Lung cancer Flashcards
Which lung cancers have the strongest association with smoking?
Squamous and small cell
What are the risk factors of lung cancer?
- Environmental tobacco smoke
- Ionising radiation
- Air pollution
- Asbestos
- Other e.g. fibrosis of the lung, HPV, hereditary (polymorphisms in cytochrome P450)
What are the symptoms of lung cancer?
- Cough
- Haemoptysis
- Shortness of breath
- Chest pain
- Weight loss/ anorexia
- General malaise
What are the symptoms of central lung cancer and what causes these symptoms?
- Ulceration of the bronchus: cough and haemoptysis
* Bronchial obstruction: retention pneumonia, lung abscess, bronchiectasis, wheeze, SOB
What are the symptoms of peripheral lung cancer and what causes these symptoms?
- Pleural involvement: pain, effusion
- Pericardial involvement: pericarditis and effusion
- May have few symptoms
Where are the most common metastases of lung cancer?
- Lymph nodes
- Brain
- Bone
- Liver
- Adrenals
Which areas are affected by local spread of lung cancer?
- Pleura
- Hilar lymph nodes
- Adjacent lung tissue
- Pericardium
- Mediastinum
- Pancoast tumour
What is the effect of local spread to the pleura?
Haemorrhagic effusion
What is the effect of local spread to the mediastinum?
- Superior vena caval obstruction
- Recurrent laryngeal nerve
- Phrenic nerve
What are the symptoms of a pancoast tumour?
- Involvement of the brachial plexus gives sensory and motor symptoms
- Horner’s syndrome/oculosympathetic palsy due to damage of the cervical sympathetic chain
What are the effects of a superior vena cava obstruction?
- Distension of the jugular, axillary and subclavian veins
* Oedema of the face, neck and upper chest
What is the sign of a phrenic nerve palsy on a chest X ray?
Raised semi diaphragm
What is a sign of a left phrenic nerve palsy?
Hoarseness
How does haematogenous spread occur from lung cancer?
Invasion of the pulmonary veins
What are the non metastatic endocrine effects of lung cancer?
- ACTH secretion,Adrenal hyperplasia, Raised blood cortisol: Cushing’s syndrome
- ADH secretion, retention of water, dilution hyponataemia (SIADH)
- Parathyroid hormone related peptide (PTHrP) secretion, osteoclastic activity, hypercalcaemia
Which lung cancer is most associated with Cushing’s syndrome?
Small cell carcinoma
What are the symptoms of Cushing’s syndrome?
- moon face
- Buffalo hump
- Obesity
- Thin, wrinkled skin
- Abdominal striae
- Amenorrhoea
- Muscle weakness
- Osteoporosis
- Purpura
- Skin ulcers
Describe prognosis of small cell cancer
- Usually advanced at diagnosis
* Repsonds to chemotherapy
Describe the prognosis of non-small cell cancer
May be localised at diagnosis and can be treated by surgery or radiotherapy
What type of tumours do central tumours tend to be?
Squamous or small cell carcinoma
What type of tumours do peripheral tumours tend to be?
Predominantly adenocarcinoma
Where do squamous cell carcinomas tend to arise from?
Centrally from the major bronchi
Describe the formation and growth of squamous cell carcinomas in the lung
- Often arise within dysplastic epithelium following squamous metaplasia
- Slow growing and metastasise late
- May undergo cavitation
- May block the bronchi leading to retention pneumonia or collapse
Describe the appearance of squamous cell carcinoma in the lung
- Malignant epithelial tumour showing keratinisation and/or intracellular bridges
- In situ squamous cell carcinoma may be seen in the adjacent airway in mucosa
Where do adenocarcinomas tend to arise
In the periphery, sometimes in relation to scarring
What is the appearance of adenocarcinoma?
- Glandular
- Solid
- Papillary or lepidic
- Mucin production
What is the appearance of small cell carcinoma?
- Oval to spindle shaped cells
- inconspicuous nucleoli
- Scant cytoplasm
- nuclear moulding
Where do large cell carcinomas tend to arise?
Usually centrally
What is large cell carcinoma
Undifferentiated malignant epithelial tumour that lacks the cytological features of SCLC and glandular o squamous differentiation
What is a carcinoid tumour?
Tumour of neuroendocrine cells
Describe the pathogenesis of lung cancer
- Chronic irritation/stimulation of cells by carcinogens
- Increased cell turnover
- Progressive accumulation of genetic abnormalities in molecules involved in cell cycle, signalling and angiogenesis pathways
What are the targeted therapies in lung cancer?
- EGFR receptor: tyrosine kinase inhibitors
- NSCLC, EML4-ALK gene fusions may respond to ALK inhibitors
- ROS-1 oncogenic fusion may respond to targeted therapies
- PD-l1 is overly expressed is some patients with NSCLC and may respond to PD-l1 inhibitors
What is the most common lung cancer
Secondary spread to the lungs i.e. metastatic
Which cancers most commonly spread to the lungs?
- Breast
- Colon
- Head and neck
- Kidney
- Testicular carcinoma
- Sarcoma
What are the symptoms of metastatic spread to the lungs?
- Cough
- Haemoptysis
- Shortness of breath
- Pleural effusion
Which stain is used to help with the diagnosis of tuberculosis?
Ziehl-Neelsen stian
What is mesothelioma?
- Primary pleural tumour
- Almost always due to asbestos exposure
- Tumour had either an epithelial or sarcomatous appearance or a mixture of both (biphasic)
where does mesothelioma tend to be
Lining the chest wall
