Carcinoma of Bronchus Flashcards
Definition?
Malignant tumour of the lung, originating from resp epithelium of bronchi, bronchioles and alveoli.
RF?
• Smoking-passive/active • Asbestos • Uranium • Chromium and nickel • Welding, coal mining, tar refiners, roofers Existing cancer
ddx?
• Diff types of lung cancers • Lymphomas • Secondary cancers • Pulmonary TB • Cyst • Hamartoma Sarcoidosis/amyloidosis
Epidemiology?
Age: Elderly
Sex: Males-females catching up
Ethnicity:
Aetiology?
- Occupational exposure
- Exposure to smoke
- Hamartomas
- Slow resolving pneumonia
- Granulomas after TB, histoplasmosis and coccidiomycosis
CP?
- Persistent cough
- Haemoptysis
- SOB
- Chest pain
- Decreased appetite
- Unexplained weight loss
- Wheeze
- Mets-jaundice, bone pain, constipation, bloody stools
Pathophysiology-small cell?
- Small portion
- Small, immature, neuroendocrine cells smoking
- Near main bronchus
- Mets quickly limited or extensive
- Paraneoplastic syndrome-ACTH, ANP, Lambet-Eaton syndrome (autoantibodies that destroy neurones)
P-non-small cell?
- Adenocarcinoma
- Glanular epithelium
- Mucin
- Peripheral
- SCC
- Centrally and linked to smoking
- Square-shaped cells
- Keratin
- PTH-osteoporosis and hypercalcaemia
- Large cell carcinoma
- Lack glandular and squamous differentiation
- Smoking
- Throughout
- Bronchial carcinoid
- Mature neuroendocrine cells
- throughout
- Serotonin release-increased peristalsis and diarrhoea and bronchoconstriction
p-cells?
• Lining cells are ciliated cells-sweep particles and pathogens to throat
• Goblet cells-secrete mucin
• Basal cells-diff into other cells
• Club cells-protect bronchiolar epithelium
Neuroendocrine cells-secrete hormones into blood
p-cancer?
- Carcinogens cause mutations and uncontrolled cell division, causing formation of a tumour
- Mutations in cells activated by dominant oncogenes and mutations in tumour suppressor genes
- Oncogenes need one mutation-ege Kras or Cmyc
- TSGs need both alleles to be inactivated eg p53 and Rb
- Malignant cells also express nicotine receptors-binding inhibits apoptosis and promotes growth.
- This tumour induces angiogenesis by outgrowing its blood supply
- Malignant invade through the basement membrane and mets to other sites
- Mets to hilar lymphnodes, lung pleura, heart, breasts, liver, adrenal glands, brain, bone
P-symptoms?
- Body raises immune response by releasing TNFa, IL1B anD il6-weight loss, fever and night sweats
- Obstruction-cough,SOB and pneumonia
- Nerve compression-pain , hoarse voice and SOB
- BV compression-back up of blood, facial sweating and SOB and haeoptysis
I-small-first line?
• CXR-mass, hilar lymphadenopathy, pleural effusion
• CT chest, liver and adrenal glands-lymphadenopathy and mediastinal invasion
Sputum cytology-malignant cells
I-small-second line?
• Bronchoscopy-endobrachial lesions
• Biopsy-malignant cells, high nuclear to cytoplasmic ratio, nuclear fragmentation often present
• Thoracentesis-malignant cells within the pleural fluid
• Thoracoscopy-pleural mets
• MRI/CT brain-mets
• Bone scan and biopsy-mets
• Mediastinoscopy-mets
• PET-distant mets and staging
FBC, LFTs, renal and lung function tests-anaemia, elevated or low, prognosis
I-non-small-first line?
• CXR-
• variable; may detect single or multiple pulmonary nodule(s), mass, pleural effusion, lung collapse, or mediastinal or hilar fullness
• CT neck, thorax, upper abdo-
shows size, location and extent of primary tumour; evaluates for hilar and/or mediastinal lymphadenopathy and distant metastases
I-non-small-second line?
• Sputum cytology-malignant cells • Bronchoscopy-endobrachial lesions • Biopsy-malignant cells • LN sampling-mediastinal LNs • VATS-intrathoracic LNs • Thoracoscopy-pleural effusion • MRI or CT-sites of mets • PET-CT-distant mets • Bone scan -mets FBC, LFTs,calcium, U and E,ECG/echo-mets and complications
