Lung Cancer

Question 1

Lung diseases

Answer 1

COPD (Chronic Obstructive Pulmonary Disease)
Acute & Chronic Bronchitis
Pneumonia
Asthma
Pulmonary fibrosis
Sarcoidosis
Pleurisy
Cystic fibrosis
Cancer

Question 2

Early symptoms of lung disease

Answer 2

Persistent cough (may see coughing up blood Haemoptysis)
Shortness of breath (Dyspnea)
Recurring temperature
Reccurring respiratory infections

Question 3

Late symptoms of lung disease

Answer 3

Bone / chest pain
Difficulty in swallowing (Dysphagia)
Weight loss and weakness
Pleural effusion
Head/neck swelling, headaches, blurred vision
Metastasis to liver

Question 4

Diagnostic tests for lung cancer

Answer 4

Spirometry – detects how much air you can breathe out in one forced breath (useful to detect signs of asthma, COPD, cystic & pulmonary fibrosis)
Blood tests – rule out other causes of symptoms i.e. infection
Chest x-ray – most lung cancers show up as a white/grey mass (but not always distinguishable from abscesses/infections etc)
CT scan – provides more detailed images inside the body

Bronchoscopy/ biopsy – cells/tissue taken and sent to Histopathology laboratory for confirmation of diagnosis, and TNM staging (see main lecture).

Question 5

Bronchoscopy method

Answer 5

Perfomed under mild local anathestic in an outpatient setting
Minimally invasive and quick
long tube with a camera on the end inserted via the nasal cavity down the throat into the trahcea to the bronchus
Camera visualises lesion of concern and a biopsy punch can be perfomed on the lesion for sampling.

Question 6

Mortality of lung cancer

Answer 6

top cancer to cause death
death rate of roughly 60/100,00 death rate in the UK
causes 35% of male cancer deaths
poor survival rate even with surgery- 5 year survival rate in 6-17%, 50% with surgery

Question 7

Lung Cancer risk factors

Answer 7

Smoking causes over 80% of lung cancers
Radiation (e.g X rays)
Ageing (senescence)
Pollution (e.g smog)
Environment (radon gas)
Diseases ( e.g COPD)
Genetics (family history)
Occupation (e.g miners)
Asbestos (sillicates)
Tobacco (Smoking)
Smoke (second hand)

Question 8

Prognosticcellular/ molecular factors of lung cancer

Answer 8

Tumour type and stage (assessed via H&E)
- High cellular proliferation rate (IHC Ki67 antibody+ detected)
- Presence of vascular invasion (detected using H&E, confirmed using IHC)
- High inflammatory response (interpreted by H&E, but IHC needed for specific interpretation of inflammatory cell type)
- Cell adhesion molecule expression (via IHC detection)
- Ras oncogene expression (via molecular testing)
- Mutations of genes controlling cell growth and apoptosis e.g p53, RB BCL2 (these can be stained via IHC)

Question 9

Molecular factors in lung cancer development

Answer 9

Arises as a multistep accumulation of genetic abnormalities/ mutations.
Each mutation gradually changes normal epithelium into hypo plastic, meta plastic and dysplastic cells and then into carcinoma in situ and then into invasive carcinoma.

Question 10

Role of carcinogens in lung cancer

Answer 10

Genetic mutations caused by carcinogens (e.g ciggarette smoke) which activate genes that enhance cell growth (proto-oncogenes) and inactivate tumour supressor genes (anti-oncogenes)

Question 11

Common anti-oncogene (tumour supressor) inactivatons and their mutation types

Answer 11

Retinoblastoma- point mutation on chromosome 13q
P53, deletion mutation on chromsome 17p- particularly associated with risk of developing lung cancer, most frequently mutated tumour supressor in lung cancer
FHIT (Fragile Histine Triad) - deletion mutation on chromosome 3p