Lung Cancer

Question 1

What is the significance of finger clubbing?

Answer 1

• Soft tissue swelling of the terminal phalanx
• Flattening of the angle that exists between nail bed and nail.
• Associated with heart, lung and digestive diseases

Question 2

What are the main factors involved in aetiology of lung cancer?

Answer 2

• Smoking
• Occupational exposure
• Air pollution
• Ionising radiation

Question 2

What does lung cancer accumulate from?

Answer 2

• Driver mutations causing transformation from benign to cancer cells

Question 3

What are the three elements to bear in mind, during histopathological diagnosis?

Answer 3

• Cell morphology
• Arrangement of cells in relation to one another
• What proteins express and where

Question 4

Describe benign neoplasias.

Answer 4

• Remains localised and can be removed surgically
• Outcomes usually good and patients usually survive
• Tumour related death is STILL A RISK

Question 5

Describe malignant neoplasias.

Answer 5

• Lesion can invade and destroy adjacent structures and metastasise
• Outcomes vary - not all are deadly
• Prognosis has improved in recent years but can still be deadly

Question 6

What are carcinomas?

Answer 6

Malignant epithelial tumours

Question 7

Describe hyperplasia.

Answer 7

• Increase in number of cells
• Increased proliferation of differentiated/less differentiated progenitor cells

Question 8

Describe metaplasia.

Answer 8

• Replacement of one type of normal epithelium by other type of epithelium

Question 9

Describe dysplasia.

Answer 9

• Pre-malignant
• Pleomorphism
• Uniform loss in architectural orientation of individual cells
• Large hyperchromatic nuclei

Question 10

Describe what happens in carcinoma in situ.

Answer 10

• When dysplastic changes severe - involve entire area of epithelium
• Pre-invasive cancer

Question 11

Describe what happens in invasive cancer.

Answer 11

• Cell proliferation through basal membrane barrier
• Invades neighbouring tissues
• Invasive cancer

Question 12

Describe lung adenocarcinoma development.

Answer 12

• ATYPICAL ADENOMATOUS HYPERPLASIA - Involves mild to moderately atypical type II pneumocytes. Pre-invasive lesion
• ADENOCARCINOMA in situ
• Becomes invasive
• Cells of origin are broncho-alveolar stem cells

Question 13

Describe the location of lung cancer and the significance of one of these locations.

Answer 13

• Central or peripheral
• Smaller peripheral tumours - likely to be adenocarcinoma

Question 14

Describe neuroendocrine tumours of the lungs.

Answer 14

• Secretion of cell produce can occur by exocytosis from cell apex into lumen (merocrine)
• Can also occur in apocrine, holocrine and endocrine manners

Question 15

Describe low grade neuroendocrine carcinoma development.

Answer 15

• HYPERPLASIA - some diffuse proliferation. Pre-inasive
• TUMOURLET - nodular proliferation
• Progresses into neuroendocrine carcinoma

Question 16

Describe bronchial carcinoids.

Answer 16

• Occur in younger age group
• Produce polypoid intrabronchial mass/plaque

Question 16

What are the hallmarks of carcinoid tumours?

Answer 16

• Less than 5mm
• Made up of small cells with granular eosinophilic cytoplasm
• Small nests, organoid and trabecular arrangement
• CK7+ and TTF1+, chromogranin + and synaptophysin + protein markers present

Question 17

What are the hallmarks of small cell carcinoma?

Answer 17

• Made up of small cells with fine chromatin and scant/no cytoplasm
• Arranged from sheets of cells/extensive necrosis
• Same neuroendocrine markers as in carcinoid tumours

Question 18

How do small cell carcinomas appear?

Answer 18

• Solid
• Large
• Central
• Associated with nodal metastasis

Question 18

What do people with lung cancer commonly present with?

Answer 18

• Cough
• Weight loss
• Dyspnea
• Night Sweats
• Fever
• Hemoptysis

Question 19

Describe STATUS 0-2 of the ECOG performance status

Answer 19

• STATUS 0 - Fully active, no performance restrictions
• STATUS 1 - Strenuous physical activity restricted. Fully ambulatory
• STATUS 2 - Capable of self-care but not any work activities. Up and about >50% of waking hours

Question 20

Describe STATUS 3 and 4 of the ECOG performance status

Answer 20

• STATUS 3 - Capable of only limited self-care. Confined to bed/chair >50% of waking hours
• STATUS 4 - completely disabled, cannot carry out any self-care, totally bed/chair confined
• At these stages, unlikely to benefit from anti-cancer treatment

Question 21

What are the modalities of tumour spread?

Answer 21

• LOCAL INVASION
• CIRCULATORY ROUTE
• LYMPH NODE ROUTE

Question 22

What type of metastasis is particularly characteristic of lung cancer?

Answer 22

ADRENAL GLAND METASTASES

Question 23

What are the three elements of TNM staging?

Answer 23

• Tumour Size
• Extent of Lymph Node Invasion
• Presence and Location of Metastatic Deposits

Question 24

What treatment is recommended from Stages 1-4 cancer?

Answer 24

• Stage 1 and 2 are surgically treatable
• Stages 3 and 4 - try other therapies

Question 25

What does metastasis to the lung result from?

Answer 25

• Spread of tumour cells to lungs from extra-pulmonary carcinomas

Question 26

Describe the spread and general presentation of lung cancer.

Answer 26

• Generally spreads early and presents late