Lung Tumors Overview

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Questions and Answers

What is the most common location for laryngeal tumors?

Base of the larynx

Glottic region (correct)

Subglottic region

Supraglottic region

Which factor is most likely to worsen the prognosis in carcinoma of the larynx?

Location of the tumor (correct)

Type of treatment administered

Keratinizing glottic tumors

Presence of voice symptoms

What distinguishes glottic tumors from supraglottic tumors regarding lymphatic spread?

Glottic tumors have sparse lymphatic supply (correct)

Glottic tumors metastasize more frequently

Supraglottic tumors are less aggressive

Supraglottic tumors are confined to the larynx

What is the typical appearance of laryngeal squamous cell carcinoma?

Pearly gray, wrinkled plaque (B) Signup and view all the answers

Which of the following is the primary cause of death in patients with laryngeal carcinoma?

Widespread metastases (B) Signup and view all the answers

What does the presence of genetic changes in benign bronchial epithelium among smokers indicate?

It suggests a field effect from carcinogen exposure. (C) Signup and view all the answers

Which type of adenocarcinoma is specifically linked to mutations in the epidermal growth factor receptor (EGFR)?

Adenocarcinomas in nonsmoking women. (B) Signup and view all the answers

What is the most significant factor contributing to the mutations that lead to lung cancers?

Cigarette smoking. (D) Signup and view all the answers

How much more likely are heavy smokers to develop lung cancer compared to nonsmokers?

60 times greater. (D) Signup and view all the answers

What happens to the risk of developing lung cancer after cessation of smoking?

It decreases but never returns to baseline. (B) Signup and view all the answers

What increases the lung cancer risk the most in smokers when exposed to asbestos?

Heavy smoking combined with asbestos exposure. (B) Signup and view all the answers

Which of the following is NOT a recognized carcinogenic influence associated with lung cancer?

Dietary intake of antioxidants. (A) Signup and view all the answers

Why do not all individuals exposed to tobacco smoke develop lung cancer?

Genetic factors may play a role. (D) Signup and view all the answers

What type of morphological characteristics are typically found in small cell lung cancer?

Small, hyperchromatic nuclei with scant cytoplasm (D) Signup and view all the answers

Which neuroendocrine markers are present in small cell lung cancer?

Chromogranin and CD56 (D) Signup and view all the answers

What is the typical response of small cell lung cancer to chemotherapy and radiotherapy?

Often complete response but invariably recurs (B) Signup and view all the answers

Which of the following mutations is most commonly associated with small cell lung cancer?

RB mutations (B) Signup and view all the answers

Which subtype of non-small cell lung carcinoma is associated with central location and has a strong correlation with smoking history?

Squamous cell carcinoma (A) Signup and view all the answers

What is the most common type of nasopharyngeal carcinoma closely linked with Epstein-Barr virus (EBV)?

Undifferentiated carcinoma (B) Signup and view all the answers

How does small cell lung cancer differ from non-small cell lung cancer in terms of mucin production?

Mucin production is absent in small cell lung cancer (C) Signup and view all the answers

Which oncogene mutation is rare in small cell lung cancer?

KRAS mutations (B) Signup and view all the answers

Which type of lung carcinoma grows more slowly and may have a variety of growth patterns, including mucinous and acinar types?

Adenocarcinoma (B) Signup and view all the answers

What histological variant of nasopharyngeal carcinoma is least likely to contain EBV genomes?

Keratinizing squamous cell carcinoma (D) Signup and view all the answers

What is a significant feature related to the response of non-small cell lung cancer to checkpoint inhibitor therapy?

Responsive in specific subtypes (A) Signup and view all the answers

What is the common presenting feature of most laryngeal tumors, including benign and malignant forms?

Hoarseness (C) Signup and view all the answers

Which feature is commonly associated with the tumor suppressor gene abnormalities in small cell lung cancer?

Over 90% TP53 mutations (A) Signup and view all the answers

Carcinoid tumors are often classified into which two subtypes based on their grade and resectability?

Typical and atypical (B) Signup and view all the answers

Which of the following is NOT a common type of non-small cell lung carcinoma?

Small cell carcinoma (A) Signup and view all the answers

What mechanism allows EBV to potentially transform nasopharyngeal epithelial cells?

Activation of NF-KB pathway (B) Signup and view all the answers

What is the primary composition of vocal cord nodules?

Fibrous tissue and stratified squamous mucosa (D) Signup and view all the answers

Which of the following factors is most strongly associated with the development of carcinoma of the larynx?

Environmental factors (A) Signup and view all the answers

What age group is most commonly affected by laryngeal carcinoma?

Adults aged 40 and older (C) Signup and view all the answers

What is the typical characteristic of laryngeal papillomas in adults compared to children?

Adults usually have single papillomas (B) Signup and view all the answers

What role does human papillomavirus (HPV) types 6 and 11 play in the development of laryngeal papillomas?

They are responsible for recurrent respiratory papillomatosis (B) Signup and view all the answers

What type of laryngeal cancer represents the majority of cases?

Squamous cell carcinoma (A) Signup and view all the answers

Which of the following is NOT a common cause associated with increased risk of laryngeal carcinoma?

Frequent viral infections (D) Signup and view all the answers

What is a common symptom related to trauma from laryngeal papillomas when located on the vocal cords?

Hemoptysis following irritation (A) Signup and view all the answers

What is the role of P-450 genes in relation to carcinogens in cigarette smoke?

They increase the capacity to activate procarcinogens. (C) Signup and view all the answers

Which sequence is proposed as analogous to the adenoma-carcinoma sequence seen in the colon?

Atypical adenomatous hyperplasia to invasive adenocarcinoma. (B) Signup and view all the answers

What is the significance of chromosomal breakages in peripheral blood lymphocytes after tobacco exposure?

They correlate with a greater than 10-fold increased risk for lung cancer. (B) Signup and view all the answers

What is true about the changes that lead to squamous cell carcinomas?

They follow a linear progression from mild changes to carcinoma. (A) Signup and view all the answers

What is a major characteristic of small cell carcinoma?

It has high growth rates and early widespread metastases. (C) Signup and view all the answers

What are bronchioalveolar stem cells (BASCs) primarily responsible for?

Facilitating epithelial regeneration after lung injury. (C) Signup and view all the answers

What distinguishes small cell carcinoma from other lung carcinomas?

Its consistent loss of function mutations in TP53 and RB. (A) Signup and view all the answers

What evolutionary step is suggested for lung adenocarcinomas following abnormal proliferation?

Atypical adenomatous hyperplasia to carcinoma in situ. (B) Signup and view all the answers

Study Notes

Lung Tumors

Roughly 95% of primary lung tumors are carcinomas.
The remaining 5% include carcinoid, mesenchymal malignancies, lymphomas, and a few benign lesions.
"Hamatoma" is the most common benign tumor, appearing as a small (1-4 cm) discrete coin lesion on imaging. It's composed of mature cartilage, fat, fibrous tissue, and blood vessels.
Carcinoma of the lung is strongly associated with tobacco smoking.
It's the leading cause of cancer-related death in high-resource countries.
In the US, it was the leading cause of cancer deaths in men since 1987 and women since 1987.
The 2022 American Cancer Society estimates included 237,000 new cases and 130,000 deaths.
Peak incidence is in the fifties and sixties.

Carcinoma Types

Four major histologic types: adenocarcinoma, squamous cell carcinoma, small cell carcinoma (subtype of neuroendocrine), and large cell carcinoma.
Combinations of histologic patterns can occur.
Squamous cell and small cell carcinoma have the strongest association with smoking.
Adenocarcinoma is the most common primary lung tumor in recent years, in women, never-smokers, and individuals under 45.
Lung carcinoma was historically classified as small cell (SCLC) and non-small cell (NSCLC).
NSCLCs are more resectable and less responsive to chemotherapy.

Lung Carcinoma Pathogenesis

Similar to other cancers, smoking-related lung carcinomas develop through a stepwise accumulation of driver mutations producing neoplastic cells with cancer hallmarks.
Inactivation of tumor suppressor genes on chromosome 3 (3p) is a common early event.
Mutations in TP53 and KRAS genes occur later.
Genetic changes like loss of 3p are found even in benign bronchial epithelium of smokers, suggesting a "field effect" (mutagenized respiratory mucosa).
Subsets of adenocarcinomas in nonsmokers show activating mutations in the EGFR receptor tyrosine kinase.
These mutations and others involve downstream signaling pathways involving RAS, PI3K, and other signaling molecules.

Lung Carcinoma Carcinogens

Cigarette smoking and environmental carcinogens are primary culprits.
Approximately 90% of lung cancer cases occur in current or recent smokers.
Increased risk is directly related to the amount and duration of smoking.
Women are more susceptible to carcinogens in tobacco smoke than men.
Other occupational exposures (uranium mines, asbestos, arsenic, chromium, nickel, vinyl chloride) contribute, often synergistically, with smoking.
Genetic factors modify the mutagenic effect of carcinogens.

Lung Carcinoma Diagnosis

The four major histologic types show varied microscopic characteristics, including location within the lung, growth pattern, and degree of differentiation.
Adenocarcinoma is typically peripheral, growing slowly and widely metastasizing early.
Squamous cell carcinoma is more common in men, central in location, and spreads to hilar lymph nodes earlier than other types.
Small cell carcinoma is usually central, spreads rapidly (often before diagnosis), and is highly sensitive to chemotherapy.
Large cell carcinoma is a diagnosis of exclusion; undifferentiated with no specific features.

Lung Carcinoma Treatment

Early detection and resection are often crucial.
Combination treatments (surgery, radiation, chemotherapy) can be beneficial, especially for early-stage disease.
Targeted therapies and immunotherapies are showing promise for various subtypes (adenocarcinomas), especially with genetic profiling of the tumors.
Prognosis varies widely with cancer type and patient factors, as determined in part by the extent of spread when diagnosed.

Nasopharyngeal Carcinoma

A rare neoplasm strongly linked to Epstein-Barr Virus (EBV).
It's highly prevalent in certain populations (Southern China).
Nasopharyngeal epithelium infection by EBV can lead to tumor transformation.
Three histologic variants: keratinizing squamous cell carcinoma, nonkeratinizing squamous cell carcinoma, and undifferentiated carcinoma (strongly linked with EBV).

Laryngeal Tumors

A variety of epithelial and mesenchymal neoplasms can occur in the larynx.
Vocal cord nodules, papillomas, and squamous cell carcinoma are the most common, often identified by hoarseness.
Vocal cord nodules are usually (but not always) benign.
Laryngeal papillomas are benign and often caused by human papillomavirus (HPV) types 6 and 11.
Laryngeal carcinoma is primarily squamous cell carcinoma in nearly all cases and is associated with smoking and alcohol use.
Location within the larynx (glottic, supraglottic, subglottic) affects prognosis due to variations in lymphatic drainage patterns.

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Description

This quiz covers essential facts about lung tumors, focusing on the prevalence of carcinomas and the characteristics of various tumor types. It also highlights the impact of tobacco smoking on lung cancer rates and the associated statistics from the American Cancer Society. Test your knowledge on lung tumors and their implications.