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50 Cards in this Set

  • Front
  • Back
the leading cause of cancer death in the United States and the world.
Lung cancer
Greater than ____% have metastatic disease at presentation
50
________ causes over 85% of lung cancer
Cigarette smoking
______ gas probably causes many of lung cancers in non-smokers.
Radon
Asbestos (5X risk) and cigarettes (10 X risk) are probably ______ (50-90X risk).
synergistic
Lung cancer is broadly divided into what 2 "cell" categories?
small cell (oat cell) cancer and non-small cell cancer.
How do you treat small cell lung cancer?


non-small cell?
Small cell: chemotherapy,

non-small cell: surgery if localized
Lung cancers may be classified as what according to location?
"central" or "peripheral."
Central, aka bronchogenic, arises in a bronchus.
Typically the result of ____.
smoking
Peripheral lung cancer is typically subpleural and often associated with _____
scars
Which location-type of lung cancer is often "silent"?
peripheral
3 types of large cell lung cancer?
1-squamous cell cancer
2-adenocarcinoma
3-undifferentiated large cell


(treat with surgery ... non-small)
Most common tumor associated with ectopic PTH and hypercalcemia
squamous cell cancer
Microscopic pathology:
Usually sheets of large cells that have keratinization (keratin pearls) and or intercellular bridges (diagnostically important).
squamous cell cancer
The most common lung cancer in the United States today (30-40%)
ADENOCARCINOMA
By far the most common cancer in non-smokers and in women
ADENOCARCINOMA
smoking style associated with adenocarcinoma?
deep inhaling of low nicotine I low tar cigarettes
adenocarcinoma:

Most are _____ tumors, therefore are frequently asymptomatic with x-ray lesion as presenting symptom in 50%
peripheral
adenocarcinoma:
Frequently desmo-_______. "Scar cancer" usually has scar secondary to the tumor, but sometimes arises in areas of preexisting scar (TB, fibrotic lung)
desmoplastic
What cancer type?
Gross pathology: Large tumors with frequent necrosis, frequently central (bronchogenic), metastasize early.
LARGE CELL UNDIFFERENTIATED CARCINOMA
What canccer type?
Microscopic features: Uniform to bizarre large cells; abundant cytoplasm; no squamous or glandular differentiation
LARGE CELL UNDIFFERENTIATED CARCINOMA
Cancer with Highly significant correlation to cigarette smoking (99%)
SMALL CELL CARCINOMA
In small cell carcinoma, Chemotherapy can regularly induce a _______
temporary (one year or greater) remission
things to look for in the microscope with small cell
streaking, etc
Small cell carcinoma:
Ectopic hormones produced in some patients, including ADH, ____, and rarely serotonin.
ACTH
Small cell:
Without chemotherapy, median survival __? months and 5 year survival less than 1%
6


With chemotherapy, median survival greater than 1 year with occasional long term survival
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
NC
What type of lung tumor?

About 2% of primary lung tumors
No relation to cigarette smoking or other causative factors
CARCINOID TUMOR
Microscopically, Carcinoid tumor -the groups of tumor cells have separated from their stroma ("shrinkage artifact"). Carcinoid cells are fastened together by _______
desmosomes.
Carcinoid tumor:
A ______-epithelial tumor with biogenic amine and polypeptide production (ACTH).
neuroepithelial
Typical carcinoid is benign (90% of total, 1% mortality) versus ________ carcinoids.
atypical
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
Endocrine
80% of all mesotheliomas are in the _____, some are on the peritoneal surface
pleura
Mesothelioma:
Median survival is how long, with or without treatment ?
1 year
Mesothelioma:
Epithelial type and spindle components are seen. May mimic either ______ or fibroblastic lesions
adenocarcinoma
Mesothelioma:
________ bodies (asbestos bodies) occur in lung, not tumor
Ferruginous
BENIGN PULMONARY LESIONS: (4 types)
1 Hamartoma
2 Sarcoidosis
3 Vascular anomalies
4 Infectious processes
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.
Pulmonary hamartoma-
MEANS OF DETECTION AND DIAGNOSIS:
Clinical presentations (12)
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
Where would you detect metastatic disease?
a. perihilar nodes
b, paratracheal nodes
c. supraclaicular nodes (Virchow)
d, other organs
What are paraneoplastic syndromes of lung cancer?
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
Wher ewould you harvest cells for Cytology of lung cancer ?
1 Sputum
2 Bronchoscopic brushing or lavage
3 Fine needle aspirate
PATTERNS OF SPREAD:
Specific locations
? (4)
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
What are the qualifications for curing lung cancer by surgery?
For cure, has to be localized disease, no lymph node involvement
Should be non-small cell, i.e. -squamous cell, adenocarcinoma, undifferentiated large cell.
What is the survival rate for pt with surgically treated lung cancer?
5 year survival of localized 4 cm or less carcinoma is 40%for squamous cell carcinoma and 30%for adenocarcinoma
Radiation is used for ______ therapy for lung cancer
Palliative
Lung cancer that has weak association with smoking
Adenocarcinoma
The central lung cancers
Squamous cell
Undifferentiated
Small cell
The lung cancer that can be treated with surgery
Squamous cell
Undifferentiated
Adenocarcinoma
Lung cancer type that is mostlly peripheral
adenocarcinoma