Lung Tumours Flashcards
Briefly describe the epidemiological data of lung cancers in Australia and globally.
Australia: in 2007, lung cancer was the 4th most commonly diagnosed cancer in both males and females. 80% over 60 y.o., 5 year survival of 11% for men and 15% for women.
Globally: 1.3 million deaths/year, #1 in men and #2 in women.
Tobacco is responsible for 87% of cases. In Australia, 1/6 adults smoke. 1ppd = 22x risk for dying from lung cancer.
List some smoking related cancers besides lung.
mouth, nose, throat, larynx, trachea, oesophagus, stomach, pancreas, liver, kidneys, ureters, bladder, colon, rectum, cervix.
List some common presentations of lung cancer.
Asymptomatic and caught by chance (CXR for other indication)
Cough, weight loss, dyspnoea, chest pain, haemoptysis, bone pain, hoarseness.
List risk factors, other than smoking, for lung cancer.
Exposure to: asbestos, radon, halogen ether, arsenic, radioisotope, atmospheric pollution, chromium, nickel, vinyl chloride.
Chronic interstitial pneumonitis.
How are lung cancers typically classified?
Into small cell lung carcinoma (SCLC), 15% cases, and non-small cell lung carcinoma (NSCLC), 85% cases. NSCLC further into adenocarcinoma (40%), squamous cell carcinoma (30%), and large cell carcinoma (15%)
Briefly describe the features of adenocarcinoma.
More common in women, non-smokers, those
Briefly describe the features of squamous cell carcinoma of the lung.
More common in men, smokers.
Centrally located around hilar regions and in major bronchi. Disseminate later - eventually spread via hilar lymph nodes.
On microscopy often form intercellular bridges and keratin pearls.
Briefly describe the features of small cell carcinoma.
Centrally located around the hilar, with rapid growth and early dissemination to hilar and mediastinal lymph nodes. Primary may be difficult to find and develop paraneoplastic syndrome without primary or with primary presenting later.
Derived from neuroendocrine cells of the lung.
Microscopically cells have minimal cytoplasm, are hyperchomatic.
Briefly describe the features of large cell carcinoma.
Peripherally located mainly but also can be central, poor prognosis as spread early to distant sites.
Cells lack cytological differentiation, are large cells with prominent nuclei, giant and spindle cell variants.
What is done for the treatment of adenocarcinomas?
All adenocarcinomas are sent for EGFR testing, as if positive can be treated with an EGR inhibitor, such as gefitinib or Erlotinib. This inhibits the growth factors of the adenocarcinoma.
When is surgery a treatment option for lung cancer?
If non-small cell and in stages 1-3, treat with surgery, with addition of radiation at stage 2 and chemo at stage 3. Stage 4 is only chemo. All small cell need chemo as often detected at metastasis.
Briefly describe the histology of normal bronchial mucosa.
Four cell types: ciliated columnar, goblet cells, neuro-endocrine cells and basal cells.
What determines the relationship between smoking and lung cancer?
amount smoked, tendency to inhale, duration of smoking, age of initiation of smoking expressed in pack years.
