Resp 2 - Peterson Pulmonary Neoplasms

Front 1

Lung cancer is currently the most commonly diagnosed major cancer in the world. 90-95% of pulmonary neoplasms are _______

Back 1

carcinomas

Front 2

Since the 1990s lung cancer incidence and mortality has decreased in ____.
Since 1987 more women have died each year from lung cancer than _____ cancer

Back 2

men

breast

Front 3

_ year survival has increased from 34% (1975) to 41% (2007), from advances in surgical technique.
But _ year survival for all stages is only 16%.

Back 3

1
5

Front 4

Tobacco smokers have a ___ greater risk than nonsmokers. Heavy (40 cigarettes/day/years) have a __x increased risk.
Which gender is more susceptible to cigarette carcingoens?
Smoking cessation for __ years reduces risk but not back to baseline

Back 4

10x
60x
women
10

Front 5

linear correlation between intensity of cigarette exposure and the appearance of epithelial changes:
Squamous ______ -> squamous _______-> carcinoma

Back 5

metaplasia
dysplasia

Front 6

Lung tumors of smoker frequently contain G:C>T:A mutations in the __ gene thought to be caused by ______, a carcinogen in tobacco smoke.

Back 6

p53
benzopyrene

Front 7

What are the 5 dominant oncogenes frequently involved in lung cancer?
c-___
k___
e___
c-___
c-___

Back 7

c-myc
kras
egfr* mutated in non-smoking women
c-met
c-kit

Front 8

Tumor suppressor genes frequently inactivated include:
P__, RB1, p__, and multiple loci on 3p

Back 8

p53
RB1
p16
multiple loci on 3p

Front 9

Carcinomas can be divided into two broad groups (Small cell, and Non-small cell).
C-KIT, MYCN, MYCL, p53, 3p, RB, bcl-2 (Small cell)
EGFR, KRAS, p53, p16 (Non-small cell)
How can you remember non-small cell?

Back 9

EGFR and p53 are easy to remember... p53 is in both. Then the other p one (p16) and a weird one KRAS

Front 10

__ deletions are frequently seen in non-cancerous epithelium of smokers

Back 10

3p deletions

Front 11

25% of lung cancer occurs in non-smokers most commonly _____ with mutations in ____

Back 11

women
EGFR

Front 12

There are three types of precursor lesions recognized:
_______ dysplasia and carcinoma in-situ
Atypical _______ hyperplasia
Diffuse idiopathic pulmonary _______ cell hyperplasia

Back 12

squamous
adenomatous
neuroendocrine

Front 13

Which tumor has resulting horner's syndrome from axillary nerve plexus invasion?

Back 13

Pancoast tumor - ptosis, miosis, anhidrosis, sympathetic chain invasion.

Front 14

What syndrome results in arms not draining when raised, edema and rubor seen in skin, and varicosities in the abdomen?

Back 14

Superior vena cava syndrome - tumor is squishing the SVC

Front 15

What is the best way to diagnosis/screen for lung cancer?
What are two poor ways?

Back 15

Superclavicular node biopsy or biopsy with endoscopy, fine needle, open.
Chest x-ray or sputum exfoliative cytology = too late, usually not resectable at the point of detection

Front 16

Which type of carcinoma is more centrally located and necrosis with cavitation is common? Forms keratin pearls histologically

Back 16

Squamous cell carcinoma - dysplasia and hyperplasia of squamous cells

Front 17

Which type of carcinoma is more peripheral, puckering appearance grossly, brushing comes out like a bunch of grapes, prominenet NUCLEOLI

Back 17

Adenocarcinoma - most common
mucus and gland formation histologically

Front 18

Which type of carcinoma has neurosecretory granules, positive for IP stain, little cytoplasm in cells, blue appearance typically, growing in large, undefined mass

Back 18

Undifferentiated carcinoma: Small cell type

Front 19

Which type of carcinoma really doesn't have any clue twoards origin, large mass of cells

Back 19

Undifferentiated carcinoma: large cell type ("garbage dx")

Front 20

Which type of carcinoma has better prognosis than other forms when found early, percolates along pre-existing alveolar network which eventually become necrotic, not a large mass

Back 20

Bronchioloalveolar cell carcinoma

Front 21

Which type of carcinoma is rare, more common in GI tract, secretes hormones, centrally located typically, grows in "nests" or "balls of cells"

Back 21

Carcinoid carcinoma

Front 22

Which type of carcinoma is rare, non-malignant, normal tissue in abnormal location?

Back 22

Hamartoma

Front 23

Which type of carcinoma can cause overproduction of steroids due to ACTH secretion. Also can cause Kushing syndrome. Or peeing all the time from too much ADH

Back 23

Small cell carcinoma (neurosecretory granules!)

Front 24

Which type of carcinoma pumps out a calcitonin like secretion causing hypercalcemia?

Back 24

Squamous cell carcinoma

Front 25

Surgery:
Less than __% resectable
If resectable, up to 50% live five years
What type of carcinoma rarely resectable (usually metastatic widely)

Back 25

10

small cell

Front 26

What tx is most effective for small cell?

Back 26

Chemo - rarely curable, 20% cure if only one node area involved

Front 27

Mutation of what gene makes 10% of patients with non-small cell Ca very susceptible to chemoRx response to gefitanib?

Back 27

Epidermal growth factor receptor (EGFR)

Front 28

Which carcinoma has the worst prognosis?
Best?
Which gender has it worse and why?

Back 28

Small cell with no Rx = 1.5-3 mos; with Rx = 10-12 mos
For bronchioloalveolar Ca: 5 year survival = 25% (better prognosis); bronchial carcinoids = 50-95% / 5yrs
Differences in women (more rapidly lethal):
Have decreased DNA repair from point mutations that occur and build up in genome
K-ras mutations more common