Lung tumors Flashcards
What are primary lung tumours usually?
- Epithelial (>95%)
What are metastatic lung tumours?
- Colon
- Breast
- Renal cell carcinoma
- Prostrate
- Melanoma
What are benign lung tumours?
- Hamartoma (most common)
- papilloma
- adenoma
- chondroma
- haemangioma
What is the most common malignant lung tumour?
Non small cell carcinoma
- adenocarinoma
- squamous cell carcinoma
- large cell carcinoma
- NSCLC, NOS
What malignant tumours of the lung are less common?
Neuroendocrine carcinoma
- small cell carcinoma
- large cell neuroendocrine carcinoma
- carcinoid tumour
What are risk factors for lung tumours?
- Cigarette smoking (85% carcinoma occurs in smokers)
- Air pollution
- Industrial exposure (asbestos)
- Radon gas
- COPD, fibrotic lung diseases
- Genetics
What is bronchogenic carcinoma?
- any type or subtype of lung cancer
What does lung carcinoma presentation depend on?
- Site and Stage
- Asymptomatic: CXR
What are local effects of lung tumours?
- mass surrounding main bronchus
- mucosa ulcerated, roughened
- cough
- haemoptysis
- pleural effusion/pneumothorax
- Reccurent pneumonia (carcinoma narrows lumen of bronchus)
Where do lung tumours spread locally?
- Hilar + mediastinal lymph nodes
- Superior mediastinum obstruction
mediastinal spread worse
What is Pancoast tumour?
- apical lung tumour
- Horner syndrome: invasion of sympathetic chain
- Miosis
- Ptosis
- Anhidrosis
- Shoulder + arm pain
What are distant metastases of lung tumours?
- Lymph nodes (axilla, cervical)
- Bone
- Liver
- Brain
What are non-metastatic systemic signs of lung tumours?
- Cachexia (driven by metabolic changes caused by humour)
- Clubbing
What is paraneoplastic syndrome?
- cross reacting of antibodies
- interferes with normal metabolic pathways
- mostly seen in small cell lung carcinoma
immune system also attacks normal cells
What are some examples of paraneoplastic syndromes?
- neuropathy, myopathy
- Cushing Syndrome → ACTH
- Hypercalcaemia
- Hyponatraemia
look at slide 17 for more
What investigations are done for lung cancer?
- Radiology (CXR , CT, PET)
- Bloods (FBC, Ca, LFT, U&E)
- Bronchoscopy
- Tissue sampling
What IHC test is positive for adenocarcinoma?
glandular
- TTF-1
- Napsin A
What distinct features are found in squamous cell carcinoma?
IHC: CK5/6 and p63
- keratin produced, intercellular bridges
- Necrosis + cavitation
What are some common molecular targets in lung carcinoma?
- EGFR
- ALK
- ROS-1
- RET
- B-RAF
What drugs target EGFR?
- First and third generation EGFR TKI
What drugs target ALK?
CNS disease:
- Second generation ALK TKI
- Crizotinib
Non-CNS disease:
- Crizotinib first, then ALK TKI (opposite)
What drugs target ROS?
- Crizotinib
What drugs target RET?
- Cabozantinib
What drugs target BRAF?
- BRAF inhibitors
What are immune checkpoint inhibitors?
- PD-1/PD-L1
- Blocking PD allows T-cells to kill tumour cells
- Works well with lung cancers because of more mutations - smoking
What is ECOG status?
for NSCLC
- used alongside TNM staging
- ECOG 0-4 is evaluated
- Patients with lung carcinoma have multiple co-morbidities
What tests are positive for small cell carcinoma?
type of neuroendocrine
- Giemsa stain
- TTF1
- CD56
- Chromogranin
What is the management for SCLC?
- Chemotherapy: platinum + etoposide
- Radiotherapy
very chemo sensitive
What staging is used for SCLC?
- Limited vs Extensive
- Limited: cancer only reached one area of lung (radiotherapy)
- Extensive: metastasis to other lung, pleural cavity, lymph, bones
What are carcinoid tumours and what tests are positive?
- Neuroendocrine tumours
- CD56
- Synaptophysin
- Chromogranin
