Lung tumours Flashcards

Question

treatment and prognosis of Non-Small Cell Lung Cancer (NSCLC)

Answer 1

``` 5 year survival dependent on stage Wide range (3-60%) but overall only 20% ``` About 25% have resectable local disease Surgery if resectable and no metastasis Radiotherapy if non-resectable Chemotherapy if metastatic, but response poor

Answer 2

A measure of how far tumour has spread T (tumour) N (nodes) M (distant metastases) commonly used Information derived from: Clinical – Bronchoscopy, Surgery Radiology – CT, MRI, Bone scan, PET scan Pathology – Cytology, Histology, PM Common distant sites include adrenal, brain, liver and bone

Answer 3

TNM used to produce stage grouping Useful prognostic tool: Stage I – 60% 5 year survival Stage II – 40% 5 year survival Stage IIIa – 20% 5 year survival Stage IIIb – 5% 5 year survival Stage IV – 3% 5 year survival

Answer 4

TNM not used as most tumours metastatic Instead use limited vs extensive disease: Limited – 1-2 year median survival. Disease confined to ipsilateral thorax, Including supraclavicular fossa and pleural effusion Extensive – 6-12 month median survival All other patients

Answer 5

Low grade malignant tumour CF from their intraluminal growth, capacity to metastasise, ability of some lesions to emanate vasoactive amines. Multiple Endocrine Neoplasia type 1 (MEN1) is a rare hereditary endocrine cancer syndrome - tumors of the parathyroid glands (95% of cases), endocrine gastroenteropancreatic (GEP) tract (30-80% of cases), and anterior pituitary (15-90% of cases). Other endocrine and non-endocrine neoplasms including adrenocortical and thyroid tumors, visceral and cutaneous lipomas, meningiomas, facial angiofibromas and collagenomas, and thymic, gastric, and bronchial carcinoids also occur. MEN 2 – thyroid, pth and adrenal usually 5% of all lung tumours Arise from neuroendocrine cells M=F, <40 years No known relationship with smoking. Carcinoid tumours – younger patients, not usually smoking related Can occur as part of Multiple Endocrine Neoplasia (MEN) syndromes Can cause local and paraneoplastic symptoms Carcinoid syndrome most common 90% benign and 10% malignant Usually small and well-circumscribed yellow mass. Peripheral or central position.

Answer 6

``` Due to Serotonin (5HT) production Enters systemic circulation Flushing Nausea and vomiting Abdominal pain Coughing and wheezing Carcinoid heart disease: Endocardial, Tricuspid & pulmonary valve scarring Rarely Aortic & Mitral stenosis ``` Cardiac problems in 50% of people with carcinoid syndrome Serotonin and bradykinin have direct effect on right side of heart These are inactivated as travel through the pulmonary circulation due to high monoamine oxidase levels

Answer 7

Most common lung tumour Common in both carcinoma and sarcoma Breast, GI tract and kidney most common sites Therefore adenocarcinoma most common histological type Can’t usually be distinguished histologically from a primary tumour Use immunohistochemistry to give a “clue” as to the primary Haematogenous spread – discrete nodules Lymphatic spread – diffuse dissemination with macroscopic nodularity (lymphangitis carcinomatosa) or microscopic only

Answer 8

tumour dispersed | within lymphatic vessels

Answer 9

Primary pleural tumour Arise from mesothelial cells Often extensive and bilateral Aggressive - direct invasion to lung and mediastinum Metastatic spread less common

Answer 10

Rare overall, about 1000 cases yearly in UK Asbestos exposure Mining, fabrication and working with insulation 10% lifetime risk if heavy exposure Up to 40 year latency period Smoking does not increase risk of mesothelioma But magnifies risk of lung cancer in smokers

Answer 11

Chest pain Dyspnoea Pleural effusion Weight loss Diagnosis can be difficult but IMPORTANT! Diffuse and widespread thickening of pleura with extension into underlying lung Variable histology - spindle cell ‘sarcoma-like’ areas & acinar ‘adenocarcinoma-like’ areas. Diagnosis between mesothelioma and adenocarcinoma requires immunohistochemistry

Answer 12

Surgery rarely possible Poor response to radio and chemotherapy 50% dead within 1 year, most within 2 years If known occupational exposure then an ‘unnatural’ cause of death Requires referral to Coroner, post mortem (if diagnosis not confirmed in life) and inquest

Answer 13

History and examination ``` Chest X-ray Low specificity / positive predictive value Many mimics of tumour Tumour type not identifiable 20% of tumours not visible ``` CT / MRI High specificity but expensive Tumour type still not identifiable Bronchoscopy

Answer 14

Sputum Cytology Can be induced Samples large volume of lung Pleural Fluid Drained for symptomatic relief Diagnosis is an extra “bonus” ``` Bronchoscopic specimens Best for central lesions Bronchial washings and brushings Bronchial or transbronchial biopsy Transbronchial fine needle aspiration ``` Transthoracic Fine Needle Aspiration or biopsy Peripheral lesions CT guided so usually: Central: Bronchoscopic diagnosis - Washings / Brushings / Biopsy Peripheral: CT guided transthoracic FNA / biopsy Pleural: Pleural fluid CT guided transthoracic FNA / biopsy

Answer 15

Well-circumscribed usually single masses of one cell type | that are well-differentiated and show little cytological atypia

Answer 16

Usually presents at late stage: ``` Local tumour growth: Cough – mucosal irritation Dyspnoea – atelectasis, obstruction Weight loss – tumour cachexia Chest pain – invasion of chest wall ``` Metastatic tumour spread Paraneoplastic phenomena

Answer 17

by degree of differentiation.