lecture 6: lung pathology

Question 1

what is the epidemiology of lung cancer?

Answer 1

• 3rd most common cause of death in the UK

- 5 year survival is only 5.5%

Question 2

what are the causative factors of lung cancer?

Answer 2

• tobacco
• radon
• Asbestos

Question 3

what is the clinical presentation of lung cancer?

Answer 3

• haemoptysis
• unexplained or persistent
  cough
  shoulder pain
  chest pain
  short of breath
  finger clubbing
  hoarseness

Question 4

what are the choices of treatment for lung cancer based upon?

Answer 4

• histological cell type
• stage of the lung cancer
• performance status of the patient

Question 5

what are the two types of malignant lung cancer cells?

Answer 5

• small cell lung cancer 25%
  this is more aggressive
• non small cell lung cancer 75%

Question 6

what are the types of carcinoma?

Answer 6

• squamous cell carcinoma
• adenocarcinoma
• large cell carcinoma
• anaplastic carcinoma
• bronchiolo alveolar carcinoma

Question 7

what is the staging system for lung cancer?

Answer 7

TNM
tumour
lymph Nodes
distant metastasis

Question 8

how does the tumour staging work?

Answer 8

• looks at how big the tumor is
• there are different boundaries
• the location of the tumor is indicated in the T staging
• the closer the tumor is to the chest wall or mediastinum the more serious it is

Question 9

how does lympth node staging work?

Answer 9

NX – Regional lymph nodes cannot be assessed.

• N0 – No regional lymph node metastasis.
• N1 – Metastasis in ipsilateral peri-bronchial and/or ipsilateral hilar lymph nodes.
• N2 – Metastasis in ipsilateral mediastinal and/or sub-carinal lymph nodes.
• N3 – Metastasis in contra-lateral mediastinal, contra-lateral hilar, ipsilateral or contra-lateral scalene or supraclavicular lymph nodes

Question 10

how does metastasis staging work?

Answer 10

MX – Presence of distant metastasis cannot be assessed.

• M0 – No metastasis.
• M1 – Distant metastasis (also includes separate tumour nodules in a different lung lobe).

Question 11

what are scanning methods of diagnosing lung cancer?

Answer 11

FDG - PET -CT

trans thoracic CT biopsy

Question 12

what is a PET scan doing?

Answer 12

• patients fast
• fed radioactive glucose
• the tumor will be very metabolically active therefore can be easily detected

Question 13

what is transthoracic CT biopsy?

advantages and disadvantages?

Answer 13

Advantage:
Real-time
Sensitivity 70-100%

Disadvantage:
Risk of pneumothorax (25-30%)
Small sample size
In case of bleeding no immediate intrabronchial treatment possible

Question 14

***when can lung cancer be detected

Answer 14

only at 10 mm
normally 30 mm
can only be detected late on and doesn’t present with symptoms, therefore, prevention is much better than screening

Question 15

what to do for local small cell cancer?

Answer 15

• if it is localized

- the best treatment is surgery

Question 16

what to do for advanced non small cell cancer?

Answer 16

normally better to use chemotherapy