tumor showing keratinization and/or intercellular bridges that arises from bronchial epithelium is known as?

Back 20

Squamous cell carcinoma

Front 21

What percentage of cases of squamous cell carcinoma occur in cigarette smokers?

Back 21

90%

Front 22

Where do squamous cell carcinomas generally arise?

Back 22

Centrally in the mainstem, lobar, or segmental bronchi

Front 23

Which type of carcinomas are white to gray and often undergo cavitary necrosis?

Back 23

Squamous cell carcinoma

Front 24

Presence of keratinization is characteristic of which type of lung cancer?

Back 24

Squamous cell carcinoma

Front 25

How is the grade of squamous cell carcinoma determined?

Back 25

By the level of keratinization

Well differentiated = abundant keratinization
Poorly differentiated = little to no keratinization (must rely on finding intracellular bridges)

Front 26

Is the survival rate of squamous cell carcinomas better or worse than that of adenocarcinomas of the same stage?

Back 26

Better survival rate

Front 27

What is the percentage of 5yr survival for resected Stage 1 squamous cell carcinoma?

Back 27

80% survival

Front 28

A malignant epithelial tumor with glandular differentiation and/or mucin production is known as?

Back 28

Adenocarcinoma

Front 29

Which types of lung cancers usually grows peripherally?

Back 29

Adenocarcinoma
Large cell carcinoma

Front 30

Which type of lung cancer may show hemorrhage, necrosis, or cavitation, and may cause pleural retraction or puckering?

Back 30

Adenocarcinoma

Front 31

Which type of lung cancer may appear gelatinous?

Back 31

Adenocarcinoma
(due to mucin production)

Front 32

Which type of adenocarcinoma grows non-invasively along alveolar septa, leading to pulmonary consolidation resembling pneumonia?

Back 32

Bronchioloalveolar carcinoma

Front 33

Easily depicted glandular structures on a histology slide would be indicative of what stage of adenocarcinoma-- well-differentiated or poorly differentiated?

Back 33

Well-differentiated

Front 34

Which type of carcinoma spreads in a "lepidic" fashion?

Back 34

Bronchioloalveolar carcinoma
(specific type of adenocarcinoma)

Front 35

What is the percent 5-yr survival rate for resected Stage 1 adenocarcinomas?

Back 35

70%

Front 36

What is the percent 5-yr survival rate for localized resected bronchioloalveolar carcinomas?

Back 36

100%

Front 37

A malignant neuroendocrine tumor composed of relatively small cells with scant cytoplasm, fine nuclear chromatin, necrosis, and a high mitotic rate is called?

Back 37

Small cell carcinoma

Front 38

Small cell carcinomas are usually located where?

Back 38

Centrally
(with invasion of mediastinum and lymph node involvement)

Front 39

Which lung cancer as the following gross appearance:
White-tan, soft mass with extensive necrosis, peribronchial growth, and lymphangitic spread?

Back 39

Small cell carcinoma

Front 40

Which type of lung cancer resembles a lymphoma?

Back 40

Small cell carcinoma

Front 41

Which types of lung cancer are malignant neuroendocrine tumors?

Back 41

Small cell carcinoma
Large cell neuroendocrine tumor

Front 42

Which type of lung cancer has a lymphangitic spread?

Back 42

Small cell carcinoma

Front 43

Untreated patients with extensive small cell carcinoma have a median survival of...?

Back 43

6 weeks

Front 44

What is the 5yr prognosis for limited and extensive small cell carcinomas?

Back 44

Limited --> 5yr survival rate of 20%

Extensive --> 5yr survival rate <5 %

Front 45

An undifferentiated non-small cell carcinoma that lacks features of either glandular or squamous differentiation is know as...?

Back 45

Large cell carcinoma

Front 46

Are large cell carcinomas generally located centrally or peripherally?

Back 46

Peripherally

Front 47

Which lung cancer has the following gross appearance:
Large peripheral masses that often invade visceral pleura, chest wall, or adjacent structures?

Back 47

Large cell carcinoma

Front 48

Which type of lung cancer appears as an undifferentiated tumor with large cells, abundant cytoplasm, and large nuclei?

Back 48

Large cell carcinoma

Front 49

Is there a significant difference in prognosis between large cell neuroendocrine carcinoma and small cell carcinoma?

Back 49

No. The prognosis is about the same

Front 50

List 4 types of neuroendocrine tumors of the lung.

Back 50

1. Carcinoid tumor
2. Atypical carcinoid tumor
3. Large cell neuroendocrine carcinoma
4. Small cell carcinoma

Front 51

Do carcinoid tumors typically centrally or peripherally in the lung?

Back 51

Centrally

Front 52

Which tumors are very monotonous and bland with fine nuclear chromatin, increased mitotic activity, and foci of necrosis?

Back 52

Carcinoid

Front 53

List 3 types of pleural tumors

Back 53

1. Malignant mesothelioma
2. Lymphoma
3. Mesenchymal tumors

Front 54

What are the 3 types of malignant mesotheliomas?

Back 54

1. Epitheloid type
2. Sarcomatoid type
3. Biphasic type

Front 55

Are malignant mesotheliomas more frequent in men or women? why?

Back 55

Men
(higher asbestos exposure)

Front 56

What is the latency period of malignant mesothelioma?

Back 56

30 - 40 years

Front 57

Which type of pleural tumor appears as confluent pleural nodules that encase and constrict lung perenchyma?

Back 57

Malignant mesothelioma

Front 58

List some clinical presentations that can result from lung tumors

Back 58

1. Chronic cough
2. Hemoptysis
3. Anorexia
4. Weight loss
5. Chest pain
6. Dyspnea

Front 59

What kind of obstructive effects can lung tumors cause?

Back 59

1. Atelectasis
2. Pneumonia
3. Abscess
4. Bronchiectasis

Front 60

What are some intrathoracic effects caused by lung tumors?

Back 60

1. SVC obstruction
2. Paralysis of diaphragm
3. Paralysis of vocal cords
4. Horner syndrome (Pancoast tumor)
5. Intrathoracic spread

Front 61

SIADH is most often associated with which type of lung cancer?

Back 61

Small cell carcinomas

Front 62

List 3 types of paraneoplastic neurologic syndromes.

Back 62

1. Subacute sensory neuropathy
2. Mononeuritis multiplex
3. Lambert-Eaton myasthenic syndrome

Front 63

List 2 skeletal paraneoplastic syndromes.

Back 63

1. Hypertrophic osteoarthropathy
2. Clubbing

Front 64

A mass in the apex of the lung with cavitary necrosis is most likely what type of tumor?

Back 64

Pancoast tumor
(results in Horner's syndrome)

Front 65

List 3 general diagnostic procedures for lung tumors.

Back 65

1. Bronchoscopy
2. Transthoracic CT-guided FNA +/- core needle biopsy
3. Surgical "wedge" lung biopsy