Lung cancer Flashcards
Epidemiology of lung cancer
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%)
Histopathologic classifications of primary lung cancers and rates.
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
Describe adenocarcinoma
Cancer formed in glandular epithelial tissue
What are the mutations that occur in non small cell carcinomas?
k-ras, EGFR, ALK
What do newly funded by pharmacy tyrosine kinase inhibitors target and for what cancer type?
non small cell cancers with EGFR mutations
Local effects of lung cancer
Cough, dypnoea, haemoptysis, chest pain, obstructive pneumonia
Local spread patterns
Pleural effusions, nerve entrapment eg horners syndrome (miosis, pitosis)
Mediastinal spread
SVC obstruction, nerve entrapment syndrome eg recurrent laryngeal palsy
Clinical features of SVC obstruction
Face goes red when pt lifts arms above head
Prominent jugular vein
Oedema of face, head, neck and upper chest
Features of recurrent laryngeal nerve entrapment
Hoarse voice
Metastatic spread of lung cancer
Regional lymph nodes (hilar)
Extra nodal e.g. brain, bone, adrenal
Paraneoplastic syndromes
Small lung cell cancer e.g. cushing syndrome- inappropriate ADH secretion
Non small cell lung cancer e.g. hypercalcaemia
Finger clubbing
Weight loss
Describe features of small cell carcinomas
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
Squamous cell carcinoma features, progression
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.
Pathology of SqCC
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
Features of adenocarcinoma of the lung
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
Bronchioalveolar carcinoma
Subtype of adenocarcinoma.
Arising in existing alveolar walls
Up to 5% of all lung cancer
Can be single or multiple nodules or diffuse infiltration
Other lung cancers
:are cell carcinoma- poorly differentiated with features of others.
Carcinoid tumours… neuroendocrine tumours but usually silent. Not related to smoking
Tumours of the pleura
Malignant mesothelioma. Tumour of mesothelial cells, Complication of asbestos fibre exposure.
Encases and compresses the lung
