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68 Cards in this Set
- Front
- Back
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What are three types of primary lung cancers and their prevalences?
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Bronchogenic carcinomas - 95%
Bronchial carcinoids - 5% Sarcomas, Lymphomas - rare |
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Who is most at risk of lung cancer?
Prognosis |
40-70+ yo
SMOKERS - avg 10x risk 5 year survival 16% |
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What are 4 etiological factors in lung cancer?
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1. SMOKING
2. Industrial: radiation, asbestos 3. Air pollution: radon 4. Genetic: polymorphisms in cyt P450 |
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Besides the lung, in which other organs is smoking associated with cancer?
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Mouth, pharynx, larynx, esophagus, pancreas, cervix, urinary bladder
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With which types of lung cancer does smoking have a
a) very strong association b) moderate association c) no association |
a) sq. cell, small cell
b) adenocarcinoma, large cell carcinoma c) bronchial carcinoids, mesotheliomas |
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What are the 4 major histologic types of bronchogenic carcinoma?
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1. Adenocarcinoma (35-40%)
2. Squamous cell (30-35%) 3. Small cell (15-20%) - only one that is small cell carcinoma 4. Large cell (~15%) |
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What is a central tumor?
What are 2 examples? |
Located centrally in relation to large stem bronchus
1. Sq. cell - respiratory epithelium 2. Small cell carcinoma - neuroendocrine |
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What is a peripheral tumor?
What are 2 examples? |
Tumor at periphery of lung, not related to a large bronchus
1. Adenocarcinoma - alveolar epithelial cells 2. Large cell carcinoma |
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What are 3 examples of non-small cell lung carcinoma?
How do you treat? |
1. squamous cell carcinoma
2. Adenocarcinoma 3. Large cell carcinoma Surgery |
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What percentage of lung cancer is small cell lung carcinoma?
What is its progression at time of diagnosis? Treatment? |
15-20%
Chemotherapy +/- radiotherapy |
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Squamous cell carcinoma
Who does it affect? Risk factors? Prognosis? |
Older men
Smoking Better prognosis than other types |
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What is the pathogenesis of sq. cell carcinoma?
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Squamous metaplasia and dysplasia --> carcinoma in situ --> carcinoma
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What does Squamous cell carcinoma look like histologically?
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Keratin pearls
Intracellular bridges |
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Squamous cell carcinoma
Spread? |
Usually to hilar lymph nodes, later extrathoracically
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Adenocarcinoma
a. prevalence b. who it affects c. course/prognosis |
a. most common type of lung cancer
b. women, non-smokers c. metastasize early/poor prognosis |
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What is Adenocarcinoma?
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malignant tumor of epithelium with glandular differentiation or mucin production
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What are the molecular mutations responsible for adenocarcinoma? Which is worse?
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EGFR mutation
K-Ras mutation (mostly in smokers) -WORSE OUTCOME |
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What is the pathogenesis of Adenocarcinoma?
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atypical adenomatous hyperplasia --> bronchioalveolar carcinoma --> invasive adenocarcinoma
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What are some characeristic pathologic findings in Adenocarcinoma?
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Glandular differentiation/mucin production
Peripherally located Associated with scar Grows slowly, metastasizes early |
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What is bronchioalveolar carcinoma?
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peripheral nodules that can coalesce --> pneumonia-like consolidation
in-situ neoplasm, better prognosis than most |
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What are the pathologic features of broncioalveolar carcinoma?
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Lepidic spread:
Grows in monolayer along existing structures without destruction of alveoli or stromal invasion Good prognosis |
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Brochioalveolar carcinoma
a. gross morphology b. histolgy c. imaging |
a. spongy looking lung
b. Bubbly cytoplasm Nodules Butterfly-pattern c. Consolidation miliary tumor |
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What are 2 subtypes of bronchioalveolar carcinoma?
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Mucinous - spreads aerogenously --> satellite nodules, hard to surgically remove
Non-mucnous - single nodule, easy to surgically remove |
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What are 4 histologic subtypes of Adenocarcinoma?
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1. solid
2. papillary 3. acinar 4. bronchioalveolar |
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What is atypical adenomatous hyperplasia?
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Small focus of type 2 pneumocyte proliferation
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How aggressive is small cell carcinoma?
Treatment options? |
Highly aggressive, metastasizes, neuroendocrine tumor
Not sensitive to surgery, use chemo and radiotherapy |
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To whom does small cell carcinoma happen?
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Smokers
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Small cell carcinoma
arises from? Spreads to? |
Main stem bronchi --> hilar and mediastinal nodes
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How does Small cell carcinoma look microscopically?
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Small "blue" cells with scant cytoplasm, fine granular chromatin, inconspicous nucleoli
HIgh apoptosis, necrosis Blue = Azzopardi effect |
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What is large cell carcinoma?
Prognosis? |
Peripheral, undifferentiated, non-small cell carcinoma
Lack cytologic/architectural features of other lung carcinomas Highly malignant, poor prognosis |
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What are 6 signs/symptoms of lung cancer?
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1. None - long pre-clinical phase
2. cough 3. weight loss 4. chest pain 5. dyspnea 6. post obstructive pneumonia, abscess, atelectasis |
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What are 6 local sites to which lung carcinomas spread?
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pleura
pericardium chest wall diaphragm esophagus hilar LN |
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What are 6 distant sites to which lung carcinomas spread?
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Distant LN
Brain/meninges Bone Marrow Liver Adrenal |
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What are 3 types of other syndromes caused by cancer?
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1. Vena caval syndrome - compression of SVC --> congestion of face, upper arms
2. Horner Syndrome Brachial/cervical plexus invasion --> pain in ulnar nerve dist + ptosis, miosis, anhidrosis 3. Paraneoplastic syndromes - cannot be explained by spread or production of hormones endogenous to tissue from which tumor arose |
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What are 3 paraneoplastic syndromes associated with small cell carcinoma?
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1. Inappropriate secretion of ADH - hyponatremia
2. Increased ACTH --> Cushing's 3. Neurological Lambert-Eaton Myasthenia, polyneuropathy, polymyositis |
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What are 3 paraneoplastic syndromes associated with non-small cell carcinoma?
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1. Squamous cell carcinoma --> PTH related peptide --> hypercalcemia
2. Adenocarcinoma --> clubbing 3. Large cell/adeno --> migratory thrombophlebitis, non-bact. endocarditis, DIC |
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What are bronchial carcinoids?
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Well-differentiated Neuroendocrine tumor - polypoid mass that extends into lumen of bronchus
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bronchial carcinoids
a. affects whom? b. Prognosis |
a. kids, nonsmokers
b. resectable and curable |
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bronchial carcinoids
a. histological? |
a. nests of cells with round nucleus, moderate cytoplasms, salt-and-pepper chromatin, no necrosis, rare mitosis
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What is carcinoid syndrome?
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Diarrhea, flushing, cyanosis
Rare |
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What are the pathologic features of broncioalveolar carcinoma?
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Lepidic spread:
Grows in monolayer along existing structures without destruction of alveoli or stromal invasion Good prognosis |
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Brochioalveolar carcinoma
a. gross morphology b. histolgy c. imaging |
a. spongy looking lung
b. Bubbly cytoplasm Nodules Butterfly-pattern c. Consolidation miliary tumor |
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What are 2 subtypes of bronchioalveolar carcinoma?
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Mucinous - spreads aerogenously --> satellite nodules, hard to surgically remove
Non-mucnous - single nodule, easy to surgically remove |
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What are 4 histologic subtypes of Adenocarcinoma?
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1. solid
2. papillary 3. acinar 4. bronchioalveolar |
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What is atypical adenomatous hyperplasia?
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Small focus of type 2 pneumocyte proliferation
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How aggressive is small cell carcinoma?
Treatment options? |
Highly aggressive, metastasizes, neuroendocrine tumor
Not sensitive to surgery, use chemo and radiotherapy |
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To whom does small cell carcinoma happen?
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Smokers
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Small cell carcinoma
arises from? Spreads to? |
Main stem bronchi --> hilar and mediastinal nodes
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How does Small cell carcinoma look microscopically?
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Small "blue" cells with scant cytoplasm, fine granular chromatin, inconspicous nucleoli
HIgh apoptosis, necrosis Blue = Azzopardi effect |
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What is large cell carcinoma?
Prognosis? |
Peripheral, undifferentiated, non-small cell carcinoma
Lack cytologic/architectural features of other lung carcinomas Highly malignant, poor prognosis |
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What are 6 signs/symptoms of lung cancer?
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1. None - long pre-clinical phase
2. cough 3. weight loss 4. chest pain 5. dyspnea 6. post obstructive pneumonia, abscess, atelectasis |
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What are 6 local sites to which lung carcinomas spread?
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pleura
pericardium chest wall diaphragm esophagus hilar LN |
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What are 6 distant sites to which lung carcinomas spread?
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Distant LN
Brain/meninges Bone Marrow Liver Adrenal |
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What are 3 types of other syndromes caused by cancer?
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1. Vena caval syndrome - compression of SVC --> congestion of face, upper arms
2. Horner Syndrome Brachial/cervical plexus invasion --> pain in ulnar nerve dist + ptosis, miosis, anhidrosis 3. Paraneoplastic syndromes - cannot be explained by spread or production of hormones endogenous to tissue from which tumor arose |
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What are 3 paraneoplastic syndromes associated with small cell carcinoma?
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1. Inappropriate secretion of ADH - hyponatremia
2. Increased ACTH --> Cushing's 3. Neurological Lambert-Eaton Myasthenia, polyneuropathy, polymyositis |
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What are 3 paraneoplastic syndromes associated with non-small cell carcinoma?
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1. Squamous cell carcinoma --> PTH related peptide --> hypercalcemia
2. Adenocarcinoma --> clubbing 3. Large cell/adeno --> migratory thrombophlebitis, non-bact. endocarditis, DIC |
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What are bronchial carcinoids?
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Well-differentiated Neuroendocrine tumor - polypoid mass that extends into lumen of bronchus
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bronchial carcinoids
a. affects whom? b. Prognosis |
a. kids, nonsmokers
b. resectable and curable |
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bronchial carcinoids
a. histological? |
a. nests of cells with round nucleus, moderate cytoplasms, salt-and-pepper chromatin, no necrosis, rare mitosis
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What is carcinoid syndrome?
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Diarrhea, flushing, cyanosis
Rare |
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Neuroednocrine tumors
a. worst prognosis b. middle prognosis c. best prognosis |
a. small cell carcinoma
b. atypical carcinoid c. typical carcinoid |
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When tumors metastasize to the lung, what do they look like?
From where do they come? |
Cannonball like lesions, many
Breast, colon, kidney |
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What are 4 methods of spread to the lung?
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Direct extension
Vascular invasion Lymphatic invasion Pleural space seeding |
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What is a mesothelioma?
Cause? |
Cancer of mesothelial cells from pleura, peritoneum, or pericardium
Asbestos exposure, NOT SMOKING |
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What is the gross appearance of mesothelioma?
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Pleural effusion, thick fleshy tumor around lung
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What are the two cytologic types of cells in mesothelioma?
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epithelioid and spindle (sarcomatoid)
May form papillary, tubular, or glandular structures that resemble adenocarcinoma; spaghetti-like microvilli on surface of mesothelial cells |
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What are the two types of asbestos fibers seen in mesothelioma?
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Serpentine - flexible, more common, low oncogenicity
Amphibole - brittle, less prevalent, more oncogenic |
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What is the clinical course of mesothelioma?
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Highly aggressive, 50% die within 12 months
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