H. Tumors Of The Lung - Part I

Front 1

What are the 2 main types of lung tumors? What percent is each?

Back 1

-Bronchogenic carcinoma 95%
-Carcinoid 5%

Front 2

Where do bronchogenic carcinomas originate?

Back 2

In the bronchial or bronchiolar epithelium.

Front 3

What are the 2 really bad facts about bronchogenic carcinoma?

Back 3

-It is the #1 cancer in developed countries
-It is the most common visceral malignancy in males

Front 4

What portion of cancer death is caused by Bronchogenic carcinoma
-In Males
-In both sexes

Back 4

Males: 1/3 of all cancer
Both sexes: 7%

Front 5

What sex is bronchogenic carcinoma seen in more commonly?

Back 5

Males

Front 6

What puts anyone at increased risk of getting Bronchogenic carcinoma?

Back 6

Smoking

Front 7

What has happened to females in terms of incidence of bronchogenic carcinoma?

Back 7

-frequency is increasing
-Surpassed breast cancer as a cause of cancer death

Front 8

What is Bronchogenic carcinoma the most frequent cause of?

Back 8

Fatal malignancy

Front 9

At what age is the peak incidence of bronchogenic carcinoma?

Back 9

50s - 60s

Front 10

What are the 5 etiologies of bronchogenic carcinoma?

Back 10

1. Smoking
2. Occupational hazards
3. Air pollution
4. Genetics
5. Scarring

Front 11

How much higher of a risk are
-Smokers
-Heavy smokers

Back 11

Smokers = 10X higher
Heavy smokers = 20X higher

Front 12

What can reduce the risk of getting lung cancer all the way back to control level?

Back 12

Stopping smoking for 10 years

Front 13

What is a pack year defined as?

Back 13

(# of packs/day)x (years)

Front 14

So what is 1 pack year?

Back 14

1 pack per day for 1 year
or
2 packs per day for 6 months

Front 15

How many cigs are in a pack?

Back 15

20

Front 16

What is the clinical evidence showing that smoking tobacco increases the risk of lung cancer?

Back 16

~97% of smokers have atypical changes in the bronchial epithelium

Front 17

What are the 3 main Industrial Hazards that increase the risk of getting lung cancer?

Back 17

-Radiation
-Uranium
-Asbestos

Front 18

In whom is radiation seen as a cause of lung cancer?

Back 18

-Hiroshima survivors
-Nagasaki survivors

Front 19

In whom does Uranium cause higher rates of lung cancer than the general population?

Back 19

Uranium miners

Front 20

What type of industrial hazard causes the highest increase in risk of developing lung cancer?

Back 20

Asbestos

Front 21

Compared to the general population, What is the increase in risk for getting lung ca from
-Asbestos exposure alone
-Asbestos + smoking

Back 21

Asbestos - 5X greater risk

Asbestos + smoking = 50-90X greater risk

Front 22

What is the period of latency between exposure to asbestos and getting cancer?

Back 22

10-30 years

Front 23

What are the 3 main types of cancer caused deaths in asbestos exposure, and in what fractions?

Back 23

Lung cancer death = 1/5
Mesothelioma = 1/10
GI cancer = 1/10

Front 24

If you see MESOTHELIOMA think..

Back 24

ASBESTOS!!!

Front 25

Does asbestos exposure + smoking increase the risk of getting mesothelioma?

Back 25

No; only with lung cancer is this a factor.

Front 26

What is asbestos exposure more associated with; lung cancer or mesothelioma?

Back 26

Mesothelioma

Front 27

But which type of cancer is more likely to cause death?

Back 27

Lung cancer caused by asbestos exposure.

Front 28

What type of air pollution is associated with bronchogenic carcinoma?

Back 28

Radon exposure

Front 29

What is Radon?
Who is at risk of exposure?

Back 29

A ubiquitous radioactive gas

-Miners are exposed to higher concentrations

Front 30

What are 2 types of genes which when altereded are associated with Bronchogenic carcinoma?

Back 30

-Oncogenes
-Tumor suppressor genes

Front 31

What 2 oncogenes lead to neoplasia when mutations accumulate?

Back 31

-C-myc
-K-ras

Front 32

What type of cancer is associated with C-myc?

Back 32

Small cell carcinoma

Front 33

What type of cancer is associated with K-ras?

Back 33

Adenocarcinoma

Front 34

What 2 tumor suppressor genes are associated with neoplasia?

Back 34

p53
Retinoblastoma

Front 35

What damages the same codons of p53 as seen in mutations in clinical lung cancers?

Back 35

Benzopyrene

Front 36

What type of cancer is Scarring usually associated with?

Back 36

Adenocarcinomas

Front 37

What are Scar cancers?

Back 37

Cancers occurring in the vicinity of pulmonary scars

Front 38

What is the scar caused by in most cases?

Back 38

The tumor itself

Front 39

So at what age is the usual clinical presentation of bronchogenic carcinoma?

Back 39

50-60's

Front 40

What are the major presenting complaints in bronchogenic carcinoma? (highest freq to low)

Back 40

Cough - 75%
Weight loss - 40%
Chest pain - 40%
Dyspnea - 20%

Front 41

When a lung tumor obstructs the airway, what are 3 clinical complications seen?

Back 41

-Pneumonia
-Abscess
-Lobar collapse

Front 42

When a tumor obstructs the airway and cellular lipid accumulates in foamy macrophages what is this called?

Back 42

Lipid pneumonia

Front 43

What is the result of a lung tumor spreading into the pleura?

Back 43

Pleural effusion

Front 44

What results if tumors invade
-the recurrent laryngeal nerve
-the esophagus
-the phrenic nerve

Back 44

Recurrnt nerve: hoarseness
Esophagus: dysphagia
Phrenic nerve: diaphragm paralysis

Front 45

What is Thoracic outlet syndrome?

Back 45

A condition where an apical lung tumor compresses the SVC and results in decreased blood return to the heart.

Front 46

Do lung tumors normally cause collapse of the airway?

Back 46

No; more often they incompletely obstruct the airway

Front 47

What is the result of incomplete obstruction of the airway by a lung tumor?

Back 47

Atelectasis

Front 48

How is Bronchogenic carcinoma classified?

Back 48

Based on what the tumor's response will be to chemotherapy

Front 49

What are the 2 main classes of bronchogenic carcinoma?

Back 49

1. Small cell carcinoma
2. Non-small cell carcinoma

Front 50

Which class of bronchogenic carcinoma is always treated with chemo? Why?

Back 50

Small cell - because it is highly malignant.

Front 51

What are 2 subtypes of Small cell bronchogenic carcinoma?

Back 51

-Oat cell lymphocytic like carcinoma
-Intermediate cell (polygonal) carcinoma

Front 52

What are 4 subtypes of non small cell bronchogenic carcinoma?

Back 52

-Squamous cell (epidermoid)
-Adenocarcinoma
-Combined
-Large cell carcinoma

Front 53

What is Adenocarcinoma of the lung also called?

Back 53

Bronchioloalveolar carcinoma

Front 54

What does Combined consist of?

Back 54

-Small cell
-Squamous cell

Front 55

What are the 4 subtypes of Large cell carcinoma of the lung?

Back 55

-Neuroendocrine
-Undifferentiated
-Giant cell
-Clear cell

Front 56

What is the most common type of non small cell bronchogenic carcinoma in males?

Back 56

Squamous cell carcinoma

Front 57

What do you see in gross exam of the lung of a patient with Squamous cell carcinoma of the lung?

Back 57

Central cavitary necrosis in the tumor

Front 58

Where does the tumor usually arise in Squamous cell carcinoma of the lung?

Back 58

Centrally - in the main or lobar bronchi
-Polypoidal growth, endobronchial

Front 59

What does Endobronchial or Polypoid growth mean?

Back 59

It grows up off the epithelial lining of the bronchus and into the airway

Front 60

What is the 5-year survival rate of a person with Squamous cell carcinoma of the lung?

Back 60

37%

Front 61

What is seen on microscopic histology of squamous cell carcinoma of the lung?

Back 61

-Keratin formation (whirls)
-Intercellular bridges
-Atypia
-Invasion

Front 62

What type of bronchogenic carcinoma has equal frequency to squamous cell carcinoma of lung?

Back 62

Adenocarcinoma

Front 63

In what patients is broncheoloalveolar carcinoma (adenocarcinoma) more commonly seen in? What patients is it MOST commonly seen in?

Back 63

-Women
-Non smokers
But still MOST commonly seen in SMOKERS.

Front 64

What is the most common form of lung cancer in the USA?

Back 64

Adenocarcinoma - broncheoloalveolar carcinoma

Front 65

Where squamous cell bronchogenic carcinoma is more central, where is adenocarcinoma of the lung seen?

Back 65

Peripheral

Front 66

What are 4 gross features often seen in Adenocarcinoma of the lung?

Back 66

-Peripheral tumors
-Pleural retraction
-Puckering
-Scarring

Front 67

How does adenocarcinoma of the lung compare to squamous cell, in terms of growth rate, metastasis and diagnosis?

Back 67

Rate: more slowly growing
Metastasis: more frequent
Diagnosis: late - it is asymptomatic because it's more peripheral and you can still breathe

Front 68

What are the 3 histologic features of Adenocarcinoma of the lung?

Back 68

-Glandular with mucin
-Papillary
-Solid

Front 69

What subtype of Adenocarcinoma comprises 1-9% of all lung carcinomas?

Back 69

Broncheoloalveolar carcinoma

Front 70

Why do we differentiate Bronchioloalveolar carcinoma from other adenocarcinomas?

Back 70

Because there are distinct gross features seen that have correlating histologic abnormalities too.

Front 71

What are 3 different gross presentations of bronchioloalveolar carcinoma?

Back 71

1. Single peripheral nodule
2. Multiple nodules
3. Diffuse pneumonia-like infiltrate

Front 72

What histologic feature is seen in ALL types of bronchioloalveolar carcinomas?

Back 72

Lepidic spread

Front 73

What is Lepidic spread?

Back 73

Spreading of tumor cells along alveolar septations

Front 74

What type of lepidic spread is associated with bronchioloalveolar carcinoma when the gross features seen are Single peripheral nodules OR Multiple nodules?

Back 74

Nonmucinous

Front 75

What cell type makes up the tumor in bronchioloalveolar carcinoma of the Nonmucinous subtype? What fraction of subtypes are this type?

Back 75

Clara cells (Type II pneumos)
2/3

Front 76

What cell type comprises the tumors in the other 1/3 of bronchioloalveolar carcinomas, and what gross morphology is seen?

Back 76

-Tall columnar mucinous cells
-Diffuse pneumonia-like infiltrate

Front 77

Which subtype of bronchioloalveolar carcinoma has a worse prognosis?

Back 77

Mucinous/diffuse pneumonia like infiltrate

Front 78

What type of bronchogenic carcinoma is seen in intermediate frequency?

Back 78

Small cell carcinoma

Front 79

In what patient population is small cell carcinoma predominant?

Back 79

Male smokers

Front 80

Where are tumors located in SCC?

Back 80

Centrally

Front 81

Why is SCC so bad?

Back 81

Because it is highly malignant and has a median survival of 4 months

Front 82

How does the tumor growth of SCC compare to that in squamous cell carcinoma of the lung?

Back 82

SCC = central but NONpolypoid

Squamous = central but polypoid

Front 83

Where squamous cell carcinoma is growing out of the lung epithelium, what type of infiltration is seen in SCC?

Back 83

Submucosal/circumferential infiltration

Front 84

If you see a central tumor in the lung, other than it not being polypoid how could you tell if it's SCC?

Back 84

There will NOT be central necrosis

Front 85

What happens to the cell morphology in small cell carcinoma samples? Why?

Back 85

Crush artifiact - due to extensive necrosis

Front 86

What is the microscopic HALLMARK of small cell carcinoma?

Back 86

Secretory granules of the neuroendocrine type

Front 87

Why is small cell carcinoma such bad news?

Back 87

Because by the time it is diagnosed 70% of patients already have metastasis

Front 88

What additional symptom is a hallmark that clues you in to diagnose small cell carcinoma?

Back 88

Paraneoplastic syndrome - ectopic hormone production

Front 89

What is the best and really only treatment for small cell carcinoma?

Back 89

Chemo

Front 90

How is the recovery in patients with small cell carcinoma?

Back 90

Rapid