Lung Cancer

Question 1

Describe the micro pathological features of large cell carcinoma

Answer 1

Undifferentiated non-small cell carcinoma that lacks the cytological features of adenocarcinoma, SCC, or small cell carcinoma

Question 2

How do presenting symptoms differ in relation the location of the tumour?

Answer 2

Centrally located - Haemoptysis, cough, SOB, wheeze

Peripheral - Pleuritic chest pain

Tumours at the apex - Pancoast syndrome

Question 3

What are carcinoid tumours?

Answer 3

Neuroendocrine tumours typically found around the main bronchus. Commonly an incidential finding but still have metastatic potential

Question 4

Describe the macro and micro pathology features of adenocarcinomas

Answer 4

Macro - Peripheral, often with pleural involvement

• Grey white with necrosis and haemorrhage and mucoid appearance

Micro - Generally well to moderately well differentiated with glandular and papillary structures

• Mucin producing cells with cytoplasmic mucin granules

Question 5

What are some targeted biological therapies for lung Ca?

Answer 5

EGFR receptor antagonist

ALK

Question 6

How can lung cancer present?

Answer 6

Local complications

• Cough, change in voice
• Pruritic chest pain
• SOB (effusion, pneumothorax, PE, SVC obstruction)
• Haemoptysis

Metastatic Disease

• Bone pain
• CNS signs

Systemic symptoms

• Fatigue, LOW
• Hypercalcaemia

Question 7

What treatment options are available in lung Ca? Which has the best chance of cure in lung cancer?

Answer 7

Surgery (best)

Chemotherapy

Radiotherapy

Target biological

Palliation

Question 8

What are some risk factors for the development of lung Ca?

Answer 8

Smoking

Radiation exposure

Second hand smoke

Abestos

Radon

Pulmonary fibrosis

Question 9

Describe the macro and micro pathology features of small cell carcinomas?

Answer 9

Macro - Often local obstruction of bronchi and SVC

Micro - neuroendocrine type architecture with nests, ribbons, rosettes and trabeculae

• Cells have high N/C ratio with large ovoid nuclei, granular chromatin, inconspicuous nucleoli, scanty cytoplasm

Question 10

What are the common sights of lung Ca metastasis?

Answer 10

Adrenal (>50%)

Liver

Brain

Bone

Question 11

What are the types of adenocarcinomas are there?

Answer 11

Mucinous

Non-mucinous

Mixed

Question 12

What patient population have ALK mutation? How do their tumours appear?

Answer 12

Males 40-60 with no or light hx of smoking

Tumours have a solid pattern with signet ring cells and prominent host inflammatory response

Question 13

Metastases in the lung typically come from where?

Answer 13

Breast

Lower GIT

Renal cell carcinoma

Melanoma

Question 14

Describe the macro and micro pathology features of carcinoid tumours?

Answer 14

Macro - Soft tan colour and well demarcated

May have areas of congestion and haemorrhage

Micro

• Neuroendocrine type architecture with nests, ribbons, rosettes and trabeculae
• Cells have high N/C ratio with large ovoid nuclei, granular chromatin, inconspicuous nucleoli, scanty cytoplasm

Question 15

What is a adenocarcinoma in situ (aka bronchiolo-alveolar carcinoma)?

Answer 15

Adenocarcinoma growing out of existing structures with no evidence of invasion of stroma, blood vessels, or pleura

Question 16

Describe the macro and micro pathology features of Squamous Cell Carcinomas

Answer 16

Macro - centrally located, often with cavitation

• Grey-white to yellow, often flaky due to keratinisation

Micro - intercellular bridges and keratinisation

Question 17

What is pancoast syndrome?

Answer 17

Tumours at the apex of the lung in the superior sulcer causing blocking the thoracic inlet and damage to the brachial plexus and cervical sympathetic nerves which can result in:

• Pain in the shoulder radiating to the ulnar aspect of the hand
• Atrophy of hand muscles
• Horner syndrome
• Compression of blood vessels with oedema

Question 18

What patient population typically have EGFR mutations? How do the tumour appear?

Answer 18

Non or light smoking young asian females with low stage disease

Tumour often are well differentiated with lepidic growth and no necrosis

Question 19

Outline staging for lung cancer

Answer 19

I - Primary with no nodal metastasis

II - Primary with ipsilateral nodal metastasis to peribronchiolar or hilar LNs

III - Local invasion plus mediastinal LN spread or local invasion to adjacent organs

IV - Distant organ metastasis

Question 20

How do adenocarcinomas in situ present on imaging?

Answer 20

Single or multi-nodular consolidation that can involve a whole lobe - can be pneumonic in appearance