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Respiratory > 8. Respiratory Pathology > Flashcards

8. Respiratory Pathology Flashcards

1
Q

Lung cancer as a COD

A

3rd most common COD

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2
Q

6 Causes of lung cancer

A

Tobacco
Asbestos exposure
Radiation (radon exposure, therapeutic radiation)
Genetic predisposition
Familial (RARE)
Other (heavy metals (chromates, arsenic, nickel))

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3
Q

How does smoking cause lung cancer?

A

Smoking damages/ destroys p53 genes which usually regulate cell cycle
Uncontrollable cell division occurs

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4
Q

7 Clinical features of lung cancer

A 
Haemoptysis (coughing up blood)
Cough
Chest/ Shoulder pain
Dyspnoea
Weight loss
Finger clubbing 
Hoarseness
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5
Q

What is clubbing?

A

Angle between nail and nail bed becomes more obtuse

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6
Q

What are the local effects of bronchial obstruction in Lung cancer?

A

Cancerous tumour pushes on bronchus/ bronchiole, no air can get in/ out, anything past obstruction collapses: causes breathlessness
Impaired drainage of bronchus: Chest infection, Pneumonia, abscess

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7
Q

What are the effects of invasion of local structures in Lung cancer?

A

Invasion of local airways and vessels: Haemoptysis, cough
Invasion around large vessels: SVC syndrome: venous congestion, head and arm oedema, ultimately circulatory collapse
Oesophagus: Dysphagia
Chest wall: Pain
Nerves: Horners syndrome

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8
Q

What are the effects of inflammation/ irritation/ invasion of pleura or pericardium in Lung cancer?

A

Pleuritis or pericarditis, with effusions
=Breathlessness
=Cardiac compromise

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9
Q

Name 3 features of benign tumours and give an example

A

Grow more slowly
Do NOT metastasis
Do NOT invade adjacent tissues
E.g. Chrondroma

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10
Q

What are the 3 types of non-small cell carcinoma? What percentage of lung cancers are non-small cell?

A

Non-Small Cell = 80%
Squamous cell carcinoma (20-40%)
Adenocarcinoma (20-40%)
Large cell carcinoma (Rare)

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11
Q

How does cancer arise?

A

Multistep accumulation of mutations resulting in:
Disordered growth
Loss of cell adhesion
Invasion of tissue by tumour
Stimulation of new vessel formation around tumours

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12
Q

Name 2 features of malignant tumours and give an example

A

Potential to metastasise
Variable clinical behaviour from relatively indolent to aggressive
Commonest are epithelial tumours: “carcinomas”

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13
Q

4 Characteristics of small cell carcinoma

A

Undifferentiated
Aggressive
Paraneoplastic syndromes
Often outgrow blood supply and become necrotic

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14
Q

Presentation of small cell carcinoma

A

Close association with smoking
Often presenting in advanced stage
Often central near bronchi

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15
Q

Treatment and prognosis for small cell carcinoma

A

Chemotherapy only option

Poor survival and prognosis

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16
Q

Non-small cell cancer:

3 Characteristics of Squamous cell carcinoma

A

Local spread, metastasize late
Traditionally central, arising from bronchial epithelium, but recently increase in peripheral SqCC
Close association with smoking

17
Q

Non-small cell cancer:

Arisal of Squamous cell carcinoma

A

In smokers, ciliated epithelium gets irritated and changes via metaplasia into squamous epithelium
Squamous epithelium is more resistant to irritants, but has no cilia so can’t clear mucus, causes cough

18
Q

What are the 5 stages in the pathway to carcinoma?

A 
Hyperplasia
Metaplasia
Dysplasia
Carcinoma in situ
Invasive Carcinoma
19
Q

Non-small cell cancer:

Adenocarcinoma: What is it and where is it?

A

Cancer of glandular epithelium

Tends to develop in periphery of lung around terminal airways and in interstitium

20
Q

What is the precursor stage of adenocarcinoma?

A

Atypical adenomatous hyperplasia: proliferation of atypical cells lining the alveolar walls.
Increases in size and eventually can become invasive

21
Q

Which 2 mutations lead to adenocarcinomas in smokers and non-smokers?

A

Smokers: K ras mutation, DNA methylation p53

Non-smokers: EGFR mutation/ amplification

22
Q

Which type of lung cancer is more common in non-smokers and females?

A

Adenocarcinoma

23
Q

Non-small cell cancer:

Adenocarcinoma: metastasis

A

Extrathoracic metastases common and early

24
Q

Non-small cell cancer:

Adenocarcinoma cytology

A

Malignant cells with large nucleoli and mucin vacuoles

25
Q

How are the incidences of squamous cell carcinoma and adenocarcinoma changing?

A

Squamous cell carcinoma incidence is decreasing

Adenocarcinoma incidence is increasing

26
Q

Non-small cell cancer:

Large cell carcinoma

A

Poorly differentiated tumours composed of large cells

Poorer prognosis

27
Q

Small cell lung carcinoma survival

A

Untreated: 2-4 months
With current therapy: 10-20 months
=Chemoradiotherapy
(surgery very rarely undertaken as most have spread at time of diagnosis)

28
Q

Non-small cell lung carcinoma survival

A

Depends on stage at diagnosis
Early Stage 1: 60% 5 yr survival
Late Stage 4: 5% 5 yr survival
20-30% have early stage tumours suitable for surgical resection.
Difficult to identify when at early stage
Less chemo-sensitive

29
Q

Why is it important to differentiate between the different pathways leading to adenocarcinoma?

A

K ras mutation: unlikely to respond to targeted therapies

EGFR mutation: respond well to highly targeted therapy

30
Q

What type of receptor is EGFR and what is used to block this receptor?

A

Tyrosine kinase receptor

Tyrosine kinase inhibitors work against this

31
Q

What are paraneoplastic syndromes?

A

Systemic effect of tumour due to abnormal expression by tumour cells of factors (e.g. hormones) NOT normally expressed by the tissue from which the tumour arose

32
Q

State some endocrine paraneoplastic syndromes.

A

SIADH (inappropriate ADH, causes hyponatremia)

Cushing’s Syndrome (producing ectopic ACTH)

33
Q

Tumour cells can evade immune system through interaction with PD-l1 and PD-1, inhibiting cytotoxic T cells from targeting tumour cells

A

PD-L1 Inhibitors inhibit this action so our immune system can recognise tumour cells

34
Q

How can samples be acquired for cytological analysis?

A

Bronchial brushing
Sputum
Pleural fluid

35
Q

How can the tissue be examined for histological analysis?

A

Biopsy
Central tumour: bronchoscopy
Peripheral tumours: CT guided biopsy through skin
Surgical biopsy:
Mediastinal lymph node biopsy: for staging

36
Q

How do we describe tumour spread (stage)?

A 
T = Tumour (T1-4): tumour size or extent of local invasion
N = Nodes (N0-3): No of lymph nodes involved 
M = Metastases (M0-1): presence of metastases
37
Q

Systemic effects of bronchogenic carcinoma

A

Brain (fits)
Skin (lumps)
Liver (liver pain, deranged LFTs)
Bones (bone pain, fracture)

38
Q

Non-endocrine example of paraneoplastic syndrome

A

Haematologic/coagulation defects

39
Q

What is strongly associated with mesothelioma?

A

Asbestos

Respiratory (21 decks)

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