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Respiratory System (CA) > 14. Pathology of Lung Cancers > Flashcards

14. Pathology of Lung Cancers Flashcards

1
Q

Is Lung Cancer the most common cancer and cause of death by cancer worldwide?

A

Yes

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2
Q

What percentage of all deaths in Scotland are lung cancer accountable for?

A

6%

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3
Q

What is the leading cause for lung cancer?

A

Tobacco

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4
Q

What are other causes for lung cancer?

A 
Asbestos
Environmental Radon
Other occupational exposure (Chromates, Hydrocarbons, Nickel)
Air pollution and Urban environment
Other Radiation
Pulmonary FIbrosis
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5
Q

What percentage of Lung Cancer can Tobacco be attributed to?

A

> 85%

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6
Q

What percentage of smokers get lung cancer?

A

10%

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7
Q

By how many times is the risk of cancer increased in both males and females?

A

22x Males
12x Female
Females may be more susceptible however

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8
Q

What is the risk related to?

A

Risk related to consumption

- Inhalation and Pack years (Packs per day per year)

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9
Q

What are the dangers of other people’s smoke?

A

50-100% increased risk

Causes at least 25% of so-called non smoking lung cancers

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10
Q

The more you smoke…

A

The greater your risk

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11
Q

Risk reduces with

A

abstinence but only slowly

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12
Q

What is caused by smoking?

A

Persisting genomic damage

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13
Q

What fraction of the world’s population smoke and what percentage of men and women?

A

A third of males and females
50% men
12% women

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14
Q

Is it true that adolescents are smoking in increasing numbers?

A

Yes

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15
Q

Where is tobacco consumption soaring?

A

China
S & SE Asia
South America

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16
Q

Where is tobacco consumption increasing?

A

America

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17
Q

How many chemical compounds are found in tobacco smoke?

A

4000 chemical compounds

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18
Q

How many of the chemical compounds found in tobacco smoke are carcinogens?

A

~60

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19
Q

What are the two main pathways of carcinogenesis in the lung?

A

In the lung periphery

  • Bronchioloalveolar epithelial stem cells transform
  • Adenocarcinoma

In the central lung airways

  • Bronchial epithelial stem cells transform
  • Squamous cell carcinoma
20
Q

What is a key driver mutation?

A

Oncogene addiction

21
Q

Which biomarker is smoking induced?

A

KRAS - approx 35%

22
Q

Which biomarkers are not related to tobacco carcinogenesis?

A

EGFR - approx 15%
BRAF, HER2 – approx 2% each
ALK rearrangements – approx 2%

23
Q

What are tumours of the lung?

A 
Benign causes of mass lesion
Carcinoid Tumour
-  <5% of Lung Neoplasms			
- Low Grade Malignancy
Tumours of the bronchial gland (VERY RARE)
- Adenoid Cystic carcinoma				
- Mucoepidermoid carcinoma			
- Benign adenomas
Lymphoma
Sarcoma
24
Q

What is a very common occurrence to the lung?

A

Metastases

25
Q

What are the four main cell types that experience carcinomas?

A 
Squamous Cell 
1970-80’s - 40-60 %	
NOW - 40 %
Adenocarcinoma 
1970-80’s - 10-25 %
NOW - 41 %
Small Cell Carcinoma
1970-80’s -  7-25%	
NOW - 15 %
Large Cell Carcinoma
1970-80’s 5-15 %
NOW - 4 %

Bronchioloalveolar cell carcinoma (Alveolar cell ca ) was a subtype of adenocarcinoma.
Now it is called Adenocarcinoma in situ, though the situation is complex

26
Q

What are the percentages for types of Lung carcinoma?

A

~15% Small Cell Carcinoma
85% Adenocarcinoma
Large cell carcinomas
All = NSCLC

27
Q

What term is used when a certain type of carcinoma can not be distinguished?

A

NSCLC

Non-small cell carcinomas

28
Q

What are the traits of Primary Lung Cancer?

A

Probably grows ‘clinically silent’ for many years
Presents LATE in its natural history
Few, if any, signs or symptoms until disease is very advanced
May be found incidentally, during investigation for something unrelated

29
Q

What is generally said about symptomatic lung cancer?

A

It is fatal

30
Q

What are the local effects of lung cancer in terms of bronchial obstruction?

A

Collapse
Endogenous Lipoid Pneumonia
Infection/Abscess
Bronchiectasis

31
Q

What are the local effects of lung cancer in terms of Pleural involvement ?

A

Pleural

  • Inflammatory
  • Malignant
32
Q

What are the local effects of lung cancer in terms of direct invasion?

A

Chest wall
Nerves
- Phrenic – diaphragmatic paralysis
- L Recurrent laryngeal –Hoarse, Bovine cough
- Brachial plexus – Pancoast T1 damage
- Cervical Sympathetic - Horner’s syndrome
Mediastinum ( SVC, Pericardium )

33
Q

What are the local effects of lung cancer in terms of lymph node metastases?

A

Mass effect

Lymphangitis carcinomatosa

34
Q

What are the distant metastases?

A 
Liver
Adrenals
Bone
Brain 
Skin
35
Q

What are secondary to local effects?

A

Neural

Vascular

36
Q

What are the non-metastatic paraneoplastic effects of lung cancer (skeletal)?

A

Clubbing

HPOA

37
Q

What are the non-metastatic paraneoplastic effects of lung cancer (endocrine)?

A

ACTH, SIADH, PTH
Carcinoid syndrome
Gynecomastia

38
Q

What are the non-metastatic paraneoplastic effects of lung cancer (neurological)?

A

Polyneuropathy
Encephalopathy
Cerebellar degeneration
Myasthenia (Eaton-Lambert)

39
Q

What are the non-metastatic paraneoplastic effects of lung cancer (cutaneous)?

A

Acanthosis nigricans

Dermatomyositis

40
Q

What are the non-metastatic paraneoplastic effects of lung cancer (haematologic)?

A

Granulocytosis
Eosinophilia
DIC

41
Q

What are the non-metastatic paraneoplastic effects of lung cancer (cardiovascular)?

A

Thrombophlebitis migrans

42
Q

What are the non-metastatic paraneoplastic effects of lung cancer (renal)?

A

Nephrotic syndrome

43
Q

Which of the Non-Metastatic Paraneoplastic Effects in Endocrine are small cell?

A

ACTH and SIADH

44
Q

Which of the Non-Metastatic Paraneoplastic Effects in Endocrine are squamous?

A

PTH

45
Q

What are the investigations for Lung Cancer?

A 
Chest X-Ray
Sputum Cytology rarely used
Bronchoscopy
- Bronchial biopsy
- Bronchial brushings and Washings
- Endobronchial US-guided aspiration (EBUS)
Trans-thoracic Fine Needle Aspiration
Trans-thoracic Core Biopsy
Pleural effusion

Advanced Imaging Techniques

  • CT scanning
  • MRI, PET
  • Other imaging

Respiratory System (CA) (32 decks)

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