Lung Cancer Flashcards
Describe the micro pathological features of large cell carcinoma
Undifferentiated non-small cell carcinoma that lacks the cytological features of adenocarcinoma, SCC, or small cell carcinoma
How do presenting symptoms differ in relation the location of the tumour?
Centrally located - Haemoptysis, cough, SOB, wheeze
Peripheral - Pleuritic chest pain
Tumours at the apex - Pancoast syndrome
What are carcinoid tumours?
Neuroendocrine tumours typically found around the main bronchus. Commonly an incidential finding but still have metastatic potential
Describe the macro and micro pathology features of adenocarcinomas
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
What are some targeted biological therapies for lung Ca?
EGFR receptor antagonist
ALK
How can lung cancer present?
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
What treatment options are available in lung Ca? Which has the best chance of cure in lung cancer?
Surgery (best)
Chemotherapy
Radiotherapy
Target biological
Palliation
What are some risk factors for the development of lung Ca?
Smoking
Radiation exposure
Second hand smoke
Abestos
Radon
Pulmonary fibrosis
Describe the macro and micro pathology features of small cell carcinomas?
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
What are the common sights of lung Ca metastasis?
Adrenal (>50%)
Liver
Brain
Bone
What are the types of adenocarcinomas are there?
Mucinous
Non-mucinous
Mixed
What patient population have ALK mutation? How do their tumours appear?
Males 40-60 with no or light hx of smoking
Tumours have a solid pattern with signet ring cells and prominent host inflammatory response
Metastases in the lung typically come from where?
Breast
Lower GIT
Renal cell carcinoma
Melanoma
Describe the macro and micro pathology features of carcinoid tumours?
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
What is a adenocarcinoma in situ (aka bronchiolo-alveolar carcinoma)?
Adenocarcinoma growing out of existing structures with no evidence of invasion of stroma, blood vessels, or pleura
Describe the macro and micro pathology features of Squamous Cell Carcinomas
Macro - centrally located, often with cavitation
- Grey-white to yellow, often flaky due to keratinisation
Micro - intercellular bridges and keratinisation
What is pancoast syndrome?
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
What patient population typically have EGFR mutations? How do the tumour appear?
Non or light smoking young asian females with low stage disease
Tumour often are well differentiated with lepidic growth and no necrosis
Outline staging for lung cancer
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
How do adenocarcinomas in situ present on imaging?
Single or multi-nodular consolidation that can involve a whole lobe - can be pneumonic in appearance
