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Respiratory > Lecture 16- Lung Cancers > Flashcards

Lecture 16- Lung Cancers Flashcards

1
Q

Basic Lung Cancer Facts

A

5th most common
most common cause of cancer death in NZ (1st males, 3rd females)

-Most 50-80yrs, peak age 60-70yrs

males 2:1

Strong link with smoking (85%)

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2
Q

Pathogenesis of Lung cancer… main cause is?

A

Strongest link is which SMOKING

  • 90% of lunger cancers are in smokers ; squamous cell carcinoma and small cell lung cancer. (lots of evidence to support this)
  • Linear correlation between yrs smoking and incidence of lung cancer (there are other genetic and environmental factors, eg SNPs)
  • injury to bronchial epithelium.
  • Sequence of dyplasia to carcinoma in situ to invasive tumour
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3
Q

How does the carcinogen exposure do damage

A

progressive transformation of benign bronchial epithelium > neoplasm (via continued exposure)

-Stepwise accumulation of molecular changes including 3p deletions, p53 mutations, K-ras mutation

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4
Q

Histopathologic classification of ‘Primary’ lung cancer

A

Small Cell Lung Cancer (20-25%)

Non small cell lung cancer (70-75%) :
squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

Combined pattern (5-10%)

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5
Q

What are the implications of the histopathologic classification

A

-Reflects cell of origin in lung

There differences at a molecular/mutational level (different patterns)
-K-ras, EGFR and ALK mutations in NSCLC:can be constituately activated resulting in features of malignancy
This has clinical and therapeutic implications

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6
Q

Adenocarcinoma, Small cell carcinoma and squamous cell carcinoma location

A

Adenocarcinoma: Not due to smoking. At the periphery (alveolus) (EGFR)

Small-cell Carcinoma: Occur more proximally (p53)

Squamous cell Carcinoma: also proximal (cell-differentiation)

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7
Q

In NZ Pharmac have funded two tyrosine kinase inhibitors for non small cell lung cancer with EGFR mutations:
We should take from this …

A

Erlotinib
Gefitinib
We now need to have a genomic profile as this can influence our decisions.

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8
Q

Clinicopathologic Features of Lung Cancer

A 
Local Effects:
Cough (irritation)
Dyspnoea
Haemoptysis (lesion in lung? Ulcer?)
Chest pain
obstruction pneumonia

Local Spread:
Pleural effusions
Nerve entrapment (horners Syndrome)

Mediastinal Spread:
SVC obstruction
Nerve entrapment Syndromes (‘recurrent laryngeal nerve palsy’)

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9
Q

SVC obstruction in lung cancer. How to diagnose

A

Normal: can see large jugular vein and networks

Lift arms: increase the jugular vein obstruction, face red and body white

Tumor mass presses on the SVC, jugular veins get blocked and distended. Other venous networks may open up to bypass this, this can lead to facial swelling and edema

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10
Q

Horner’s Syndrome

A

Due to Nerve entrapment

Tumor mass in the apex of the lung. A ranch of the sympathetic nerve trails over the apex, so if impinged on by tumor it will cause
ptosis: ‘drooping’ of the eye.
miosis
anhidrosis

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11
Q

Appart from Horners syndrome, what’s another consequence of Nerve entrapment

A

Secondary Hoarse voice: Tumor mass can impinge on vocal cords
Can’t do high ‘E’

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12
Q

Metastatic Spread

A
  • Regional lymph nodes eg) hilar
  • extranodal: brain (neuro issue), Bone (pathological fracture), liver and adrenal

Therefore diagnosis may initially be from secondary symptoms

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13
Q

Paraneoplastic Features

A

Number of cytokine or endocrine factors that can cause a systemic syndrome

Any weight loss, general malaise, fatigue are non-specific features

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14
Q

Small-cell Lung Cancer Paraneoplastic Features:

A

Cushing Syndrome; indirectly increased cortisol production (moon face, osteoporosis), from secondary effect of ACTH

Low Sodiums; Due to inappropriate ADH secretion

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15
Q

Non small-cell Lung Cancer Paraneoplastic Features:

A

Hypercalcaemia: secondary to PTH-rp

Finger Clubbing

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16
Q

Finger Clubbing

A

A para-neoplastic feature of non-small cell cancer.

Early on loss of nail-fold, mechanism unsure. Seen in patents with pulmonary pathologies

17
Q

Fractions of NSCL and SCLC. How much of all cancer?

A

3/4 NSCL and 1/4 SCLC

30% of all lung cancer

18
Q

NSCL: Squamous cell carcinoma.

Where they arise and the pathology

A

Most arise centrally in main/major or segmental bronchi, in mucosal surface.

Pathology:

  • firm, grey, ulcerated lesions in bronchial wall.
  • Extend through into adjacent lung parenchyma
  • often necrosis, cavitation
  • Microscopy shows variable differentiation with ‘keratin pearls’, intercellular bridging.

Bronchoscopy with show ulcerating lesions at bifurcation

19
Q

NSCL: Adenocarcinoma

A

Most arise in the periphery of the lungs, out of alveolar cells.

Irregular 2-5cm peripheral mass, can be larger
Often in pleural fibrosis or scars.
chest pain? horners syndrome?

Architecture: parenchyma it arised from but subtypes of acinar/papillary
30% of invasive lung cancer
females> males

Most common lung cancer in non-smokers

20
Q

AC: Bronchioalveolar Carcinoma

A

-Subtype of adenocarcinoma that exists in alveolar walls
Upto 5% all LCs
-Single or multiple nodules or diffuse infiltration

21
Q

Small cell carcinoma facts

A

20-25% all Lung cancers

  • Strong link with smoking
  • Highly malignant/aggresive, epithelial tumour but exhibits neuroendocrine features
22
Q

Common Paraneoplastic syndromes of small cell carcinoma

A

cushing or hyponeutreimia

23
Q

Small cell carcinoma presentation and issues

A

Arise as peri-hilar mass (centrally), often around main stem bronchi with lymph node invasion

Frequently shows haemorrhage and necrosis as they outgrow their blood supply

Microscopic sheets of small round or spindle shaped cells, high mitotic rate

24
Q

Other lung cancer types

A

Large Cell Carcinoma: poorly differentiated, 10% lung cancers

Carcinoid tumors: neuroendocrine tumors, usually silent, not related to smoking (2% Lung tumours)

25
Q

Pulmonary Metastatic disease

A
  • Most common neoplasm of the lung (from colorectal, breast etc)
  • Typically multiple and circumscribed
  • have the histology of the primary tumor
26
Q

Malignant Mesothelioma

A

Tumour of the pleural mesothelial cells

Source: Asbestos fibre exposure, long latency (builders, plumbers)

Difficult to treat, bad prognosis

27
Q

Pathology of malignant mesothelioma?

A
  • Encases and compresses lung

- Microscopically: has epithelial and sacromatous elements

Respiratory (19 decks)

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