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01. Respiratory System - HP > - Neoplasia : Pathology of Lung Cancers > Flashcards

- Neoplasia : Pathology of Lung Cancers Flashcards

1
Q

What is the most common cause of death by cancer worldwide?

A

Lung cancer

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2
Q

Lung cancer kills more than which 2 cancers combined?

A

Breast and prostate

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3
Q

Lung cancer accounts for what percentage of ALL deaths in Scotland?

A

6%

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4
Q

What is the aetiology of lung cancer?

A
  • Tobacco
  • Asbestos
  • Environmental radon
  • Occupational exposure ( chromates, hydrocarbons, nickel)
  • Air pollution and urban environment
  • Other radiation
  • Pulmonary fibrosis
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5
Q

What is the biggest cause of lung cancer?

A

85% of cases are attributed to tobacco

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6
Q

What percentage of smokers get lung cancer?

A

10%

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7
Q

How does the risk of smokers getting lung cancer differ in the sexes?

A
  • Risk of cancer increased by 22x in males
  • Risk of cancer increased by 12x in females
  • However, females may be more susceptible per cigarette smoked
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8
Q

What is the risk of getting lung cancer related to in smoking?

A

Consumption- Inhalation and pack years

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9
Q

What risks does passive smoking pose?

A
  • 50-100% increased risk

- Causes at least 25% of non-smoking lung cancers

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10
Q

How many chemicals are in tobacco?

A

Over 4000

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11
Q

How many carcinogens are in tobacco?

A

60 recognised carcinogens

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12
Q

What are 2 major classes of chemicals in tobacco?

A
  • Polycyclic aromatic hydrocarbons

- N-nitrosamines

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13
Q

What are polycyclic aromatic hydrocarbons believed to be linked to?

A

Squamous small cell lung carcinoma

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14
Q

What are N-nitrosamines believed to be linked to?

A

Adenocarcinomas

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15
Q

What does tobacco smoke cause?

A
  • Epithelial effects
  • Multi-hit theory of carcinogenesis
  • Host activation of pro-carcinogens
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16
Q

What can inherited polymorphisms predispose?

A
  • Metabolism of pro-carcinogens

- Nicotine addiction

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17
Q

Where do adenocarcinomas normally from?

A

In the lung periphery when bronchioalveolar epithelial stem cells transform

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18
Q

Where do squamous cell carcinomas usually form?

A

In the central lung airways when bronchial epithelia stem cells transform

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19
Q

What are the states involved in the development of an invasive bronchogenic carcinoma?

A
  • Squamous dysplasia
  • Carcinoma-in-situ
  • Invasive bronchogenic carcinoma

Process strongly associated with smoking

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20
Q

What are the states involved in the development of an invasive adenocarcinoma?

A
  • Atypical adenomatous hyperplasia
  • Adenocarcinoma-in-situ
  • Invasive adenocarcinoma

Process associated with smoking, but also occurs in non-smokers

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21
Q

Slide 21

A

emailed lecturer

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22
Q

What tumours can occur in the lung?

A
  • Benign causes of mass lesion
  • Carcinoid tumour
  • Tumours of bronchial gland :VERY RARE
  • Lymphoma
  • Sarcoma
  • Metastases to lung are common
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23
Q

What could be a benign cause of mass lesion?

A

Fibrous tissue formed during pneumonia

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24
Q

What are examples of bronchial gland tumours?

A
  • Adenoid cystic carcinoma
  • Mucoepidermoid carcinoma
  • Benign adenoma
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25
Q

What are the 4 main types of carcinoma of the lung?

A
  • Adenocarcinoma
  • Squamous cell
  • Small cell carcinoma
  • Large cell carcinoma
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26
Q

What is bronchiolalveolar cell carcinoma now known as?

A
  • It was a subtype of adenocarcinoma

- Now called adenocarcinoma in situ

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27
Q

What are the 2 histological types of lung carcinoma?

A
  • Small cell carcinoma (SCLC)

- Non-small cell carcinomas (NSCLC)

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28
Q

What is included in NSCLC?

A
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell carcinoma
  • Others
29
Q

Why is the term NSCLC used in diagnosis?

A

Sometimes the term is used as we cannot distinguish between particular types of non-small cell carcinomas on small biopsy samples

30
Q

What is NSCLC not?

A

A single type of lung carcinoma

31
Q

What is NSCLC?

A

A group of very biologically different diseases which have to be treated in very different ways

32
Q

What is the main problem with primary lung cancer?

A

It grows clinically silent for many years and presents late in its natural history

33
Q

What is a very important symptom in lung cancers

A

Haemoptysis

34
Q

What are the local effects of lung cancer?

A
  • Bronchial obstruction
  • Pleural
  • Direct invasion
  • Lymph node metastasis
35
Q

What can cause bronchial obstruction in cancer?

A
  • Collapse
  • Endogenous lipoid pneumonia
  • Infection/abscess
  • Bronchiectasis
36
Q

What effects can cancer have on the pleura?

A
  • Inflammation

- Malignant

37
Q

What can be directly invaded in lung cancer?

A
  • The chest wall
  • Nerves
  • Mediastinum
38
Q

What nerves can be affected by direct invasion in cancer?

A
  • Phrenic: diaphragmatic paralysis
  • L recurrent laryngeal: hoarse, bovine cough
  • Brachial plexus: Pancoast T1 damage
  • Cervical sympathetic: Horner’s syndrome
39
Q

What can be affected by direct invasion in the mediastinum in cancer?

A
  • Superior vena cava

- Pericardium

40
Q

What can lymph node metastases lead to?

A
  • Mass effect

- Lymphangitis carcinomatosa

41
Q

Where can lung cancer metastasise to?

A
  • Liver
  • Adrenals
  • Bone
  • Brain
  • Skin
42
Q

What local effects can be secondary to lung cancer?

A
  • Neural

- Vascular

43
Q

What systems can non-metastatic paraneoplastic effects of lung cancer affect?

A
  • Skeletal
  • Endocrine
  • Neurological
  • Cutaneous
  • Haematological
  • Cardiovascular
  • Renal
44
Q

Non-metastatic paraneoplastic effects of lung cancer: Skeletal

A
  • Clubbing

- HPOA

45
Q

Non-metastatic paraneoplastic effects of lung cancer: Endocrine

A
  • ACTH, SIADH, PTH
  • Carcinoid syndrome
  • Gynecomastia
46
Q

Non-metastatic paraneoplastic effects of lung cancer: Neurological

A
  • Polyneuropathy
  • Encephalopathy
  • Cerebellar degeneration
  • Myasthenia
47
Q

Non-metastatic paraneoplastic effects of lung cancer: Cutaneous

A
  • Acanthosis nigricans

- Dermatomyositis

48
Q

Non-metastatic paraneoplastic effects of lung cancer: Haematological

A
  • Granulocytosis
  • Eosinophilia
  • DIC
49
Q

Non-metastatic paraneoplastic effects of lung cancer: Cardiovascular

A

-Thrombophlebitis migrans

50
Q

Non-metastatic paraneoplastic effects of lung cancer: Renal

A

Nephrotic syndrome

51
Q

What Non-metastatic paraneoplastic effect of lung cancer is associated with small cell carcinoma?

A

Release of ACTH and SIADH by the endocrine system

52
Q

What Non-metastatic paraneoplastic effect of lung cancer is associated with squamous cell carcinoma?

A

Release of PTH by the endocrine system

53
Q

What does release of PTH lead to?

A

Hypercalcaemia

54
Q

What does HPOA cause?

A

Sore ankles and wrists

55
Q

What investigations are often carried out with lung cancer?

A
  • Chest X-ray
  • Sputum cytology is rarely used
  • Bronchoscopy
  • Trans-thoracic fine needle aspiration
  • Trans-thoracic core biopsy
  • Pleural effusion
56
Q

What are the limitations of samples collected during investigations?

A

Often very small so not much material to work with

57
Q

What advance imaging techniques can be used in the investigation of lung cancer?

A
  • CT scanning
  • MRI
  • PET
  • Other imaging
58
Q

What type of bronchoscopies can be carried out?

A
  • Bronchial biopsy
  • Bronchial brushings and washings
  • Endobronchial US guided aspiration
59
Q

What prognostic factors are there in lung cancer?

A
  • Stage of disease

- Classification/ type of disease

60
Q

What might prognostic factors be used for in selection of patients?

A

To select patients for adjuvant therapy

61
Q

What is the prognosis for operable lung cancer?

A
  • Type I >60% 5YS

- Type II 35% 5YS

62
Q

What is the 5YS rate for Non-small cell carcinomas?

A
  • Anywhere between 10-25%

- Some cell types do badly

63
Q

What is the 5YS for small cell carcinoma?

A
  • 4%

- Medial survival 9 months

64
Q

After diagnosis is made what predictive factors can be used to select patients for therapy?

A

Predictive biomarkers:

  • Adenocarcinoma: EGFR, KRAS, HER2, BRAF mutations, ALK translocations
  • Squamous cell: FGFR1 gene copy number, DDR2 and FGFR2 mutations
65
Q

What do immune checkpoints do?

A

Control immune reactions

66
Q

How do tumours use immune checkpoints?

A

To avoid immune destruction

67
Q

What are examples of immune checkpoints?

A
  • PD1
  • PD-L1
  • CTLA4
68
Q

What are gaining use in cancers?

A

Drugs against immune checkpoints known as immune checkpoint inhibitors

01. Respiratory System - HP (82 decks)

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