Pathophysiology

Neoplasia

Case Study

Patient Profile

Name: Christopher Hugo

Age: 55 years old

Gender: male

History of Present Illness

C.H. is a 55-year-old man who reports a persistent cough for the past 6 months, which has progressively worsened. He also experiences occasional shortness of breath, especially during physical activity, and occasional chest pain on the right side. The patient has noted significant weight loss (approximately 10 pounds) over the last 3 months without any changes in diet or exercise. Wants to quit smoking.

Smoking History: 30 pack-years (1 pack per day for 30 years)

Attempts to Quit:

  • First Attempt: At age 30, tried to quit using nicotine patches, but relapsed after 3 months.
  • Second Attempt: At age 40, attempted to quit with the help of a smoking cessation program and nicotine gum, but relapsed after 6 months.
  • Third Attempt: At age 50, tried quitting cold turkey but only able to stay smoke-free for 2 months.
  • Additional Relevant History: Possible occupational exposure to carcinogens (e.g., asbestos, radon), family history of lung cancer (father – deceased)

Social History

Skilled tradesman, kitchen remodeling

Review of Systems

  • General: Some fatigue, weight loss
  • Neurological: No headaches, dizziness, or changes in vision
  • Respiratory: Persistent cough, shortness of breath
  • Cardiovascular: No chest pain at rest, no palpitations
  • Gastrointestinal: No nausea, vomiting, or changes in bowel habits

Physical Assessment

Vitals

  • Blood pressure 130/85 mm Hg
  • Heart rate 88 bpm
  • Respiratory rate 22 bpm
  • Temperature 98.6°F
  • SpO2 93% on room air

General Survey

  • General: Tired but alert and oriented
  • Respiratory:
    • Inspection: Use of accessory muscles for breathing, asymmetrical chest expansion.
    • Palpation: Reduced tactile fremitus over the right lung.
    • Percussion: Dullness to percussion over the right lung.
    • Auscultation: Decreased breath sounds over the right lung, wheezing, and crackles noted.
  • Cardiovascular: Normal S1 and S2, no murmurs.
  • Lymphatic: Palpable right supraclavicular lymphadenopathy.
  • Extremities: No clubbing or cyanosis.

Diagnostic Testing at Urgent Care

  • Chest X-ray: Right hilar mass with possible right upper lobe collapse.

Patient transported to the emergency room via EMS.

Diagnostic Testing after Arrival in the Emergency Room

  • Computerized Tomography (CT) Scan: Solid mass with soft tissue density and irregular borders identified in right bronchi with obstructive changes and possible peripheral growth, cavitation consistent with tumoral necrosis, enlarged regional lymph nodes in the mediastinal region.
  • Bronchoscopy: Biopsy confirmed squamous cell carcinoma.
  • Positron emission tomography (PET) scan scheduled for evaluation of metastasis.

Diagnosis

Squamous cell carcinoma of the lung, located in the right bronchus.

Activity: Pathophysiology of Cancer Cell Characteristics

(Options: replicative immortality, apoptosis, angiogenesis, proliferation, metatasis)

Cancer is a disorder of unregulated cell proliferation, often originating from DNA mutations due to environmental exposure or random chance. Cancer cells exhibit a range of distinct characteristics that enable their uncontrolled growth and survival. They rely on uncontrolled proliferative signaling, bypassing normal regulatory mechanisms and evading growth suppressors that would otherwise inhibit this excessive proliferation. Their genomic instability leads to the accumulation of mutations, driving further malignant transformations and adaptability. Additionally, cancer cells acquire the ability to enable ____________________, avoiding the natural limits of cell division, and they resist cell death by evading ____________________, the programmed cell-suicide mechanism. To sustain their rapid growth, they promote the formation of their own blood supply through ____________________, ensuring a constant supply of nutrients and oxygen. Furthermore, they invade neighboring tissues and spread to distant sites in the body via metastasis, establishing secondary tumors. Notably, cancer cells can also evade immune destruction, avoiding detection and attack by the body’s immune system, allowing them to persist and thrive unchecked. These hallmarks collectively define their aggressive and resilient nature.

Activity: Pathophysiology of Smoke-Induced Lung Cancer

(Options: metaplasia, hypertrophy, increases, decreases)

Cigarette smoke contains more than 70 chemicals known to cause cancer.  These carcinogens can damage the DNA in the epithelial cells lining the airway and lungs, leading to mutations that can result in cancer.  Smoke also causes chronic inflammation in the lungs, leading to cellular damage and changes in the lung tissue.  Simultaneously, this weakens the immune system, making it less effective at detecting and destroying abnormal cells, allowing them to survive and proliferate. The body ____________________ cell turnover, attempting to repair the damage.  The increase in cell proliferation heightens the likelihood of cancer-causing mutations.  Chronic irritation from smoking leads to ____________________, where normal columnar epithelium is replaced by squamous epithelium. This metaplastic change can progress to dysplasia and eventually carcinoma in situ, which can invade surrounding tissues and metastasize.

Activity: Common Locations of Metastasis of Lung Cancer

(Options: common, unlikely, asymptomatic, detected during remission)

  • Lymph Nodes: Lung cancer often spreads first to the lymph nodes within the lung or around the major airways.
  • Bones: Commonly affected bones include the spine, pelvis, thigh bone, and upper arm bone. Bone metastases can cause pain, fractures, and high calcium levels in the blood.
  • Brain: Lung cancer is the most ____________________ cancer to metastasize to the brain, leading to symptoms like headaches, seizures, and neurological deficits.
  • Liver: Metastasis to the liver can cause symptoms such as weight loss, fatigue, and jaundice.
  • Adrenal Glands: Although often ____________________, metastasis to the adrenal glands is common and usually discovered during routine staging.

Review Questions

Click the arrow to expand the section and view the correct answers.

  1. What is the most significant risk factor for squamous cell carcinoma of the lung?
    1. Radon exposure
    2. Smoking
    3. Family history
    4. Air pollution
Answer:

B) Smoking. Feedback: Smoking is the leading cause of squamous cell carcinoma of the lung. Cigarette smoke contains numerous carcinogens that directly damage the DNA of airway epithelial cells, greatly increasing the risk of lung cancer. While other factors like radon exposure and family history can contribute, smoking is by far the most significant and well-established risk factor.

  1. Which symptom is commonly associated with squamous cell carcinoma of the lung?
    1. Abdominal pain
    2. Persistent cough
    3. Frequent urination
    4. Headache
Answer:

B) Persistent cough. Feedback: A persistent cough is a hallmark symptom of lung cancer, especially squamous cell carcinoma, because the tumor often arises in the central airways, irritating the bronchial lining. Other symptoms, like abdominal pain or frequent urination, are not typical of lung cancer.

  1. What diagnostic test is typically used first to identify lung masses?
    1. MRI
    2. PET scan
    3. Chest X-ray
    4. Ultrasound
Answer:

C. Chest X-ray. Feedback: A chest X-ray is usually the first imaging test performed when lung cancer is suspected. It is widely available, quick, and effective at detecting masses or abnormalities in the lungs, prompting further investigation if needed.

  1. Which of the following is a common site for metastasis in squamous cell carcinoma of the lung?
    1. Kidneys
    2. Brain
    3. Pancreas
    4. Spleen
Answer:

B) Brain. Feedback: The brain is a common site for metastasis in lung cancer, including squamous cell carcinoma. Lung cancer is actually the most frequent source of brain metastases among all cancers.

  1. What is the role of bronchoscopy in the diagnosis of lung cancer?
    1. To perform a complete blood count
    2. To visualize and biopsy the tumor
    3. To measure lung function
    4. To administer chemotherapy
Answer:

B) To visualize and biopsy the tumor. Feedback: Bronchoscopy allows direct visualization of the airways and enables the provider to obtain tissue samples (biopsies) from suspicious lesions, which is essential for confirming the diagnosis of lung cancer.

  1. Which of the following is a secondary risk factor for squamous cell carcinoma of the lung?
    1. Smoking
    2. Radon exposure
    3. Genetic mutations
    4. Viral infections
Answer:

B) Radon exposure. Feedback: Radon exposure is a recognized secondary risk factor for lung cancer. While not as significant as smoking, radon is a radioactive gas that can accumulate in homes and increase lung cancer risk, especially in smokers.

  1. What is the primary characteristic of cancer cells?
    1. Slow growth
    2. Unregulated cell proliferation
    3. Limited cell division
    4. Controlled cell death
Answer:

B) Unregulated cell proliferation. Feedback: The defining feature of cancer cells is their ability to proliferate uncontrollably, bypassing the normal regulatory mechanisms that keep cell growth in check. This unregulated growth leads to tumor formation and progression.

  1. What often triggers the DNA mutations that lead to cancer?
    1. Genetic inheritance
    2. Environmental exposure
    3. Controlled cell division
    4. Limited cell growth
Answer:

B) Environmental exposure. Feedback: Environmental exposures, such as carcinogens in cigarette smoke, are a major cause of the DNA mutations that initiate cancer. While genetic inheritance can play a role, most mutations are acquired from environmental factors.

  1. What is a benign tumor?
    1. A tumor that grows slowly and is non-invasive.
    2. A tumor that grows rapidly and is invasive.
    3. A tumor that originates in the blood.
    4. A tumor that has metastasized.
Answer:

A) A tumor that grows slowly and is non-invasive.. Feedback: Benign tumors are characterized by slow growth and a lack of invasion into surrounding tissues. They do not metastasize or spread to distant sites, distinguishing them from malignant tumors.

  1. Which process allows cancer cells to sustain their growth by developing their own blood supply?
    1. Metastasis
    2. Angiogenesis
    3. Genomic instability
    4. Immunotherapy
Answer:

B) Angiogenesis. Feedback: Angiogenesis is the process by which cancer cells stimulate the formation of new blood vessels to supply the tumor with oxygen and nutrients, supporting continued growth and survival.

References

American Cancer Society. (2023). What causes non-small cell lung cancer? Retrieved from https://www.cancer.org/cancer/types/lung-cancer/causes-risks-prevention/what-causes.html

Centers for Disease Control and Prevention. (2023). Health effects of cigarette smoking. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm

Heavey, E. (2024) Neoplasia lecture. [Transcript].

Microsoft. (2024). Copilot (version 4) [Large language model]. Retrieved from https://copilot.microsoft.com

Tkacs, N. (Ed.). (2020). Advanced physiology and pathophysiology: Essentials for clinical practice. Springer Publishing Company.

You.com. (n.d.). Homepage. You.com. Retrieved February 22, 2025, from https://www.you.com

definition

License

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Be Prepared for Your Nurse Practitioner Clinical Readiness Exam Copyright © 2026 by Elizabeth Heavey, Renee Biedlingmaier, Colleen Burgoyne and Carnel C. Jackson is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Share This Book