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Respiratory: Lung cancer > Pathology > Flashcards

Pathology Flashcards

1
Q

what are the three types of tumours?

A
  • 4 common smoking associated types
  • neuroendocrine tumours
  • bronchial gland tumours
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2
Q

what are the 4 types of smoking associated?

A
  • adenocarcinoma
    small cell
    large cell
    squamous
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3
Q

what is the most common one?

A

adenocarcinoma- it is common in non-smokers too

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4
Q

what does adenocarcinoma often cause on CXR/CT?

A

peripheral lesions

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5
Q

how does adenocarcinoma arise?

A

from mucus secreting glandular cells

it metastasises widely

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6
Q

how does squamous carcinoma arise?

A

from epithelial cells

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7
Q

what are some characteristics of sqaumous carcinoma?

A

local, slow metastasis

hypercalcaemia

PTH

produces keratin pearls

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8
Q

what problems are often related to squamous ?

A

bronchiectasis and obstructive pneumonia as the tumour is often centrally located

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9
Q

how does small cell arise?

A

from APUD cells- these are A GROUP OF unrelated endocrine cells
they secrete ACTH

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10
Q

where is small cell often located?

A

centrally

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11
Q

on CXR/CT what may be seen with small cell?

A

hilar mass with extension onto lymph nodes

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12
Q

what are some features of small cell

A

its hard to treat because of rapid metastasis

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13
Q

what is seen on a slide for small cell?

A

not much cytoplasm and lots of nuclei. The nuclei look like lymphocytes so it can be confused with lymphoma

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14
Q

what are some characteristics of large cell carcinoma?

A

pooorly differentiated

metastasis early on

Necrosis and haemorrhage are frequent and there may be acute and/or chronic inflammation. They form large necrotic masses

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15
Q

what is shown on slides for large cell?

A

it consists of sheets and nests of large cells with prominent vesicular nuclei and nucleoli

The cell borders are easily vascularised.

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16
Q

what may happen to the pleura in large cell?

A

the large necrotic masses frequently invade the overlying pleura and grow into adjacent structures

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17
Q

what is the pathophysiology of bronchial tumours - i.e. tumours of the lung ?

A
  1. squamous metaplasia
  2. dysplasia
  3. carcinoma in situ
  4. invasive malignancy
18
Q

what happens in peripheral adenocarcinoma

A

spread of neoplastic cells along alveolar walls (bronchioalveolar carcinoma) without invading underlying stroma.

19
Q

what are some examples of other lung neoplasms?

A

carcinoid

bronchial gland neoplasms (tumours often seen in salivary glands)

20
Q

what are two bronchial gland neoplasms

A
  • adenoid cystic carcinoma

- mucoepidermoid carcinoma

21
Q

what are carcinoid neoplasms?

A

neuroendocrine neoplasms of low grade malignancy and they tend to occur in younger patients

22
Q

what are the pleural neoplasia kinds?

A

benign tumours are rare

the primary malignant neoplasms - mesothelioma

the pleura is a very common site of invasion of lung carcinomas and metastatic cancers

23
Q

what would mesothelioma look like on CXR?

A

usually unilateral, starting as small nodules over the visceral pleura and extending to cover the entire lung

24
Q

which cancer has the worst and best prognosis ?

A

small cell is the worst

large cell worse than squamous or adenocarcinoma

squamous worse than adenocarcinoma

25
Q

why is classification important?

A

for treatment purposes

  • small cell known to be chemosensitive but with rapidly emerging resistance
  • surgery is the treatment in other types
26
Q

for which cancer is pemetrexed contraindicated?

A

squamous carcinoma

27
Q

why is classification also quite difficult?

A

because its hard to subtype tumours on small biopsies

28
Q

how is immunochemistry often used to help classify biopsies?

A

in adenocarcinoma - expresses TTF (thyroid transcription factor ) 1

small cell carcinoma expresses nuclear antigen p63 and high molecular weight cytokeratins

29
Q

what else is used to classify biopsies?

A

molecular genetic abnormalities

30
Q

what oncogenes and tumour suppressor genes are expressed in SCLC?

A

oncogenes- myc

tumour suppressor genes - p53, Rb, 3p

31
Q

what oncogenes and tumour suppressor genes are expressed in NSCLC?

A

oncogenes - myc, K-ras, her2 (neu)

tumour suppressor genes - p53, 1q, 3p, 9p, 11p, Rb

32
Q

Molecular pathology and targeted treatment - Adenocarcinoma

A

specific point mutations render the EGFR gene active in the absence of ligand (epidermal growth factor) binding

these mutations can be identified in DNA extracted from biopsy or cytology samples

mutations seen almost exclusively in adenocarcinoma (esp. non-smokers and asian populations)

these tumours respond to tyrosine kinase inhibitors (erlotinib)

EML4-ALK fusion oncogene also identifies a target for specific drug treatment (crizotinib)

33
Q

how are tumours classified?

A

TNM scale

34
Q

what does T stand for?

A

primary tumour 

35
Q

what does N stand for?

A

regional nodes

36
Q

what does M stand for?

A

distant metastasis

37
Q

what markers are in stage 1 ?

A
  • carcinoma insitu/ ≤3cm, in lobar or more distal airway/>3cm and >2cm distal to carina or any size if pleural involvement or obstructive pneumonitis extending to hilum, but not all the lung

N0- None involved (after mediastinoscopy)

M0- none

38
Q

what markers are in stage 2 ?

A

≤3cm, in lobar or more distal airway/>3cm and >2cm distal to carina or any size if pleural involvement or obstructive pneumonitis extending to hilum, but not all the lung

N1 Peribronchial and/or ipsilateral hilum

M0 none

39
Q

what are the markers in stage 3a?

A

Involves the chest wall, diaphragm, mediastinal pleura, pericardium, or 7cm diameter and nodules in same lobe

n1- Peribronchial and/or ipsilateral hilum

M0

or T1-3 N2 M0

40
Q

what are the markers in stage 3b?

A

T1-4
T1 ≤3cm, in lobar or more distal airway

T2 >3cm and >2cm distal to carina or any size if pleural involvement or obstructive pneumonitis extending to hilum, but not all the lung

T3 Involves the chest wall, diaphragm, mediastinal pleura, pericardium, or 7cm diameter and nodules in same lobe

T4 Involves mediastinum, heart, great vessels, trachea, oesophagus, verte- bral body, carina, malignant effusion, or nodules in another lobe

N3 Contralateral mediastinum or hilum, scalene, or supraclavicular

M0

Respiratory: Lung cancer (4 decks)

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