Lung Cancer Flashcards
What is the most common cancer found in head and neck region and its risk factors and major issues?
Squamous carcinoma. The major issues are lymph node spread and local recurrence. Risk factors are:
- Tobacco, alcohol, HPV, hygiene and repeated trauma.
Describe how HPV effects squamous cell carcinoma.
If HPV positive then there dents to be a better prognosis whereas in Non- HPV there is a p53 mutant which causes more aggressive cancer
What are the different types of COPD?
Emphysema and chronic bronchitis
Why doesn’t every smoker get lung cancer?
It is to do with pharmacogenomics and inter-individual susceptibility.
Describe the difference between centrilobular and panacinar emphysema
Centrilobular emphysema - This damage occurs first as particles become trapped here.
Panacinar emphysema - This is associated with host defence in protection against reactive species, eg, alpha 1 antitrypsin deficiency.
What is emphysema and what does it result in?
It is enlargement of air spaces due to destruction of tissue. This causes increased volume of spaces but decreases surface area so there is less gas exchange
Name the different types of interstitial lung diseases
- Hypersensitivity pneumonitis,
- Sarcoidosis,
- Idiopathic pulmonary fibrosis
Describe features of hypersensitivity pneumonitis
- Type 3 and 4 hypersensitivity. It can be caused by contact with bird feathers or hay. It causes restrictive lung disease
Describe features of sarcoidosis
- It is cell mediated and results in the intersititum not being able to expand.
- It causes granulomas, hilar lymphadenopathy and raised angiotensin converting enzyme
Describe features of idiopathic lung fibrosis
- Could have many causes, eg, post viral, or other systemic diseases. Results in honeycomb lung and indicates for a lung transplant
Name an example of a benign tumour
Mesenchymoma - Largely made of cartilage
Name some examples of primary malignant tumours
- Epithelium (importance of metaplasia and dysplasia)
- Vessels,
- Muscle,
- Cartilage,
- Lymphoid,
- Pleura
What are secondary malignancies and where can they arise from?
It is a tumour spread from a primary tumour. Most common tumours they arise from are;
- Sarcoma, renal carcinoma and lymphoma
Name some different types of primary epithelial cells
- Squamous,
- Adeno,
- Small cell undifferentiated,
- Carcinoid,
- Large cell undifferentiated
How are malignancies diagnosed and classed?
- Radiology, cytology EBUS and biopsy.
- They are then classed based on their grade and stage TNM
What are some causes of squamous malignancies? (NSCLC)
- Smoking, air pollution, asbestosis, fibrosing lung disease (classified by TNM staging)
What are the causes of adenocarcinomas (NSCLC)
Smoking, lung scar, air pollution and asbestos
What can small cell undifferentiated malignancies cause?
Paraneoplastic effects and neurological (demyelination)
Describe features of typical and atypical carcinoid?
Typical - Towards the less aggressive end of spectrum.
Atypical - Smoking related which is at the more malignant end of spectrum
What are paraneiplastic syndromes?
A set of signs and symptoms not directly caused by the cancer. May be related to factors they produce. eg, Neurological, endocrine, skin (acanthosis nigricans), CT/bone (finger clubbing), haematological (EPO) and kidney disease (immune complex GN)
What is the function of molecular pathology?
It allows the identification of EGFR amplification, BRAF, RAS and ALK rearrangements meaning it stratifies tumours for different treatments.
What are the functions of PD1 and PDL1 checkpoint inhibition?
When a tumour expresses PDL1 or PD1 it interacts with lymphocytes which inhibits the immune response. Inhibitors of this can prevent inactivation of immune response
What are the current treatments for malignancy?
- Conventional chemotherapy,
- Targeted, small molecule,
- Immuno-oncology and checkpoint inhibitors
What are the features of mesothelioma?
Caused by asbestos. Has a long lag period of 20-40 years and causes fibrous pleural plaques
What does TNM mean?
Tumour, nodes and metastasis
