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2. Respiratory Medicine (Lectures) > Pathology of Lung Cancer > Flashcards

Pathology of Lung Cancer Flashcards

1
Q

What is the most common cancer to cause death?

A

Lung cancer

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2
Q

What is the aetiology of lung cancer?

A

Tobacco

Asbestos

Environmental radon

Other occupational exposure (chromates, hydrocarbons, nickel)

Air pollution and urban environment

Other radiation

Pulmonary fibrosis

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3
Q

What chemicals can lead to lung cancer?

A

Chromates

Hydrocarbons

Nickel

Asbestos

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4
Q

What percentage of lung cancer is due to smoking?

A

85%

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5
Q

What percentage of smokers get lung cancer?

A

10%

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6
Q

How does smoking affect the risk of getting lung cancer in males and females?

A

Males are 22x more at risk and females are 12x more at risk

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7
Q

What is the risk of smoking and causing lung cancer proportionate to?

A

Packs per day per year

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8
Q

How does passive smoke increase the risk of lung cancer?

A

50-100% increased risk

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9
Q

What percentage of non-smoking lung cancers does passive smoke cause?

A

25%

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10
Q

What is passive smoking?

A

Involuntary inhaling of smoke from other people’s cigarettes

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11
Q

How does stopping smoking change your risk of getting lung cancer?

A

Risk slowly decreases

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12
Q

What does abstinence mean?

A

Practice of restraining oneself from indulging in something

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13
Q

What percentage of males and females in the UK smoke?

A

33%

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14
Q

What percantage of males and females in the world smoke?

A

50% of men

12% of woman

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15
Q

What does tobacco smoke do that leads to lung cancer?

A

Epithelial effects

Multi-hit theory of carcinogenesis

Host activation of pro-carcinogens

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16
Q

What are the 2 main pathways of carcinogenesis in the lung?

A

Squamous cell carcinoma in the central lung airways

Adenocarcinoma in the lung periphery

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17
Q

Where does squamous cell carcinoma occur?

A

Central lung airways

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18
Q

Where does adenocarcinoma occur?

A

Lung periphery

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19
Q

What happens during adenocarcinoma?

A

Bronchioloalveolar epithelial stem cells transform

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20
Q

What happens during squamous cell carcinoma?

A

Bronchial epithelial stem cells transform

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21
Q

What is a squamous dysplasia becoming an invasive bronchogenic carcinoma strongly linked with?

A

Smoking

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22
Q

What are the key driver mutations for adenocarcinoma?

A

KRAS (35%)

EGFR (15%

BRAF, HER2 (1-2%)

ALK rearrangements (2%)

ROS1 gene rearrangements (1%)

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23
Q

What mutational driver for lung cancer is smoking induced?

A

KRAS

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24
Q

What mutations linked to adenocarcinomas has therapy been approved for targeting?

A

EGFR mutation

BRAF mutation

ALK rearrangement

ROS1 rearrangement

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25
What therpies that target mutations linked to squamous cell carcinomas has been approved?
Very few suitable targets Commonest alterations are inactivating mutations in tumour suppresor genes
26
What are some examples of tumours of the lungs\>
Benign causes of mass lesion Carcinoid tumour Tumours of bronchial glands Lymphoma Sarcoma
27
What is a carcinoid tumour?
One originating in the neuroendocrine system
28
What are tumours originating in the neuroendocrine system called?
Carcinoid tumours
29
What is the malignancy of carcinoid tumours?
Low grade malignancy
30
What percentage of lung neoplasms are carcinoid tumours?
\<5%
31
What are examples of tumours of the bronchial glands?
Adenoid cystic carcinoma Mucoepidermoid carcinoma Benign adenoma
32
How common are metastasis to the lung?
Common
33
What are the different kinds of lung cell carcinoma?
Squamous cell (40%) Adenocarcinoma (41%) Small cell carcinoma (15%) Large cell carcinoma (4%)
34
What percentage of lung carcinomas are squamous cells?
40%
35
What percentage of lung carcinomas are adenocarcinomas?
41%
36
What percentage of lung carcinomas are small cell carcinomas?
15%
37
What percentage of lung carcinomas are large cell carcinomas?
4%
38
What is bronchioloalveolar cell carcinoma subtype of?
Adenocarcinoma
39
What is bronchioloalveolar cell carcinoma also called?
Alveolar cell carcinoma Now called adenocarcinoma in situ
40
What does NSCLC stand up for?
Non-small cell carcinomas
41
What are examples of non-small cell carcinomas (NSCLC)?
Adenocarcinoma Squamous cell carcinoma Large cell carcinoma
42
How has the prevalance of squamous, small cell and adenocarinomas changed?
Squamous and small cell has plateued or fallen Adenocarcinomas has risen
43
What can be said about the years before a lung cancer diagnosis?
Lung cancer grows clinically silent for many years
44
When does a lung cancer clinically present in its history?
Late
45
What are the symptoms of lung cancer like as it progresses?
Initially may have few if any symptoms until the disease is very advanced
46
Generally speaking, what is symptomatic lung cancer?
Fatal
47
What local effects does lung cancer have?
Bronchial obstruction Pleural Direct invasion Lymph node metastasis
48
What effects may lung cancer have on bronchial obstruction?
Collapse Endogenous lipid pneumonia Infection/abscess Bronchiectasis
49
What effect may lung cancer have on the pleura?
Inflammatory Malignant
50
What may lung cancer directly invade?
Chest wall Nerves Mediastinum
51
What nerves may lung cancer directly invade?
Phrenic L recurrent laryngeal Brachial plexus Cervical sympathetic
52
What does lung cancer invading the phrenic nerve cause?
Diaphragmatic paralysis
53
What does lung cancer invading the L recurrent laryngeal nerve cause?
Hoarse Boving cough
54
What does lung cancer invading the brachial plexus cause?
Pancoast T1 damage
55
What does lung cancer invading the cervical sympathetic nerves cause?
Horner's syndrome
56
What effects can lung cancer have on lymph nodes?
Mass effect Lymphangitis carcinomatosa
57
What distant effects does lung cancer have?
Distant metastasis Secondary to local effects Non-metastatic effects
58
What distant metastasis can lung cancer cause?
Liver Adrenals Bone Brain Skin
59
What distant effects can be secondary to local effects?
Neural Vascular
60
What systems can lung cancer have non-metastatic effects on?
Skeletal Endocrine Neurological Cutaneous Haemoatologic Cardiovascular Renal
61
62
What are some examples of non-metastatic effects that lung cancer can have?
Finger clubbing Hypertrophic pulmonary osteoarthropathy (HPOA)
63
What investigations can be done for lung cancer?
Chest X-ray Sputum cytology rarely used Bronchoscopy Trans-thoracic fine needle aspiration Trans-thoracic core biopsy Pleural effusion cytology and biopsy Advanced imaging techniques
64
What are examples of advanced imaging techniques?
CT MRI PET
65
What are examples of bronchoscopy?
Bronchial biopsy Bronchial brushings and washings Endobronchial US-guided aspiration (EBUS)
66
What are prognostic factors in lung cancer?
Stage of disease Classification (type of disease) Markers/oncogenes/gene expression profiles Growth rate Cell proliferation DNA aneuploidy Immune cell infiltration
67
How would you describe the prognosis of lung cancer?
Generally terrible
68
What percentage of people with lung cancer surcive 5 years in Scotland?
\<9.8% (\>15% in USA)
69
What percentage of people with stage 1 lung cancer survive more than 5 years?
\>60%
70
What percentage of people with stage 2 lung cancer survive more than 5 years?
35%
71
In Scotland, what percentage of people with lung cancer get surgical treatment?
10-12%
72
What percentage of people with non-small cell carcinomas survive more than 5 years?
10-25% (some types do badly)
73
What percentage of people with small cell carcinoma survive more than 5 years?
4%
74
What is the median survival time for people with small cell carinomas?
9 months
75
Do non-small cell or small cell carinomas have a better prognosis?
Non-small cell carinomas
76
What can be used after the diagnosis to select patients for therapy?
Predictive biomarkers
77
What has transormed practice in non-small cell carcinomas?
Immunotherapy
78
What does immunotherapy do?
Target immune checkpoints such as PD1/PD-L1 in NSCLC
79
What immune checkpoint is targeted in non-small cell carcinomas?
PD1/PD-L1
80
What do immune checkpoints do?
Control immune reactions
81
What can tumours do to immune checkpoints?
Adapt them to avoid immune destruction
82
What can target immune checkpoints to help treat cancer?
Immune checkpoint inhibitors

2. Respiratory Medicine (Lectures) (50 decks)

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