lecture 8/tutorial 10 - lung cancer Flashcards
What are some of the risk factors for lung cancer?
Cigarette smoking/second hand smoke, radon gas, asbestos, genetics
What are the 2 key types of lung cancer?
Small cell carcinoma, non-small cell carcinoma
What type of lung cancer accounts for 15 % of cases but is highly malignant?
Small cell carcinoma
What type of lung cancer accounts for 85% of cases but is only moderately malignant?
Non-small cell carcinoma
What are the 3 sub-types of non-small cell lung carcinoma?
Large cell carcinoma, adenocarcinoma, squamous cell carcinoma
What is transformation, in terms of cancer development?
A genetic mutation or epigenetic event that alters mechanisms that control cell growth, proliferation or survival.
What are some of the mechanisms that malignant cells must evade/adapt to to survive?
become insensitive to growth-inhibitory signals, evade apoptosis, sustain angiogenesis, avoid immune cell destruction
What is the term for a benign mesenchymal tumor of fibroblasts?
Fibroma
What is the term for a benign mesenchymal tumor of cartilage cells?
Chondroma
What is the term for a benign mesenchymal tumor of fat cells?
lipoma
What is the term for a benign mesenchymal tumor of osteoblasts?
Osteoma
What is the term for a benign epithelial tumor of glands?
Adenoma
What is the term for a benign epithelial tumor forming a projection on a mucosal surface?
Polyp
What is the term for a benign epithelial tumor with finger-like projections from the epithelial surface?
Papilloma
What is the term for a malignant mesenchymal tumor?
Sarcoma
What is the term for a malignant epithelial tumor?
Carcinoma
What is a teratoma?
A tumor that contains tissues from multiple embryonic germ cell types and arises in the ovaries or testes.
How can differentiation be used to determine the difference between a benign and malignant tumor?
Benign tumors are well differentiation and malignant tumors are anaplastic/poorly differentiated.
What are some of the morphological hallmarks of cellular anaplasia?
- pleomorphism (cells all have different shapes)
- hyperchromatic nuclei
- prominent nucleoli
- mitoses (actively proliferating cells)
- tumor giant cells
What is a low grade tumor?
A well differentiated, less aggressive tumor
What is a high grade tumour?
A poorly differentiated, aggressive tumor
What is a carcinoma insitu?
When there is high grade dysplasia affected the entire thickness of an area of epithelium, but the invasion has not yet invaded through the basement membrane
What is the difference between benign and malignant tumors in terms of their rate of growth?
Benign tumors grow more slowly that malignant tumors.
What process will immediately mark a tumor as malignant not benign?
Metastasis
What are the components of the TNM staging system for cancer?
- T: size/extentof tumour
- N: spread to regional lymphnodes
- M: presence/absence of metastasis
What are the possible classifications of the primary tumor (T) in TNM staging?
T1, T2, T3, T4
What are the possible classifications of regional lymphnodes (N) in TNM staging?
Nx, N0, N1, N2, N3
What are the possible classification of metastasis (M) in TNM staging?
Mx, M0, M1
What is the gross morphology of a lung carcinoma?
grey-white, firm tumor, often speckled with anthracosis if patient was a smoker.
What type of lung cancers are typically related to the main or lobar bronchi?
Squamous or small cell carinomas
What lung cancer is typically found peripheral to the bronchi, under the pleura?
Adenocarinoma, large cell carcinoma (though can be hilar too)
What is the growth pattern of a small cell lung carcinoma?
Grows along the bronchial wall and infiltrate hilar lymphnodes - overall hilar location
What is the growth pattern of squamous cell lung carcinoma?
Arises from the main bronchi and infiltrates adjacent lung tissue
What is the growth pattern of large cell lung carcinoma?
Variable -can grow peripherally or centrally
What are histological features of a lung adenocarcinoma?
Glandular appearance, often with mucus secretion. May be a central region with a collagenous scar Found in the periphery so may invade the pleura.
What structures can lung cancer invade locally?
Chest wall, pleura, nerves, mediastinum, intrapulmonary lymphnodes
What are paraneoplastic syndromes?
A syndrome that occurs when a tumour produces chemical signalling molecules that act on different parts of the body. Can be endocrine, neurological, skeletal, etc.
What are some examples of paraneoplastic syndromes?
Hypercalcaemia, Cushing’s syndrome, peripheral neuropathy.
What is the size and/or location of a T1 lung carcinoma?
Smaller than 3cm across
What is the size and/or location of a T2 lung carcinoma?
Larger than 3 cm across, but not T3 or T4
What is the size and/or location of a T3 lung carcinoma?
Within 2 cm of the carina of the tracheal bifurcation
What is the size and/or location of a T4 lung carcinoma?
Invades into the mediastinum or vertebrae
What is the key histological feature of a well differentiated squamous cell lung carcinoma?
Keratin pearls, cell nests
What is the key histological feature of small cell lung carcinoma?
Dark hyper-chromatic nuclei that mould to one another.
What are the symptoms of lung cancer?
Chest pain, cough, dyspnoea, weight loss
What investigations are used in the diagnosis of lung cancer?
Chest xray, sputum cytology, MRI/CT, bronchoscopy with biospy.
What paraneoplastic syndromes are commonly causes by lung carcinoma?
hyponatremia, cushing syndrome, hypercalcemia
Which paraneoplastic syndrome is most commonly caused by squamous cell carcinoma?
Hypercalcemia
Which 2 paraneoplastic syndrome are most commonly caused by small cell carcinoma?
Cushing Disease (excess cortisol production), Hyponatremia
