Neoplasia 3 Flashcards
What is the clinical presentation of a lung tumour?
cough, haemoptysis, wheeze, dyspnoea, pneumonia, Pancoast’s syndrome
What are some of the common clinical presentations of metastases?
lymphadenopathy, bone pain/hypercalcaemia, jaundice, seizures
What causes weight loss and anorexia in cancer?
TNF-alpha and IL-1
What are paraneoplastic effects?
Symptoms which aren’t related to the local presence of a tumour
What are some common paraneoplastic effects?
endocrine problems, immunological problems, clubbing, hypertrophic osteoarthropathy, venous thrombosis, endocarditis
What are some paraneoplastic endocrine effects of lung cancer?
hypercalcaemia, cushings, inappropriate ADH/ACTH
What are some other paraneoplastic endocrine disorders?
hypoglycaemia, polycythaemia
What blood tests might you order for a cancer patient?
blood picture, liver function test, tumour markers
What are tumour markers?
Proteins in the blood which are useful in follow up of a tumour such as prostate specific antigen in prostate cancer, carcinoembryonic antigen, alpha fetoprotein in colon cancer
Why is tissue sampling important?
To confirm malignancy and to determine features relevant to prognosis and management
What type of stains may be done on a tissue sample?
H&E, stains for melanin, stains for musin, immunohistochemistry to determine cell line
Why is cytology not as useful as a whole tissue sample?
Can’t see stroma and don’t see relationship of cells to each other
What do you need to know about the tumour?
specific tumour type and subtype, grade, stage, presence of lymphovascular invasion
What are the 4 main types of lung carcinomas?
squamous cell carcinoma, adenocarcinoma, large cell carcinoma, small cell carcinoma
What type of lung carcinoma is the most common?
adenocarcinoma
What type of lung carcinoma is the most likely if the patient is a non smoker?
adenocarcinoma
What type of lung carcinoma is a result of squamous metaplasia?
squamous cell carcinoma
What type of lung carcinoma is the most aggressive?
squamous cell carcinoma
What are the macroscopic features of lung cancer?
Pale irregular mass often related to a bronchus that may be necrotic. Can lead to lung collapse or bronchiecstasis. Hilar lymph nodes often appear black.
What type of lung carcinoma tends to be more peripheral?
adenocarcinomas
What are the microscopic features of adenocarcinoma?
The cells show a glandular structure - they cell may try and form a lumen or there may just be an accumulation of mucous
What are the microscopic features of squamous cell carcinoma?
There are rounded areas of keratin in the centre of the tumour and intracellular bridges
What are the microscopic features of small cell carcinoma?
The cells are small and don’t show the typical features of malignancy
What are the microscopic features of large cell carcinoma?
The cells are large and atypical and are undifferentiated
How does immunohistochemistry work?
Labeled antibodies which are labeled either with fluorescence or an enzyme are used to detect the presence of particular proteins which indicate cell lineage
What does the S100 protein indicate in immunohistochemistry?
That the cells are melanocytes
What does the CAM5.2 protein indicate in immunohistochemistry?
That the cells are epithelium
What does LCA protein indicate in immunohistochemistry?
That the cells are leukocytes
What is the stage of a tumour?
Stage refers to how far advanced the tumour is - it incorporates size, how advances local spread is, if it has metastasised and if so where to
What is the TNM system?
A system for staging - T is the level of the primary tumour, N is regional lymph node metastases and M is the absence or presence of distant metastases
What is the action of traditional chemotherapy drugs?
Interfere with cell division
What is the action of targeted therapies?
Block the growth of cancer by interfering with the function of specific molecules resulting from genetic alterations
What specific mutation is targeted in non-small cell carcinomas?
EGFR tyrosine kinase
What are the benefits of this targeted treatment?
superior response rate, prolonged progression-free survival, improved quality of life
What causes death in cancer?
cachexia, secondary infection, damage to vital organ
