by mtoom


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At the time of presentation, what is treatment option for Small Cell Carcinoma (SCC)?
It is already disseminated by time of presentation, so surgery is not an option.

Chemotherapy 
Name the 4 lung cancers, in order of prevalence
  • Adenocarcinoma (50%)
  • Squamous cell carcinoma (25%)
  • Small cell carcinoma (15%)
  • Large cell carcinoma (10%)
If you see a central, cavitating lesion, what kind of cancer might it be?
Squaous Cell Carcinoma
  • Central
  • Cavitates

Nearby epithelium shows squamous metaplasia, dysplasia, carcinoma in situ
What are 2 important microscopic features of squamous cell carcinoma?
  • Keratinization (such as orangeophilia)
  • Cell bridges
What cancer is common in the peripheral lung (2/3) and most common in smokers?
Adenocarcinoma
What is the type of Adenocarcinoma where cancer grows along surface of alveolar walls and respiratory bronchioles?

What does it look like under microscope?
Bronchio-alveolar carcinoma (BAC)
BAC = Adenocarcinoma in situ (AIS) 

It looks like "ground glass opacity" (GGO) under microscope
What microscopic features do you see in Adenocarcinoma? (2)
  • Gland formation
  • Mucin production
  • Huge nucleoli
What cancer of the lung is:
  • Malignant
  • Disseminated at time of presentation
  • Central
Small cell carcinoma
  • 15%
  • Central
  • Highly malignant
  • Disseminated at presentation 
What do you see in Histology for small cell carcinoma?
Process of elimination:
  • No keratinization
  • No cell bridges
  • No nucleoli
  • No gland/mucin

Blue dots (cells) is all you see
What is a Peripheral, Poorly-differentiated cancer?
Large cell carcinoma (10%)


"waste-basket" category
What marker do you need to remember?
TTF-1
What cancers are positive/negative on TTF-1? Which 2 cancers is TTF-1  negative (-) on?
TTF-1
  • Squamous cell carcinoma (-)
  • Adenocarcinoma  (+)
  • Small cell carcinoma (+)

TTF-1 is (+) in most cancers except:
  • Squamous cancer
  • Mesothelioma
What does ALK stand for?
Anaplastic lymphoma kinase
What are adenocarcinomas analyzed for?
Activating and targetable mutations
What are 2 important genes that are tested for (because there is targeted therapy)?
  • EGFR (TKI works here)
  • ALK 

These are mutually exclusive. There is no hint of positive/negative based on histology.
Name 3 ways that lung cancer is spread
  • Local
  • Lymphatic
  • Blood
What is Horner's Syndrome, name 3 of the important features. What is affected that causes the symptoms? What does it result from?
Symptoms that results from cancer affecting cervical sympathetic chain
  • Ptosis (drooping of eyelid)
  • Miosis (constricting of pupil)
  • Anhydrosis (decreased sweating)
Indicative of a Pancoast tumor, which is a tumor of the apical lung
When a Pancoast tumor affects the arm, hand and also causes Horner's syndrome, what is causing this? What is this set of symptoms called?
Pancoast tumor is affecting the brachial plexus causing Pancoast Syndrome (3):
  • Arm
  • Hands
  • Horner's syndrome 
What is the 5 year survival for lung cancer?
Poor (5-15%)
What is the staging system used?
TNM
For non-small cell cancer, what % are inoperable?
75%
For small cell carcinoma, what is 5 year survival?
2% survival after 5 years, treated by chemotherapy.

Patient gets better but relapses and then cancer is resistant the 2nd time around.
How common is metastatic cancer TO the lung?
About as common or more common than primary lung cancers
What is malignant mesothelioma? What does it do to the lung?
  • Primary neoplasm of the pleura often associated with asbestos exposure
  • It encases the lung and also directly invades thoracic wall structures
What are the 3 microscopic patterns of mesothelioma?
  • Epithelial (gland like)
  • Sarcomatoid (spindle cell type)
  • Mixed epithelial/sarcomatoid
How do Mesothelioma spread? What is the prognosis?
  • Spreads locally much more than by metastases
  • Prognosis is very bad (death within 2 years)
What are the options for tissue biopsy (ie. histological assessment)? (8)
  • Bronchial biopsy
  • EBUS (for biopsy)
  • Mediastinal lymph node biopsy
  • Transbronchial biopsy
  • Transthoracic core needle
  • Open lung biopsy
  • Pleural biopsy
  • Lung resection
What are the options for cytology (ie. cytological assessment)? (5)
  • Sputum
  • Bronchial brushing/washing of tumor during bronchoscopy
  • EBUS (for cytology)
  • Fine needle aspiration under radiological guidance
  • Pleural fluid for identification of malignant cells
Of the lung cancers, which are generally central?

Which are peripheral?
They have an S sound.

Central:
  • Squamous cell
  • Small cell 

Peripheral:
  • Adenocarcinoma
  • Large cell 
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