Lung Cancer Flashcards
What is the significance of finger clubbing?
- 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
What are the main factors involved in aetiology of lung cancer?
- Smoking
- Occupational exposure
- Air pollution
- Ionising radiation
What does lung cancer accumulate from?
- Driver mutations causing transformation from benign to cancer cells
What are the three elements to bear in mind, during histopathological diagnosis?
- Cell morphology
- Arrangement of cells in relation to one another
- What proteins express and where
Describe benign neoplasias.
- Remains localised and can be removed surgically
- Outcomes usually good and patients usually survive
- Tumour related death is STILL A RISK
Describe malignant neoplasias.
- 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
What are carcinomas?
Malignant epithelial tumours
Describe hyperplasia.
- Increase in number of cells
- Increased proliferation of differentiated/less differentiated progenitor cells
Describe metaplasia.
- Replacement of one type of normal epithelium by other type of epithelium
Describe dysplasia.
- Pre-malignant
- Pleomorphism
- Uniform loss in architectural orientation of individual cells
- Large hyperchromatic nuclei
Describe what happens in carcinoma in situ.
- When dysplastic changes severe - involve entire area of epithelium
- Pre-invasive cancer
Describe what happens in invasive cancer.
- Cell proliferation through basal membrane barrier
- Invades neighbouring tissues
- Invasive cancer
Describe lung adenocarcinoma development.
- 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
Describe the location of lung cancer and the significance of one of these locations.
- Central or peripheral
- Smaller peripheral tumours - likely to be adenocarcinoma
Describe neuroendocrine tumours of the lungs.
- Secretion of cell produce can occur by exocytosis from cell apex into lumen (merocrine)
- Can also occur in apocrine, holocrine and endocrine manners
Describe low grade neuroendocrine carcinoma development.
- HYPERPLASIA - some diffuse proliferation. Pre-inasive
- TUMOURLET - nodular proliferation
- Progresses into neuroendocrine carcinoma
Describe bronchial carcinoids.
- Occur in younger age group
- Produce polypoid intrabronchial mass/plaque
What are the hallmarks of carcinoid tumours?
- 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
What are the hallmarks of small cell carcinoma?
- 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
How do small cell carcinomas appear?
- Solid
- Large
- Central
- Associated with nodal metastasis
What do people with lung cancer commonly present with?
- Cough
- Weight loss
- Dyspnea
- Night Sweats
- Fever
- Hemoptysis
Describe STATUS 0-2 of the ECOG performance status
- 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
Describe STATUS 3 and 4 of the ECOG performance status
- 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
What are the modalities of tumour spread?
- LOCAL INVASION
- CIRCULATORY ROUTE
- LYMPH NODE ROUTE
What type of metastasis is particularly characteristic of lung cancer?
ADRENAL GLAND METASTASES
What are the three elements of TNM staging?
- Tumour Size
- Extent of Lymph Node Invasion
- Presence and Location of Metastatic Deposits
What treatment is recommended from Stages 1-4 cancer?
- Stage 1 and 2 are surgically treatable
- Stages 3 and 4 - try other therapies
What does metastasis to the lung result from?
- Spread of tumour cells to lungs from extra-pulmonary carcinomas
Describe the spread and general presentation of lung cancer.
- Generally spreads early and presents late
