6. Respiratory Pathology Flashcards
In the UK how common is the lung cancer the cause of death?
Third most common
How many deaths per year are caused from lung cancer?
40000
List 3 causative factors of lung cancer in Non-smokers
Tobacco
Radon
Asbestos
List the clinical features of lung cancer?
Haemoptysis
Nail bed should be less than 180 degrees
Unexplained or persistant: cough, chest/shoulder pain, chest signs, dyspnoea, hoarseness, finger clubbing
How is staging of cancer performed?
Tumour, Nodes, Metastases
What does T staging indicate?
The location, size and proximity to other organs of the tumour
In terms of location what indicates a higher T staging?
If the tumour is closer to the mediastinum or chest wall (irrespective of its size)
Also if it has spread to the lymph nodes
What is fine needle aspiration?
This is used to sample a few cells which can be looked at by pathologists
Describe how a PET scan is performed?
The patient fasts for 4 hours
Given radiolabelled glucose
The tumour is very metabolically active so will show up clearly on the scan in contrast to the lungs
How is much of M staging performed?
By looking at scans
What is a tumour lung related reason to why patients can get throbbing headaches?
The throbbing headaches can be caused by the build up of tumour in the lymph nodes near the SVC and the build up of pressure in the superior venous system
What is the typical pattern of small cell lung cancer growth?
It grows rapidly and metastasise early
What is the treatment for small cell lung cancer?
Chemotherapy and radiotherapy
What treatment is given if small cell lung cancer patients are very debilitated?
They are given palliative radiotherapy
What is the procedure when the small cell lung cancer tumour disappears?
Prophylactic brain radiotherapy
What is the treatment for local non-small cell lung cancer?
Surgery
What is the 5 year survival for those with local non-small cell lung cancer?
70%
What is the procedure when dealing with advanced non-small cell lung cancer?
This means it has usually spread to the lymph nodes. Chemotherapy to reduce the extent of spread
What is the earliest point before a diagnosis of the tumour can be made?
10mm
What tumour grows slowly?
adenocarcinoma
How does a carcinoma develop?
It is a multistep accumulation of mutations
What are the types of lung tumour?
Benign lung tumours
Malignant lung tumours
What are the features of benign lung tumours?
Do not metastasise
Can cause local complications (airway obstruction)
Chondroma
What are the features of malignant lung tumours?
Potential to metastasise but variable clinical behavious. Can be aggressive
Epithelial tumours - carcinomas
What are the two types of carcinoma?
Non-small cell carcinoma
Small cell carcinoma
List 3 non-small cell carcinomas
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
Which non-small cell carcinoma is closely associated with smoking?
squamous cell cacinoma
Where does squamous cell carcinoma traditionally arise?
Bronchial epithelium but recently in peripheral SqCC
Define atypical adenomatous hyperplasia
Proliferation of atypical cells lining the alveolar walls. Increases in size and can become invasive
What does AAH become?
Adenocarcinoma-in-situ
What is the molecular pathway of adenocarcinoma in a smoker?
A precursor undergoes K ras mutation and DNA methylation p53 to form a adenocarcinoma
What is the molecular pathway of a adenocarcinoma in a non-smoker?
A precursor undergoes EGFR mutation/amplification to form a adenocarcinoma
Who group of people are adenocarcinomas common in?
Far east, females and non-smokers
Where are adenocarcinomas often found?
Peripherally
Do adenocarcinomas metastasise?
Yes, extrathoracic metastases are common and early
Describe large cell carcinomas
Poorly differentiated tumours composed of large cells
How do you treat small and non small cell carcinomas?
Small cell - chemotherapy
non-small cell - Surgery
Do small or non-small cell carcinomas have a better survival rate?
non-small cell
In the TNM staging system - what does T stand for?
Tumour T1-4
In the TNM staging system - what does N stand for?
Lymph node metastasis N0-3
N0 - lymph node not involved by tumour
In the TNM staging system - what does M stand for?
Distant metastasis M0-1
M1 tumour has spread
