CP8 malignant lung pathology

Question 1

What is the definition of lung malignancies?

Answer 1

Tumours within the lung that possess potentially lethal abnormal characteristics that enable them to invade and metastasise to other tissues.

Question 2

What are the two types of malignant lung tumour?

Answer 2

Primary and secondary

Question 3

What is the most common primary lung malignancy?

Answer 3

Carcinomas (<90%)

Question 4

What are the two types of primary malignant lung carcinomas?

Answer 4

Small cell carcinomas (15-20%) and non-small cell carcinomas (80-85%)

Question 5

What are the 3 non-small cell lung carcinomas?

Answer 5

Squamous cell undifferentiated (20-30%)
Adenocarcinoma (30-40%)
Large cell carcinoma (10-15%)

Question 6

How do small cell and non-small cell carcinomas differ?

Answer 6

Different nuclear characteristics
Different amount of cytoplasm
Different pathogenesis, treatment and prognosis

Question 7

Where do carcinomas arise from?

Answer 7

The epithelium

Question 8

How is a tumour classed as squamous cell carcinoma under a microscope?

Answer 8

Presence of keratinisation +/- intracellular bridges or have a squamous immunoprofile

Question 9

How is a tumour classed as a adenocarcinoma under the microscope?

Answer 9

Mucin production +/- gland formation or have a specific immunoprofile

Question 10

How is a tumour classed as a small cell carcinoma under the microscope?

Answer 10

A typical morphology and a specific immunoprofile

Question 11

What is a common risk factor in almost all patients with a small cell carcinoma?

Answer 11

Smoking

Question 12

What are 3 uncommon primary malignant tumours?

Answer 12

Carcinoid tumours (low grade)
Malignant mesenchymal tumours e.g. synovial sarcoma
Lung lymphomas (can be seen in HIV/AIDS patients)

Question 13

What is the most common type of secondary tumours?

What other types form secondary lung tumours?

Answer 13

Carcinomas

Sarcomas, melanomas and lymphomas

Question 14

Fill in the blanks.

Secondary lung tumours are ______ common than primary lung tumours

Answer 14

More

Question 15

What is the epidemiological of lung cancer?

Answer 15

49,000 new cases every year in the UK and >35,000 deaths usually within individuals aged between 40 and 70.

Question 16

What are 4 risk factors of lung cancer?

Answer 16

Tobacco smoking
Occupational hazards e.g. asbestos, uranium, arsenic, nickel
Radiation e.g. radon in mines, survivors of atomic bombs
Genetics

Question 17

What is an example of a condition that increases risk of lung cancer (other than other cancers)?

Answer 17

Lung fibrosis

Question 18

What is an example of a condition that increases risk of lung cancer (other than other cancers)?

Answer 18

Lung fibrosis

Question 19

What are the 3 major components of cigarette smoke?

Answer 19

Tar - carcinogenic
CO - prevent blood carrying O2
Nicotine

Question 20

What are a 3 examples of asbestos related respiratory disease?

Answer 20

Lung fibrosis
Mesothelioma
Malignant lung carcinomas

Question 21

What is the average latent period between asbestos exposure and pathogenesis of asbestos related disease?

Answer 21

20 years

Question 22

What is a pathway of pathogenesis of malignant lung tumours?

Answer 22

Squamous metaplasia —> dysplasia —> carcinoma in situ —> frank squamous carcinoma

Question 23

What are common complications of lung metastases?

Answer 23

Symptomatic complications: Haemoptysis, breathlessness, chest pain, dysphagia, seizures, weight loss, lethargy
Clinical signs as a complication: enlarged lymph nodes, finger clubbing
Disease complications: pneumonia, pleural effusion, damage to the recurrent laryngeal nerve, Horner’s syndrome

Question 24

What is lymphangitis carcinomatosa?

Answer 24

When the lymphatics within the lungs are diffusely involved with the tumour

Question 25

What are some treatments for lung cancer?

Answer 25

Targeted therapies (based on tumour genomics)
Using immune checkpoint inhibitors
Neo-adjuvant therapy (chemo +/- Immuno therapy before surgery)
Adjuvant therapy (chemo +/- targeted treatments after surgery)