Bronchogenic Carcinoma – Lung Cancer Staging (55) – Flashcards
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#1 cause of cancer deaths in the U.S.
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bronchogenic carcinomas
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Peak age group for bronchogenic carcinoma
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40-70 years (2% of all cases occur before age 40)
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How much more likely is a cigarette smoker to contract bronchogenic carcinoma?
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10x more common in smokers
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Why is the outlook for patients diagnosed with lung cancer so dismal?
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no good screening test available
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What is the most common type of lung carcinomas?
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non small cell lung carcinoma
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What is the most common type of non small cell lung carcinoma?
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adenocarcinoma
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List 4 oncogenes involved in bronchogenic carcinomas.
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c-MYC K-RAS EGF-R Her-2/neu
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List 4 tumor suppressor genes associated with bronchogenic carcinomas.
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p53 RB p16 3p
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List 3 types of non small cell lung carcinomas.
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squamous cell carcinoma adenocarcinoma large cell carcinoma
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What percent of lung carcinomas arise in smokers?
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90%
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What percent of smokers get lung cancer?
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10-20%
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List the 2 most closely studied carcinogens in cigarette smoke.
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polycyclic aromatic hydrocarbons and N-nitrosamines
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Why do only 10-20% of smokers get lung cancer?
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For the fully invasive malignant phenotype to develop, closer to 12 critical genetic alterations (in a particular order) are required).
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What epithelium is associated with small cell carcinoma and squamous cell carcinoma?
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central bronchial epithelium
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What epithelium is associated with adenocarcinoma of the lungs?
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terminal respiratory epithelium
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What system in the body converts procarcinogens in cigarette smoke into carcinogens?
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xenobiotic metabolizing enzymes such as P450
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Identify an enzyme that converts toxic compounds into less toxic ones.
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glutathione S-transferase *variability in prevalence and efficacy determine the chance of developing cancer in smokers
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Cancer associated with high-risk CYP polymorphisms and p53 mutations
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squamous cell carcinoma
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Cancer associated with glutathione-S transferase and KRAS mutations
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adenocarcinomas
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Cancer associated with ERCC1 polymorphisms
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small cell carcinomas
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What sex has a higher incidence of adenocarcinomas?
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females (Asians) *many without a history of smoking
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What mutations are associated with familial clustering of lung cancers?
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cytochrome P mutations leading to rapid conversion of procarcinogens to carcinogens
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What is the most common site of bronchogenic cancers?
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hilar
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Which 2 types of lung cancers are most strongly associated with smoking.
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squamous cell carcinoma small cell carcinoma
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Describe the epithelial change sequence in the central bronchial epithelium.
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squamous dysplasia --> carcinoma in situ --> squamous cell carcinoma and small cell carcinoma
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Describe the epithelial change sequence in the terminal respiratory unit epithelium.
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atypical adenomatous hyperplasia --> bronchoalveolar carcinoma --> adenocarcinoma
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List 5 sites of metastasis for lung cancers.
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liver adrenal brain bones kidneys
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Which type of lung cancer is most strongly associated with paraneoplastic syndromes?
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small cell lung carcinoma
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Lung cancer associated with scarring
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adenocarcinoma
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Lung cancer located peripherally (coin lesion)
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adenocarcinoma
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Lung cancer located centrally (near the hilum)
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small cell carcinoma and squamous cell carcinoma
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Sex associated with squamous cell carcinoma
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male
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List 3 complications of squamous cell carcinomas.
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obstruction atelectasis infection
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Describe speed of growth and metastasis of adenocarcinomas of the lung.
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slow growth and early metastasis *often found at stage 4 (adrenal and brain metastases)
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List 6 types of adenocarcinomas of the lung.
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Acinar Solid Papillary Broncho-alveolar Mucin-forming Mixed
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How does bronchioloalveolar carcinoma cause death?
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suffocation
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Lung cancer with alveolar growth pattern with multiple coalescing nodules
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bronchioloalveolar carcinoma
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Lung cancer characterized by tall columnar cells with mucin
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bronchioloalveolar carcinoma
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EM shows surfactant producing type 2 pneumocytes, clara cells (or mucin-secreting bronchiolar cells)
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bronchioloalveolar carcinoma
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Describe prognosis and speed of metastasis in large cell carcinoma.
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poor prognosis early metastasis
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Sex associated with small cell carcinomas
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males
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Small cell carcinomas location
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hilar location
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Describe the appearance of cells in small cell carcinomas.
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lymphocytes
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Describe mitosis and nucleoli in small cell carcinomas.
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frequent mitosis and molding inconspicuous nucleoli
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Lung cancer associated with frequent vascular invasion and wide metastasis
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small cell carcinoma
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List 4 immunohistochemistry tests used to diagnose small cell carcinoma.
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chromogranin synaptophysin CD56 TTF-1: thyroid transcription factor *need to rule out lymphoma with LCA (leukocyte common antigen)
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Small cell carcinoma EM findings
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dense neurosecretory granules
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List some areas of local spread of lung cancer.
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pleura pericardium superior vena cava cervical sympathetic plexus
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List 4 types of paraneoplastic syndrome hormones associated with small cell carcinoma.
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ACTH ADH calcitonin gastrin-releasing polypeptide
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What is the most common site of metastasis of lung cancer?
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adrenal glands (50%) *spread to visceral pleura is significant of high stage cancer
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Which lymph node is biopsied for staging before lung cancer surgery?
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mediastinal lymph nodes
