Zaman 9-28-07 Lung 5

Front 1

the leading cause of cancer death in the United States and the world.

Back 1

Lung cancer

Front 2

Greater than ____% have metastatic disease at presentation

Back 2

50

Front 3

________ causes over 85% of lung cancer

Back 3

Cigarette smoking

Front 4

______ gas probably causes many of lung cancers in non-smokers.

Back 4

Radon

Front 5

Asbestos (5X risk) and cigarettes (10 X risk) are probably ______ (50-90X risk).

Back 5

synergistic

Front 6

Lung cancer is broadly divided into what 2 "cell" categories?

Back 6

small cell (oat cell) cancer and non-small cell cancer.

Front 7

How do you treat small cell lung cancer?


non-small cell?

Back 7

Small cell: chemotherapy,

non-small cell: surgery if localized

Front 8

Lung cancers may be classified as what according to location?

Back 8

"central" or "peripheral."

Front 9

Central, aka bronchogenic, arises in a bronchus.
Typically the result of ____.

Back 9

smoking

Front 10

Peripheral lung cancer is typically subpleural and often associated with _____

Back 10

scars

Front 11

Which location-type of lung cancer is often "silent"?

Back 11

peripheral

Front 12

3 types of large cell lung cancer?

Back 12

1-squamous cell cancer
2-adenocarcinoma
3-undifferentiated large cell


(treat with surgery ... non-small)

Front 13

Most common tumor associated with ectopic PTH and hypercalcemia

Back 13

squamous cell cancer

Front 14

Microscopic pathology:
Usually sheets of large cells that have keratinization (keratin pearls) and or intercellular bridges (diagnostically important).

Back 14

squamous cell cancer

Front 15

The most common lung cancer in the United States today (30-40%)

Back 15

ADENOCARCINOMA

Front 16

By far the most common cancer in non-smokers and in women

Back 16

ADENOCARCINOMA

Front 17

smoking style associated with adenocarcinoma?

Back 17

deep inhaling of low nicotine I low tar cigarettes

Front 18

adenocarcinoma:

Most are _____ tumors, therefore are frequently asymptomatic with x-ray lesion as presenting symptom in 50%

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peripheral

Front 19

adenocarcinoma:
Frequently desmo-_______. "Scar cancer" usually has scar secondary to the tumor, but sometimes arises in areas of preexisting scar (TB, fibrotic lung)

Back 19

desmoplastic

Front 20

What cancer type?
Gross pathology: Large tumors with frequent necrosis, frequently central (bronchogenic), metastasize early.

Back 20

LARGE CELL UNDIFFERENTIATED CARCINOMA

Front 21

What canccer type?
Microscopic features: Uniform to bizarre large cells; abundant cytoplasm; no squamous or glandular differentiation

Back 21

LARGE CELL UNDIFFERENTIATED CARCINOMA

Front 22

Cancer with Highly significant correlation to cigarette smoking (99%)

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SMALL CELL CARCINOMA

Front 23

In small cell carcinoma, Chemotherapy can regularly induce a _______

Back 23

temporary (one year or greater) remission

Front 24

things to look for in the microscope with small cell

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streaking, etc

Front 25

Small cell carcinoma:
Ectopic hormones produced in some patients, including ADH, ____, and rarely serotonin.

Back 25

ACTH

Front 26

Small cell:
Without chemotherapy, median survival __? months and 5 year survival less than 1%

Back 26

6


With chemotherapy, median survival greater than 1 year with occasional long term survival

Front 27

Small cell cancer:

Microscopic features: Small oval or fusiform cells with very high __ ratio, very little cytoplasm. Cell of origin probably the Kulchitsky cell, a neuroendocrine cell

Back 27

NC

Front 28

What type of lung tumor?

About 2% of primary lung tumors
No relation to cigarette smoking or other causative factors

Back 28

CARCINOID TUMOR

Front 29

Microscopically, Carcinoid tumor -the groups of tumor cells have separated from their stroma ("shrinkage artifact"). Carcinoid cells are fastened together by _______

Back 29

desmosomes.

Front 30

Carcinoid tumor:
A ______-epithelial tumor with biogenic amine and polypeptide production (ACTH).

Back 30

neuroepithelial

Front 31

Typical carcinoid is benign (90% of total, 1% mortality) versus ________ carcinoids.

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atypical

Front 32

Microscopically:
Atypical carcinoid･"_______ pattern" (nests, trabeculae, or spindled cells separated by thin-walled vessels) with less than 2 mitoses/10 HPF･Uniformity of cells and nuclei, normal nuclear/cytoplasmic ratio, small nucleoli, stippled chromatin･No necrosis

Back 32

Endocrine

Front 33

80% of all mesotheliomas are in the _____, some are on the peritoneal surface

Back 33

pleura

Front 34

Mesothelioma:
Median survival is how long, with or without treatment ?

Back 34

1 year

Front 35

Mesothelioma:
Epithelial type and spindle components are seen. May mimic either ______ or fibroblastic lesions

Back 35

adenocarcinoma

Front 36

Mesothelioma:
________ bodies (asbestos bodies) occur in lung, not tumor

Back 36

Ferruginous

Front 37

BENIGN PULMONARY LESIONS: (4 types)

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1 Hamartoma
2 Sarcoidosis
3 Vascular anomalies
4 Infectious processes

Front 38

What type of benign lesion:
Smears show abundant fibromyxoid material. This substance has a fibrillar texture and stains bright red with giemsa. Elongated fusiform bipolar cells characteristic of fibroblasts can be seen embedded in this substance.

Back 38

Pulmonary hamartoma-

Front 39

MEANS OF DETECTION AND DIAGNOSIS:
Clinical presentations (12)

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1 Silent disease
2 Cough (75%)
3 Weight loss (40%)
4 Chest pain (40%)
5 Shortness of breath (20%)
6 Pneumonia that fails to heal (post-obstructive pneumonia)
7 Hemoptysis
8 Hoarseness
9 Metastatic disease
10. Paraneoplastic syndromes
11 Clubbing of fingers
12 On average there is a 7 month delay between onset of symptoms and definitive diagnosis

Front 40

Where would you detect metastatic disease?

Back 40

a. perihilar nodes
b, paratracheal nodes
c. supraclaicular nodes (Virchow)
d, other organs

Front 41

What are paraneoplastic syndromes of lung cancer?

Back 41

a. Cushings (ACTH) -Small cell carcinoma
b. Syndrome of inappropriate ADH secretion -Small cell Carcinoma
c. Various CNS and peripheral neuropathies (anti-neuronal antibodies) -Small cell carcinoma
d. Hypercalcemia (PTH production) -Squamous cell carcinoma

Front 42

Wher ewould you harvest cells for Cytology of lung cancer ?

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1 Sputum
2 Bronchoscopic brushing or lavage
3 Fine needle aspirate

Front 43

PATTERNS OF SPREAD:
Specific locations
? (4)

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1. Superior vena caval syndrome (lymph nodes along SVC )
2. Pancoast syndrome (apex of lung)
3. Horner's syndrome (cervical sympathetic chain)
4. Hoarseness (recurrent laryngeal nerve -usually left

Front 44

What are the qualifications for curing lung cancer by surgery?

Back 44

For cure, has to be localized disease, no lymph node involvement
Should be non-small cell, i.e. -squamous cell, adenocarcinoma, undifferentiated large cell.

Front 45

What is the survival rate for pt with surgically treated lung cancer?

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5 year survival of localized 4 cm or less carcinoma is 40%for squamous cell carcinoma and 30%for adenocarcinoma

Front 46

Radiation is used for ______ therapy for lung cancer

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Palliative

Front 47

Lung cancer that has weak association with smoking

Back 47

Adenocarcinoma

Front 48

The central lung cancers

Back 48

Squamous cell
Undifferentiated
Small cell

Front 49

The lung cancer that can be treated with surgery

Back 49

Squamous cell
Undifferentiated
Adenocarcinoma

Front 50

Lung cancer type that is mostlly peripheral

Back 50

adenocarcinoma