pathology of lung cancer Flashcards
what are the effects of tobacco smoke
epithelial effects
multi-hit theory of carcinogenesis
host activation of pro carcinogens
- inherited polymorphisms predispose
- metabolism of pro-carcinogens
- nicotine addictionwhat are the two main pathways of carcinogenesis in the lung
in the lung periphery
- bronchioalveolar epithelual stem cells transform
- adenocarcinoma
atypical adenomatoys hyperplasia - adenocarcinoma in situ- invasive adenocarcinoma
in the central lung airways
- bronchial epithelial stem cells transform
- squamous cell carcinoma
bronchial basal cell hyperplasia — squamous dysplasia and carcinoma in situ — invasive squamous cell carcinoma
what are the diff types of tumours of the lung
benign causes of mass lesion carcinoid tumour - <5% of lung neoplasms - low grade malignancy tumours of bronchial glands : very rare - adenoid cystic carcinoma -mucoepidermoid carcinoma - benign adenoma lymphoma sarcoma métastases to lung
what percentage is there of each lung cancer type
squamous cell - 40%
adenocarcinoma - 41%
small cell - 15%
large cell - 4%
what are features of primary lung cancer
probably clinically silent for many years
presents late in history
may have few is any signs or symptoms until disease is very advanced
may be found incidentally, during investigation for somthing unrelated
what are some local effects of lung cancer
bronchial obstruction
pleural
direct invasion
lymph node metastasis
what does bronchial obstruction lead to
collapse
endogenous lipoid pneumonia
infection/abscess
bronchiectasis
what does happens to the pleura
inflammation
malignant
where would be invaded
the chest wall
nerves - phrenic - diaphragmatic paralysis
- l recurrent laryngeal - hoarse, bovine cough
- brachial plexus - pancoast t1 damage
- cervical sympathetic - hornets syndrome
what does lymph node metastases lead to
mass effects
lymphangitis carcinomatosa
what are the distant effects of lung cancer
distant metastases - liver, adrenals, bone, brain, skin
secondary to local effects: neural, vascular
non metastatic effects
what are non metastatic paraneoplastic effects of lung cancer
skeletal
- clubbing
- HPOA
cutaneous
- dernatomyositis
endocrine
- ACTH. siADH, PTH
- carcinoid syndrome
haematological
- granukocytkdid
- eosinophilia
neurological
- polyneuropathy
- encephalopathy
cardio
- thrombophlebitis migrans
renal
- nephrotic syndrome
what are investigations for lung cancer
chest x-ray sputum cytology rarely used bronchoscopy - bronchial biopsy, EBUS etc trans thoracic fine needle aspiration transthoracuc core biopsy pleural effusion cytology and biopsy advanced imagine - CT, MRI, PET
what are the genes from adenocarcinogenesis
KRAS EGFR BRAF HER2 ALK ROS1
what is used to select patients for therapy
predictive bio markers
