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Flashcards in Pulmonary Neoplasms Deck (80)
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1

How many mutations are induced for every 15 cigarettes smoked?

one

2

RISK FACTORS FOR LUNG CANCER
7

1. Smoking and second-hand smoke
2. Asbestos – mesothelioma
3. Radon – uranium mining
4. Can develop lung cancer even after stopping smoking years ago
5. Other family members who have had smoking-related cancers
6. Prior lung diseases such as
-chronic bronchitis,
-emphysema, and
- tuberculosis
7. Air pollution:

3

Cigarette smokers have risk related to what factors of smoking?
5

1. Age at onset of smoking
2. Amount smoked
3. Gender (women)
4. Product smoked
5. Depth of inhalation

4

Stopping tobacco use before middle age avoids more than ____of the lung cancer risk attributable to tobacco.

90%

5

We can treat smoking cessation with what drugs?
5

1. Zyban (buproprion),
2. Chantix (varenicline) or
3. nicotine replacement therapy
4. Clonidine and nortriptyline are recommended as second- line treatments
5. hypnosis can work for some motivated smokers

6

What is a neoplasm?

What are the two kinds?

Neoplasia is uncontrolled cell growth
Growth that is not needed for normal development or replacement of dead or damaged tissues

Can be benign or malignant

7

What are the types of benign neoplasms?

Malignant? (two kinds)

Benign neoplasms – tumors
Hamartomas and granulomas

Malignant neoplasms– cancers
Metastatic
Primary: Bronchogenic carcinomas and others
small cell and non-small cell

8

What are the kind of metastatic neoplasms? 4

Primary?

breast, colon, prostate, bladder

Bronchogenic carcinomas and others small cell and non-small cell

9

BENIGN PULMONARY NEOPLASMS:
How do the cells grow? 3
Describe the borders? 2

Cells grow in fairly
1. orderly manner,
2. stick together,
3. don’t migrate

Seem to be
1. encapsulated,
2. smooth borders

10

What are hamartomas?


What is often associated with these? 2

local tissues growing in disorganized manner

Often have
1. bronchial tissue and
2. calcifications (popcorn calcification)

11

What are granulomas?

Examples? 4

chronic inflammatory lesions with macrophages

1. Tuberculosis
2. Sarcoidosis
3. Histoplasmosis
4. Cryptococcosis

(homogeneous calcification)

12

MALIGNANT CELLS/TUMORS

1. Describe the rate of cell division?
2. What do they look like?
3. How do the cells function? 2

4. How do the masses themselves look?

1. Rapid, even continuous division (occasionally in hours)
Cells are geared up for dividing

2. Show de-differentiation
Look less and less like parent cells or tissues

3. Lose some or all of their normal cell functions
Have no useful function for the body
Parasitize the host’s body
Steal nutrients, energy, blood supply – space occupying masses

4. Masses have irregular, invasive borders
Will travel in search of new lands to conquer

13

What are the different routes of spread for metastatic lung cancer?
4

Transcoelomic
Lymphatic
Hematogenous
Iatrogenic

14

Define the following routes of spread:
Transcoelomic
Lymphatic
Hematogenous
Iatrogenic

Transcoelomic: along the surface of an organ - mesothelioma
Lymphatic: most common route for carcinomas
Hematogenous: most common route for sarcomas
Iatrogenic: transplantation or implantation

15

What are the other most common places for cancer caused by smoking besides the lungs?
4

breast, colon, prostate, bladder

16

What is the most common type of lung cancer?

There are two types of this cancer. What are they? 2

BRONCHOGENIC CARCINOMA

1. Small cell lung cancer – primitive neuroendocrine cells
2. Non-small cell lung cancer

17

What are the types of non-small cell lung cancer?
3

1. Adenocarcinoma
-Broncheoalveolar carcinoma (subtype of adenocarcinoma)
2. Squamous cell carcinoma of the lung
3. Large cell lung carcinoma

18

Name some other types of lung cancers?
5

1. Carcinoid,
2. Kaposi’s sarcoma,
3. melanoma,
4. lymphoma,
5. head and neck
Mesothelioma

19

These four histologies account for approximately 90% of all epithelial lung cancers.

1.Small Cell Lung Cancer (SCLC)

2.Adenocarcinoma

3.Squamous Cell Carcinoma

4.Large Cell Carcinoma

20

SMALL CELL LUNG CARCINOMA

1. Also known as what?
2. What does it arise from?
3. This is what percent of patients with lung cancer?
4. Prognosis?
5. 90% of pts with SCLC develop what?

1. Also known as “oat cell” lung cancer

2. Arises from primitive, small
neuroendocrine calls

3. 14% of patients with lung cancer

4.
-Bad disease, early metastases
-Very aggressive cancer, rapidly fatal
-Only a small percentage of patients are curable
-Even with limited stage disease

5. 90% of patients with SCLS develop brain metastases

21

Describe the tumor in small cell carcinomas.
2

1. Poorly differentiated neuroendocrine tumor.
2. Central mass with endobronchial growth.

22

What might a SCLC produce?
4

What are these associated with?

May produce specific peptide hormones such as:

1. adrenocorticotrophic hormone (ACTH),
2. arginine vasopressin (AVP),
3. atrial natriuretic factor (ANF), and
4. gastrin-releasing peptide (GRP).

These hormones may be associated with distinctive
paraneoplastic syndromes

23

Differential diagnosis for SCLC?
5

1. Poorly differentiated non-small cell carcinomas
2. Neuroendocrine carcinomas,
poorly differentiated squamous cell carcinoma
3. Nonepithelial tumors lymphoma,
4. small round blue cell tumors,
5. sarcomas (e.g., synovial sarcoma).

24

1. Among women and young adults (less than 60 years), ____________ tends also to be the most common form of lung cancer.

2. In lifetime never smokers, all histologic forms of lung cancer can be found, although ___________ tends to predominate.

3. The incidence of small cell carcinoma is also on the ______.

1. adenocarcinoma
2. adenocarcinoma
3. decline

25

NON-SMALL CELL LUNG CARCINOMA

1. Is what percent of lung cancer?
2. What are the three most common kinds?
3. What do they have in common (2) and what makes them different (2) from each other?

4. What are signs and symtpoms related to?


5. What makes bronchoalveolar carcinomas different?

1. 80% of lung cancers. Rare before age 35, peaks at 65-80

2. NSCLC
-Adenocarcinoma of the lung 54%
-Squamous cell carcinoma of the lung 35%
-Large cell lung carcinoma 11%

3. All have similar prognosis and are treated the same, but have different locations and patterns of spread

4. Signs/symptoms are related to the location of the tumor, may have associated paraneoplastic syndromes.

5. Bronchoalveolar carcinoma is different, more aggressive
Subcategory of adenocarcinoma, found more peripherally

26

NSCLC - ADENOCARCINOMA

1. Where does this cancer arise from?

2. Found near which structures often? 3

3. What may you see before primary symtpoms?

4. What two findings will you find on tissue biopsy?

Associated with smoking

1. Peripheral - arise from surface epithelium, peripheral scars

2. Gland formation, papillary structures or mucin production

3. May see metastatic disease before primary symptoms

4. Hypertrophic osteoarthropathy and Trousseau’s syndrome

27

Adenocarcinomas…..take home?????
3

Peripheral lung locations.

Associated with a history of smoking.

It is the most common type of lung cancer occurring in never smokers

28

NSCLC: BRONCHOALVEOLAR ADNEOCARCINOMA is a subtype of adenocarcimona. How can it present?

It can occcur as early as when?

Can present as solitary or multicentric nodules, rapidly progressive

Can occur in 2nd decade of life – multiple pulmonary nodules

29

NSCLC: BRONCHOALVEOLAR ADNEOCARCINOMA
1. Symtpoms present as?
2. Nodal enlargement?
3. Spread?
4. Tends to occur is what tissues?
5. Grows where?
6. How can it present radiographically? 3
7. How can it present on CT scans?

1. Non-resolving focal or bilateral “pneumonia”
2. Nodal enlargement uncommon
3. Distant spread uncommon
4. Tends to be more peripheral
5. grows along the alveoli without invasion.
6. present radiographically as a
-single mass, as a
-diffuse multinodular lesion, as a -fluffy infiltrate.
7. on CT scans as a "ground-glass" opacity (GGO).

Also seen in nonsmokers

30

NSCLC – SQUAMOUS CELL CARCINOMA
1. What are the two kinds?
2. Most frequently seen where?
3. Tends to obstruct what?
4. Describe its spread.
5. CT sacn appearance?

1. Squamous cell or epidermoid carcinoma
2. Most frequently see in the proximal bronchi
3. Tend to obstruct bronchi….. atelectasis or pneumonia
4. Tend to remain localized and cavitate – Metastasize late.
5. On CT Scans as a “ground glass” opacity