6-Lung Tumors Flashcards
what is the epidemiology of lung cancer?
- -Incidence: second most common carcinoma ; leading cause of cancer death (worldwide)
- -Peak incidence: 50–70 years
- -Sex: ♂ > ♀ (∼ 3:1)
- -Adenocarcinoma is an exception: ♂ < ♀ (∼ 1:6)
what is the classification of malignant lung tumors?
1)primary •Epithelial (>95%) •Non-epithelial 2)Metastatic –Colon –Breast –Renal cell carcinoma –Prostate –Melanoma
what is the classification of benign lung tumors?
– Commonest is hamartoma – Papilloma – Adenoma – Chondroma – Haemangioma
what is the hamartoma?
A benign mass composed of mature cells that are native to the tissue of origin but have abnormal tissue organization. Has a low potential to undergo malignant transformation.
• A tumor composed of a mixture of cartilage, fat, blood vessels, fibrous tissue, and epithelium
• Usually an incidental finding on CXR as coin lesion
• Management:
– Biopsy: benign
– PET scan: cold on PET
hamartomas are cold or hot on PET scan?
cold
hamartomas are composed of…
mixture of cartilage, fat, blood vessels, fibrous tissue, and epithelium
often contains hair, teeth
what are the malignant lung tumors?
Primary epithelial malignancies 1)Non-small cell carcinoma • Adenocarcinoma • Squamous cell carcinoma • Large cell carcinoma • NSCLC, Nos 2)Neuroendocrine carcinoma • Small cell carcinoma • Large cell neuroendocrine carcinoma • Carcinoid tumor (typical and atypical)
what are the lung neuroendocrine tumors?
- -Small cell carcinoma
- -Large cell neuroendocrine carcinoma
- -Carcinoid tumor (typical and atypical)
what are the neuroendocrine tumors?
A tumor derived from neuroendocrine cells (i.e., cells that receive neuronal input and release hormonal output). Examples include carcinoid tumor, pheochromocytoma, pancreatic islet cell tumors (e.g., insulinomas, glucagonomas, VIPomas), and small cell lung cancer. Typically positive for synaptophysin, chromogranin A, and neuron-specific enolase.
what are the risk factors of lung cancer?
- -Nicotine: smoking causes approx. 90% of lung cancers
- -Occupational and environmental exposure to carcinogens: passive smoking, asbestos, arsenic, radon, uranium (SCLC)
- -Family history (genetic predisposition)
- -Scar tissue in the lungs (e.g., pulmonary fibrosis, history of tuberculosis)–SCC
- -Idiopathic: particularly adenocarcinoma
what is the lepidic pattern of adenocarcinoma?
- -The distinct growth pattern of bronchoalveolar carcinomas is now referred to as “lepidic”. However, many clinicians and literature sources continue to use the term bronchioloalveolar carcinoma.
- -Lepidic pattern is defined as a tumor composed of neoplastic cells lining the alveolar lining with no architectural disruption/complexity, and no lymphovascular and/or pleural invasion
what are the histologic subtypes of adenocarcinoma?
–Lepidic pattern is defined as a tumor composed of neoplastic cells lining the alveolar lining with no architectural disruption/complexity, and no lymphovascular and/or pleural invasion
–Acinar pattern is characterized by glandular formation
Papillary pattern displays true fibrovascular cores lined by tumor cells replacing the alveolar lining
–Psammoma bodies may be present
–Micropapillary is composed of ill-defined projection/tufting with no fibrovascular cores
–Solid pattern is defined as solid sheets and nests of tumor
what is the incidence of lung cancer in Ireland?
- Approximately 2000 cases diagnosed / year
- M>F; although rising incidence in females
- Accounts for 13% of cancer deaths in men, 7% in women.
- 1708 deaths in 2010 from lung cancer vs 634 from breast cancer
- Lung cancer causes more deaths per year than breast, prostate and colon cancers combined
lang cancer commonly arises from lung parenchyma. True/False
False!!!!!!!!!!!!!
Lung cancer is also known as
BRONCHOGENIC CANCER (Bronchial cancer)
Often arises from major bronchi
what is the usual presentation of lung cancer?
- Depends on Site of the primary tumour and Stage of Disease
- Local
- Intrathoracic
- Distant metastases
- Non-metastatic manifestations
- Asymptomatic - chest x-ray
what are the local effects of lung cancer?
• Mass surrounding main bronchus • Mucosa ulcerated, roughened or nodular • Cough • Haemoptysis • Pleural / mediastinal involvement – Pneumothorax – Pleural effusion • Recurrent pneumonia distal to obstructing tumour – Carcinoma narrows lumen of bronchus -> – obstruction -> retention of secretions -> – infection -> – pneumonia -> abscess formation
what are the signs of the spread of lung cancer?
- Intrathoracic spread to hilar and mediastinal lymph nodes
* Superior mediastinal obstruction
define SCLC
- -strong correlation with cigarette smoking
- -Pulmonary neuroendocrine tumor; associated with several paraneoplastic syndromes (Paraneoplastic syndromes are particularly common in SCLC because the cells originate from the diffuse neuroendocrine system (DNES) and may release substances, such as hormones and antibodies.)
- -Very aggressive ; early metastases
- -Associated mutations: l-myc
define lung adenocarcinoma
- -Most common type of lung cancer overall and in women
- -Most common lung cancer in non-smokers
- -Associated mutations: EGFR , ALK , and KRAS
- -Distant metastases are common
- -Noninvasive subtype: bronchioloalveolar carcinoma
define SCC of lung
- -strong association with smoking!
- -Cavitary lesions are common
- -Direct spread to hilar lymph nodes
- -↑ Parathyroid hormone-related protein (PTHrP) leads to hypercalcemia (See Hypercalcemia of malignancy)
what are the central vs peripheral lung tumors?
SCLC and SCC vs adenocarinoma and large cell carcinoma
what is the Pancoast tumor?
A peripheral lung carcinoma (predominantly non-small cell lung cancer) located in the superior sulcus of the lung. Can compress local structures, including the recurrent laryngeal nerve (causes hoarseness), the stellate ganglion (causes Horner syndrome), the superior vena cava (causes superior vena cava syndrome), the brachiocephalic vein (causes brachiocephalic syndrome), and the brachial plexus (causes sensorimotor deficits).
what is the Horner syndrome?
A neurologic disorder that causes a triad of miosis (an abnormally small pupil), partial ptosis (drooping of the upper eyelid), and facial anhidrosis (absence of sweating). Caused by lesions that interrupt the sympathetic nervous supply (stellate ganglion). Most cases are idiopathic, but etiologies include brainstem stroke, carotid dissection, and neoplasm.
what are the sites of distant metastases of lung cancer?
• Lymph nodes – axilla, cervical, other • Bone – Pathological fracture, pain • Liver • Brain – Seizures, stroke, headache • Adrenal gland • Skin
what are the non-metastatic manifestations of lung cancer?
• Cachexia - late symptom
– Weight loss, anorexia
• Clubbing of fingers
• Paraneoplastic syndromes
what is a paraneoplastic syndrome?
A set of clinical features that are caused by either an altered immune response to a systemic malignancy or by substances produced by tumors (e.g., hormones, cellular proteins).
paraneoplastic syndrome is mediated by?
– Cross reacting antibodies
– Production of physiologically active factors
– Interference with normal metabolic pathways
– Idiopathic
what are the paraneoplastic syndromes that are associated with both SCLC and NSCLC of the lung?
- -General paraneoplastic manifestations: cachexia, increased risk of thrombosis (and lung embolism!)
- -Dermatomyositis
- -Acanthosis nigricans
what are the paraneoplastic syndromes that are associated with NSCLC of the lung?
1) Endocrine
- -Hypercalcemia of malignancy (squamous cell carcinoma)
- -Gynecomastia (large cell carcinoma)
2) Other
- -Hypertrophic osteoarthropathy (also known as Pierre-Marie-Bamberger disease)
- -Clubbing of the fingers and toes (Hippocratic fingers)
- -Swelling and pain in joints and long bones (Caused by painful arthropathy and ossifying periostitis of the distal diaphysis of long bones)
- -Hypercoagulability and thrombophlebitis migrans (adenocarcinoma)
- -Nonbacterial verrucous endocarditis (adenocarcinoma)
what are the paraneoplastic syndromes that are associated with SCLC of the lung?
1) Endocrine
- -Cushing syndrome
- -Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
2) Neurologic
- -Lambert-Eaton syndrome (similar clinical features as myasthenia gravis)
- -Paraneoplastic cerebellar degeneration
- -Peripheral neuropathy
what is the hypercalcemia of malignancy?
A paraneoplastic syndrome in which parathyroid hormone-related peptide (PTHrP) is secreted by the tumor. Like PTH, PTHrP causes osteoclastic bone resorption, increases serum calcium levels, and decreases renal phosphate reabsorption. Hypercalcemia, in turn, suppresses the secretion of PTH from parathyroid glands (secondary hypoparathyroidism).
gynecomastia as a paraneoplastic syndrome is seen with which lung cancer?
large cell carcinoma
