Lung cancer

Question 1

Epidemiology of lung cancer

Answer 1

5th most common cancer but most common cancer death in NZ
Most patients aged 50-80, peak 60-80
Male predominance (2:1 but decreasing ratio)
Highly correlated with smoking (85%)

Question 2

Histopathologic classifications of primary lung cancers and rates.

Answer 2

Small cell lung cancer (20-25%)
Non small cell (70-75%) includes adenocarcinoma, squamous cell carcinoma and large cell carcinoma.
Cominded pattern (5-15%).
The hispatholgic classification determines the cell type of origin and has implication for treatment and prognosis

Question 3

Describe adenocarcinoma

Answer 3

Cancer formed in glandular epithelial tissue

Question 4

What are the mutations that occur in non small cell carcinomas?

Answer 4

k-ras, EGFR, ALK

Question 5

What do newly funded by pharmacy tyrosine kinase inhibitors target and for what cancer type?

Answer 5

non small cell cancers with EGFR mutations

Question 6

Local effects of lung cancer

Answer 6

Cough, dypnoea, haemoptysis, chest pain, obstructive pneumonia

Question 7

Local spread patterns

Answer 7

Pleural effusions, nerve entrapment eg horners syndrome (miosis, pitosis)

Question 8

Mediastinal spread

Answer 8

SVC obstruction, nerve entrapment syndrome eg recurrent laryngeal palsy

Question 9

Clinical features of SVC obstruction

Answer 9

Face goes red when pt lifts arms above head
Prominent jugular vein
Oedema of face, head, neck and upper chest

Question 10

Features of recurrent laryngeal nerve entrapment

Answer 10

Hoarse voice

Question 11

Metastatic spread of lung cancer

Answer 11

Regional lymph nodes (hilar)

Extra nodal e.g. brain, bone, adrenal

Question 12

Paraneoplastic syndromes

Answer 12

Small lung cell cancer e.g. cushing syndrome- inappropriate ADH secretion
Non small cell lung cancer e.g. hypercalcaemia
Finger clubbing
Weight loss

Question 13

Describe features of small cell carcinomas

Answer 13

Typically arise in neuroendocrine cells and thus exhibit paraneoplastic syndromes such as excessive ADH hormone secretion.
Highly malignant, often result in metastatic disease. 20-30% of lung cancers are small cell carcinomas

Question 14

Squamous cell carcinoma features, progression

Answer 14

30% of all lung cancer
Strong link to smoking, begin as injury to bronchial epithelium, dysplasia, carcinoma in situ, invasive tumour. Mostly arise centrally in main stem or segmental bronchi.

Question 15

Pathology of SqCC

Answer 15

Firm grey ulcerated lesions in bronchial wall, extend through into adjacent parenchyma, often show necrosis, cavitation. Microscopy shows variable differentiation with keratin pearls and intercellular bridging

Question 16

Features of adenocarcinoma of the lung

Answer 16

30% of invasive lung cancers.
Most common type in females
most common lung cancer seen in non smokers
tends to arise in the periphery- irregular makes in periphery
Architecture reflects type of lung tissue the cancer arose in

Question 17

Bronchioalveolar carcinoma

Answer 17

Subtype of adenocarcinoma.
Arising in existing alveolar walls
Up to 5% of all lung cancer
Can be single or multiple nodules or diffuse infiltration

Question 18

Other lung cancers

Answer 18

:are cell carcinoma- poorly differentiated with features of others.
Carcinoid tumours… neuroendocrine tumours but usually silent. Not related to smoking

Question 19

Tumours of the pleura

Answer 19

Malignant mesothelioma. Tumour of mesothelial cells, Complication of asbestos fibre exposure.
Encases and compresses the lung