Lung Cancer Flashcards
List 7 risk factors for lung cancer.
Smoking (causes 90%) Environmental pollution Ionising radiation Asbestos exposure Pulmonary fibrosis HPV infection Genetic conditions, e.g. -CYP450 polymorphisms -EGFR mutations
Briefly describe the pathogenesis of lung cancer. (4)
- Carcinogens cause chronic irritation and stimulation of lung cells
a. This causes increased cell turnover - Progressive accumulation of genetic abnormalities cause increased cell proliferation and abnormal cell signalling
- This causes hyperplasia, then metaplasia, then dysplasia
- Dysplasia forms a carcinoma in situ
a. This may later spread
Describe the symptoms of lung cancer. (6)
Chronic cough Haemoptysis Chest pain Effects of metastasis Effects depending on location of lung tumour Paraneoplastic syndromes
Describe the symptoms of a central lung tumour. (2)
Bronchial obstruction (breathlessness) Retention pneumonia
Describe the symptoms of a peripheral lung tumour. (2)
Fewer symptoms Pleuritic pain (if pleura involved)
Describe the signs found on examination in lung cancer. (3)
Dullness to percussion
Opacity on CXR
Appearance on other imaging
List 7 non-metastatic effects of lung cancer.
Endocrine effects Encephalopathy Cerebellar degeneration Neuropathy Myopathy Eaton-Lambert (myasthenia-like) syndrome Cancer associated retinopathy
List 3 endocrine paraneoplastic effects caused by lung cancer.
Briefly describe the symptoms you would see in each.
ACTH secretion: Cushing’s syndrome
- Moon face
- Easy bruising
- Buffalo hump
ADH secretion: SIADH
- Water retention
- Hyponatraemia
Parathyroid hormone related peptide (PTHrP) secretion
- Osteoporosis
- Hypercalcaemia
List 10 effects of local metastasis of lung cancer.
PLEURA:
Malignant pleural effusion
Haemorrhagic pleural effusion
BLOOD VESSELS:
Invasion into blood vessels
PERICARDIUM:
Pericardial effusion
Arrhythmias
LUNG APICES:
Horner’s syndrome
MEDIASTINUM: Superior vena cava obstruction Recurrent laryngeal nerve invasion Phrenic nerve palsy Hilar lymph node enlargement
How does lung cancer spread? (2)
List some common sites of metastases.
Haematogenous, e.g.
- Liver
- Bone
- Brain
- Adrenal glands
Lymphatic, e.g.
-Cervical lymph nodes
What are the 3 main types of lung cancer?
Small cell
Non-small cell
Other
What are the 3 types of non-small cell lung cancer?
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
Apart from small cell and non-small cell, what are the 4 other types of lung cancer?
Carcinoid tumours (neuroendocrine cells)
Mesothelioma (pleura)
Lymphoma
Chondroid hamartoma
If a tumour is central, what types of cancer is it likely to be? (2)
Squamous cell carcinoma
Small cell carcinoma
If a tumour is peripheral, what type of cancer is it likely to be? (1)
Adenocarcinoma
Describe the features of small cell carcinoma. (4)
Most aggressive type of lung cancer
Good response to treatment BUT frequent relapses
White, fleshy tumour
Usually central
Describe the histology of small cell carcinoma. (5)
Oval/spindle shaped cells Inconspicuous nucleoli Scant cytoplasm Nuclear moulding Many mitotic bodies
Describe the features of squamous cell carcinoma. (4)
What type of lung cancer is this?
Non-small cell
May be cavitating, with central necrosis
Usually central
Slow growing
Metastasise late
Describe the histology of squamous cell carcinoma. (4)
Malignant epithelial tumour
Keratinisation
Intercellular bridges
In situ squamous cell carcinoma in adjacent airway mucosa
Describe the features of adenocarcinoma. (2)
What sort of lung tumour is this?
Non-small cell
Usually peripheral
May have EGFR/ALK gene mutations
Describe the histology of adenocarcinoma. (3)
Glandular, solid, papillary or lepidic
Mucin production
Signet ring cells
Describe the features of large cell carcinoma. (3)
What type of lung cancer is this?
How would you diagnose it?
Non-small cell
Usually central
May have EGFR/ALK mutations
Undifferentiated tumour
Diagnosis of exclusion
Describe the histology of large cell carcinoma. (2)
Undifferentiated
Lacking features of other types of cancer
What are the 3 main types of metastatic cancer found in the lungs?
Carcinoma
Sarcoma
Teratoma
Where do metastatic carcinomas in the lung commonly originate? (2)
Colon
Breast
Where do metastatic sarcomas in the lung commonly originate? (1)
Muscles
How would you treat lung cancer? (4)
Where relevant, give some examples.
Chemotherapy Radiotherapy Immunotherapy (e.g. gefitinib for EGFR mutations) Surgery, e.g. -Metastatectomy -Total pneumonectomy
