Lung Cancer Flashcards
Which two cancers does lung cancer kill more than combined?
Prostate and breast
What is the usual aetiology of lung canceR?
Environmental
What environmental factors usually are the aetiology of lung cancer?
- Smoking
- Asbestos
- Environmental radon
- Occupational exposure
- Pollution
What precondition can result in a lung tumour?
Pulmonary fibrosis
What percentage of lung cancer cases are related to smoking tobacco?
85%
What percentage of smokers get lung cancer?
10%
Which gender is more at risk of developing lung cancer from smoking?
Males
What percentage risk does passive smoking increase the chances of developing lung cancer by?
50-100%
What percentage of non-smoker lung cancer is related to passive smoking?
25%
What are the 2 major chemical carcinogens in cigarettes?
- Polycyclic aromatic hydrocarbons
- N-nitrosamines
What are polycyclic aromatic hydrocarbons said to be linked to?
Squamous small cell lung cancer
What are N-nitrosamines said to be linked to?
Adenocarcinomas
What cells are effected by tobacco smoke?
Epithelial cells
Where do adenocarcinomas usually form?
- Lung periphery
- Bronchioalveolar epithelial stem cells transform
What are the stages of invasive bronchogenic carcinoma?
- Squamous dysplasia
- Carcinoma in situ
Then invasive bronchogenic carcinoma
What are the stages of invasive adenocarcinoma?
- Atypical adenomatous hyperplasia
- Adenocarcinoma in situ
Then invasive carcinoma
What tumours can occur in the lung?
- Benign tumours
- Carcinoid tumour
- Tumours of bronchial gland (really rare)
- Lymphoma
- Sarcoma
- Secondary tumours
What could cause a benign growth in the lung?
Fibroma during pneumonia
Examples of bronchial gland tumours
- Adenoid cystic carcinoma
- Mucoepidermoid carcinoma
- Benign adenoma
4 main carcinomas of the lung?
- Adenocarcinoma (NSCLC)
- Squamous cell (SCLC & NSCLC)
- Small cell carcinoma (SCLC)
- Large cell carcinoma (NSCLC)
What are the two histological categorisations of lung cancer?
- Small cell carcinoma (SCLC)
- Non small cell carcinomas (NSCLC)
What is the biggest problem with regards to primary lung cancer?
They grow silently for many years and then present later when they are advanced
Local effects of lung cancer?
- Bronchial obstruction
- Pleural invasion
- Direct invasion
- Lymph node metastasis
What effect can cancer have on the pleura?
- Inflammation
- Metastasis
What anatomical structures can be the location of direct invasion in lung cancer?
- Chest wall
- Nerves
- Mediastinum
What nerve structures can be affected by invasion of lung cancer?
- Phrenic nerve
- Left recurrent laryngeal
- Brachial plexus
- Cervical sympathetic
What will phrenic nerve invasion result in?
Diaphragmatic paralysis
What will left recurrent laryngeal invasion result in?
Hoarse, bovine cough
What is cervical sympathetic invasion better known as?
Horner’s syndrome
What structures can be affected by mediastinum invasion from lung cancer?
- Superior Vena Cava
- Pericardium
What common locations does lung cancer spread to?
- Liver
- Adrenal gland
- Bone
- Brain
- Skin
What non metastatic paraneoplastic effects of lung cancer are apparent in the SKELETAL system?
- Clubbing
- HPOA (hypertonic pulmonary osteoarthropy)
What non metastatic paraneoplastic effects of lung cancer are apparent in the ENDOCRINE system?
- Carcinoid syndrome
- Gynecomastia
What non metastatic paraneoplastic effects of lung cancer are apparent in the NERVOUS system?
- Polyneuropathy
- Encephalopathy
- Cerebellar degeneration
- Myasthenia
What non metastatic paraneoplastic effects of lung cancer are apparent in the CUTANEOUS system?
- Acanthosis nigricans
- Dermatomyositis
What non metastatic paraneoplastic effects of lung cancer are apparent in the HEAMOTOLOGICAL system?
- Granulocytosis
- Eosinophilia
What non metastatic paraneoplastic effects of lung cancer are apparent in the CARDIOVASCULAR system?
Thrombophlebitis migrans
What non metastatic paraneoplastic effects of lung cancer are apparent in the RENAL system?
Nephrotic syndrome
What does hypertonic pulmonary osteoarthropy cause?
Sore ankles and wrists
What initial tests are done in lung cancer?
- CXR
- Bronchoscopy
- Trans thoracic fine needle aspiration
- Trans thoracic core biopsy
- Pleural effusion
What types of bronchoscopies can be carried out in lung cancer?
- Bronchial biopsy
- Bronchial brushings and washings
- Endobronchial ultrasound guided aspiration
Prognoses of type 1 and 2 lung cancers with surgical intervention
- Type 1 >60% 5yrS
- Type 2 = 35% 5yrS
5yr survival rate for small cell lung cancer
10-25%
What do immune checkpoints do?
Control immune responses
How do tumours use immune checkpoints?
Hide from immune destruction
