PULMONARY NEOPLASMS QUESTIONS AND ANSWERS A+
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Biggest R! Factor for Lung Cancer
Smoking
Smoking and Lung Cancer R!
Directly Proportional; cessation prevents further increasing R! but does not diminish it
Pack Year
packs of day x number of years = pack year
Lung Cancer Types
Adenocarcinoma > Squamous Cell Carcinoma > Small Cell Lung Cancer > Large Cell
Lung Carcinomas
Lung Cancers Specifically Associated with Smoking
Small Cell Lung Cancers and Squamous Cell Carcinomas
Precursor Lesions
-Squamous Dysplasia and Carcinoma in Situ
-Adenocarcinoma in Situ
-Atypical Adenomatous Hyperplasia
-Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia
Squamous Metaplasia
Low Grade Squamous Dysplasia
Full Thickness Squamous Dysplasia
Carcinoma in Situ
liptic
atypical adenomatous hyperplasia w/ cuboidal epithelium and mild interstitial
fibrosis
Mucinous Adenocarcinoma in Situ
Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia
Results of the National Lung Screening Trial
-Reduction in All-Cause Mortality of 15.3%
-Modest False Positive Rate of 9%
-Relative Reduction in Lung Cancer Specific Death = 20%
-Follow up on False + had no patient impact
-Cost effective method of lung cancer mortality reduction
National Lung Screening Trial
age >55 y.o. w/ >30 pack year Hx or quit <15 years ago
randomized to 3 annual AP CXR or 3 annual low dose CT scans
followed for 6.5 yrs after screening
CT detects more early stage lung CA
Smoking and Lung Carcinoma RIsk
Average Smoking = 10 x R!
Heavy (>2ppd for mult. years) = 60x R!
Intrathoracic S/S of Lung Cancer
,-Most common = Cough, Chest P!, SOB, Weight Loss
-Others = Hoarseness, pleural pain, SVC Syndrome, or Pancoast Syndrome
SVC Syndrome
Occurs due to a tumor usually obstructing the SVC, commonly LUNG CANCER
followed by lymphoma.
S/Sx include:
Causes "facial plethora", facial edema, neck (Jugular venous distension) and upper
extremities (edema).
Medical emergency, can raise ICP, cause headache, dizziness, risk of
aneurysm/rupture in brain.
dilated collateral veins in the upper trunk !!!
Pancoast Syndrome
tumor at the apex of the lung
-pain in R shoulder
-invasion of brachial plexus (C8/T1), Ribs 1/2, or chest wall structures
-horner's syndrome due to involvement of Paravertebral sympathetic chain/Inf. stellate
ganglia
Aorto-Pulmonary Window
space underneath the arch of the aorta and above the pulmonary artery; nonvisibility
may indicate lymph node enlargement
Thorascopy
visual examination of the chest via small incisions and use of an endoscope; dx method
of choice in pts w/ suspected malignancy but negative cytology
Pleural Fluid Test for Malignancy
Cytology examination of pleural fluid w/ associated elevated protein and LDH
Superior Sulcus Tumor
Pancoast tumor
PET Scan
a visual display of metabolic activity that detects where a radioactive form of glucose
goes thorughout the body; localizes to tumors and the brain
Endobronchial ultrasound
performed during bronchoscopy to guide needle aspirate and diagnose and stage lung
cancer
Bone Scan
nuclear medicine scan using radioactive dye to visualize bones; especially useful for
finding stress fractures and bone cancer
Stage 1A Lung Cancer
Single Nodule up to 3 cm
Stage 1B Lung Cancer
Single Nodule up to 5 cm
Stage 2 Lung Cancer
Single Nodule 5-7 cm or <5cm w/ multiple tumors iw/in the same lobe
Stage 3A Lung Cancer
, Cancer has spread from the lung to involve nearby pleura/chest wall (last resectable
stage)
Stage 3B Lung Cancer
larger cancer involving the chest wall with metastases to central, thoracic lymph nodes
Stage 4 Lung Cancer
distant metastasis
Adenocarcinoma of the Lung
-Most common cancer of the general population
-Usually in <45 y.o. women who are non-smokers
-Peripheral tumor cells forming gland-like structures (usually involve visceral pleura)
-Most common matastasis to the brain
-Peripheral scarring w/ pleural retraction
Adenocarcinoma of the Lung
Adenocarcinoma of the Lung
Adenocarcinoma of the Lung Histology
glandular pattern w/ tubules, pappillae, and mucin secretion
Mucinous Adenocarcinoma
spread aerogenously forming satellite tumors
Adenocarcinoma of the Lung Tx
-Resection w/ PET scan for Metastases
-Stages 3B and 4 Inclure Chemo and Radiation therapies
Squamous Cell Carcinoma of the Lung
-S/S = coughing, wheezing, hemoptysis, Hypercalcemia, Clubbing, and bronchial
obstruction
-Develops in chronically damaged airway lining (smoking men)
-Extends centrally (may cause atelactasis, hemoptysis and post-obstructive
pneumonitis)
-CXR shows cavitation
-Least Common Brain Metastasis
Squamous Cell Carcinoma Gross Examination
-Central Lung (larger bronchi) w/ cavitation
-Invades peribronchial soft tissue, parenchyma, and lymph nodes
-May compress aa and vv
Squamous Cell Carcinoma Histology
-Sheets of Large, Polygonal malignant cells
-Keratin Pearls
-Intercellular Bridges
-Adjascent Brinchial Dysplasia or Carcinoma in situ
Squamous Cell Carcinoma Histology
Squamous Cell Carcinoma Histology
Squamous Cell Carcinoma Histology
Carcinogenic Initiator in Cigarette Smoke
Polycyclic Aromatic Hydrocarbons
Carcinogenic Promotor in Cigarette Smoke
Phenol Derivatives
Dominant Oncogenes involved in Lung Cancer
GRADED .Buy Quality Materials!
Biggest R! Factor for Lung Cancer
Smoking
Smoking and Lung Cancer R!
Directly Proportional; cessation prevents further increasing R! but does not diminish it
Pack Year
packs of day x number of years = pack year
Lung Cancer Types
Adenocarcinoma > Squamous Cell Carcinoma > Small Cell Lung Cancer > Large Cell
Lung Carcinomas
Lung Cancers Specifically Associated with Smoking
Small Cell Lung Cancers and Squamous Cell Carcinomas
Precursor Lesions
-Squamous Dysplasia and Carcinoma in Situ
-Adenocarcinoma in Situ
-Atypical Adenomatous Hyperplasia
-Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia
Squamous Metaplasia
Low Grade Squamous Dysplasia
Full Thickness Squamous Dysplasia
Carcinoma in Situ
liptic
atypical adenomatous hyperplasia w/ cuboidal epithelium and mild interstitial
fibrosis
Mucinous Adenocarcinoma in Situ
Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia
Results of the National Lung Screening Trial
-Reduction in All-Cause Mortality of 15.3%
-Modest False Positive Rate of 9%
-Relative Reduction in Lung Cancer Specific Death = 20%
-Follow up on False + had no patient impact
-Cost effective method of lung cancer mortality reduction
National Lung Screening Trial
age >55 y.o. w/ >30 pack year Hx or quit <15 years ago
randomized to 3 annual AP CXR or 3 annual low dose CT scans
followed for 6.5 yrs after screening
CT detects more early stage lung CA
Smoking and Lung Carcinoma RIsk
Average Smoking = 10 x R!
Heavy (>2ppd for mult. years) = 60x R!
Intrathoracic S/S of Lung Cancer
,-Most common = Cough, Chest P!, SOB, Weight Loss
-Others = Hoarseness, pleural pain, SVC Syndrome, or Pancoast Syndrome
SVC Syndrome
Occurs due to a tumor usually obstructing the SVC, commonly LUNG CANCER
followed by lymphoma.
S/Sx include:
Causes "facial plethora", facial edema, neck (Jugular venous distension) and upper
extremities (edema).
Medical emergency, can raise ICP, cause headache, dizziness, risk of
aneurysm/rupture in brain.
dilated collateral veins in the upper trunk !!!
Pancoast Syndrome
tumor at the apex of the lung
-pain in R shoulder
-invasion of brachial plexus (C8/T1), Ribs 1/2, or chest wall structures
-horner's syndrome due to involvement of Paravertebral sympathetic chain/Inf. stellate
ganglia
Aorto-Pulmonary Window
space underneath the arch of the aorta and above the pulmonary artery; nonvisibility
may indicate lymph node enlargement
Thorascopy
visual examination of the chest via small incisions and use of an endoscope; dx method
of choice in pts w/ suspected malignancy but negative cytology
Pleural Fluid Test for Malignancy
Cytology examination of pleural fluid w/ associated elevated protein and LDH
Superior Sulcus Tumor
Pancoast tumor
PET Scan
a visual display of metabolic activity that detects where a radioactive form of glucose
goes thorughout the body; localizes to tumors and the brain
Endobronchial ultrasound
performed during bronchoscopy to guide needle aspirate and diagnose and stage lung
cancer
Bone Scan
nuclear medicine scan using radioactive dye to visualize bones; especially useful for
finding stress fractures and bone cancer
Stage 1A Lung Cancer
Single Nodule up to 3 cm
Stage 1B Lung Cancer
Single Nodule up to 5 cm
Stage 2 Lung Cancer
Single Nodule 5-7 cm or <5cm w/ multiple tumors iw/in the same lobe
Stage 3A Lung Cancer
, Cancer has spread from the lung to involve nearby pleura/chest wall (last resectable
stage)
Stage 3B Lung Cancer
larger cancer involving the chest wall with metastases to central, thoracic lymph nodes
Stage 4 Lung Cancer
distant metastasis
Adenocarcinoma of the Lung
-Most common cancer of the general population
-Usually in <45 y.o. women who are non-smokers
-Peripheral tumor cells forming gland-like structures (usually involve visceral pleura)
-Most common matastasis to the brain
-Peripheral scarring w/ pleural retraction
Adenocarcinoma of the Lung
Adenocarcinoma of the Lung
Adenocarcinoma of the Lung Histology
glandular pattern w/ tubules, pappillae, and mucin secretion
Mucinous Adenocarcinoma
spread aerogenously forming satellite tumors
Adenocarcinoma of the Lung Tx
-Resection w/ PET scan for Metastases
-Stages 3B and 4 Inclure Chemo and Radiation therapies
Squamous Cell Carcinoma of the Lung
-S/S = coughing, wheezing, hemoptysis, Hypercalcemia, Clubbing, and bronchial
obstruction
-Develops in chronically damaged airway lining (smoking men)
-Extends centrally (may cause atelactasis, hemoptysis and post-obstructive
pneumonitis)
-CXR shows cavitation
-Least Common Brain Metastasis
Squamous Cell Carcinoma Gross Examination
-Central Lung (larger bronchi) w/ cavitation
-Invades peribronchial soft tissue, parenchyma, and lymph nodes
-May compress aa and vv
Squamous Cell Carcinoma Histology
-Sheets of Large, Polygonal malignant cells
-Keratin Pearls
-Intercellular Bridges
-Adjascent Brinchial Dysplasia or Carcinoma in situ
Squamous Cell Carcinoma Histology
Squamous Cell Carcinoma Histology
Squamous Cell Carcinoma Histology
Carcinogenic Initiator in Cigarette Smoke
Polycyclic Aromatic Hydrocarbons
Carcinogenic Promotor in Cigarette Smoke
Phenol Derivatives
Dominant Oncogenes involved in Lung Cancer
