Pathology of Lung Cancer

Question 1

What is the number one cause of cancer related deaths?

Answer 1

Lung cancer

bet you’d never have guessed that

Question 2

What is the biggest cause of lung cancer?

Answer 2

Tobacco

Question 3

After tobacco, what are the three highest causes of lung cancer?

Answer 3

1. Asbestos
2. Environmental radon (from natural uranium bearing rocks, like granite)
3. Air pollution/ urban environment

Question 4

What % of lung cancer seen is due to smoking.

Answer 4

85%

Question 5

Out of ten people how many develop lung cancer?

Answer 5

1 in 10

Question 6

Even if you don’t smoke, why may you develop smoking related lung cancer?

Answer 6

Prolonged inhalation of smoke fumes

Question 7

Describe what happens when a person stops smoking.

Answer 7

Risks of lung cancer reduce but gradually and slowly.
There will be persisting genomic damage

Question 8

Name the two groups of chemicals found in cigarettes

Answer 8

Polycyclic aromatic hydrocarbons
N-nitrosamines

Question 9

Name the two groups of carcinogenesis in lung cancer.

Answer 9

Adenocarcinoma
Squamous cell carcinoma

Question 10

How does tobacco smoke effect the epithelium?

Answer 10

It damages airway epithelial cells, causing inflammation and increasing the risk of lung cancer.

Question 11

Which process can smoking increase?

Answer 11

Carcinogenesis

Question 12

What can tobacco smoke activate?

Answer 12

Pro-carcinogens

Question 13

Where do adenocarcinomas form in the lungs?

Answer 13

Around the periphery

Question 14

Describe the development of an adenocarcinoma in the lungs.

Answer 14

Atypical Adenomatous hyperplasia

(
v

Adenocarcinoma in Situ

(
v

Invasive adenocarcinoma

Question 15

What type of cell transform in the lungs in the formation of an adenocarcinoma?

Answer 15

Bronchioloalveolar epithelial stem cells

Question 16

Where can a squamous cell carcinoma form?

Answer 16

Central lung airways

Question 17

Describe the development of a squamous cell carcinoma in the lungs.

Answer 17

Bronchial basal cell hyperplasia

(
v

Squamous dysplasia and carcinoma in situ

(
v

Invasive squamous cell carcinoma

Question 18

What type of cell transforms to form a squamous cell carcinoma?

Answer 18

Bronchial epithelial stem cells

Question 19

List some of the possible tumours in the lungs.

Answer 19

Carcinoid Tumour
Benign causes of mass lesion
Lymphoma
Sarcoma
Tumours of Bronchial Glands
Metastases

Question 20

Which tumour is very rare in the lungs but can still happen?

Answer 20

Tumours of Bronchial Glands

Question 21

Define carcinoma

Answer 21

Cancer in the epithelium tissue.

Question 22

Name the four main subdivions of carcinoma.

Answer 22

Squamous Cell
Adenocarcinoma
Small Cell Carcinoma
Large Cell Carcinoma

Question 23

Name the two main subdivions of histological types of lung carcinoma

Answer 23

Small cell carcinoma
Non-small cell carcinomas

Question 24

Name some of the carcinoma’s in the division of NSCLC.

Answer 24

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinomas
Others

Question 25

Describe symptoms for primary lung cancer

Answer 25

Kind of a trick question Often 'silent' -> no symptoms Symptoms develop late into the development

Question 26

If someone shows symptoms of lung cancer, what does this suggest?

Answer 26

That's it's potentially fatal

Question 27

How is lung cancer usually discovered?

Answer 27

Accidently while carrying out other investigations like chest x-rays etc.

Question 28

Describe what you might see on an x-ray of someone with squamous cell carcinoma?

Answer 28

Lots of holes as tumour usually causes lots of cavities

Question 29

Name one red-flag symptom which suggest lung cancer.

Answer 29

Haemoptysis

Question 30

What are some of the local effects of bronchial obstruction?

Answer 30

Bronchial collapse Endogenous Lipoid Pneumonia Infection / Abscess Bronchiectasis

Question 31

What happens when a tumour involves the pleura?

Answer 31

If a tumour invades the pleura, the pleura can come distorted and the tumour can go through it and into the chest wall

Question 32

What is the result of lung cancer impacting the phrenic nerve?

Answer 32

Diaphragmatic paralysis

Question 33

What is the result of lung cancer impacting L Recurrent laryngeal nerve?

Answer 33

Hoarse, bovine* cough *non- explosive cough of someone unable to close their glotti

Question 34

What is the result of lung cancer impacting the brachial plexus?

Answer 34

Pancoast T1 damage

Question 35

What is the result of lung cancer impacting the Cervical Sympathetic nerve?

Answer 35

Horner's syndrome

Question 36

What is Lymphangitis carcinomatosa?

Answer 36

Inflammation of the lymph nodes caused by a mallignancy

Question 37

List some distant places lung cancer can metastasise to.

Answer 37

Liver, Adrenals*, Bone, Brain, Skin *glands located at the top of the kidneys

Question 38

List the possible skeletal impacts of lung cancer.

Answer 38

Clubbing HPOA* *Hypertrophic pulmonary osteoarthropathy

Question 39

List the possible endocrine effects of lung cancer.

Answer 39

ACTH, SIADH, PTH Carcinoid syndrome Gynecomastia* *increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone

Question 40

List the possible neurological effects of lung cancer.

Answer 40

Polyneuropathy* Encephalopathy** Cerebellar degeneration Myasthenia (Eaton-Lambert) *malfunction of many nerves around the body **functioning of brain is affected ***neuromuscular disease

Question 41

List the possible cutaneous (skin) effects of lung cancer.

Answer 41

Acanthosis nigricans* Dermatomyositis** *dry patches of skin usually armpit groin area **condition which causes muscle weakness and skin rash

Question 42

List the possible haematologic effects of lung cancer.

Answer 42

Granulocytosis Eosinophilia DIC

Question 43

List the possible cardiovascular effects of lung cancer.

Answer 43

Thrombophlebitis migrans

Question 44

List the possible renal effects of lung cancer.

Answer 44

Nephrotic syndrome

Question 45

In terms of endocrine complications due to lung disease, what type of carcinoma causes ACTH and SIADH?

Answer 45

Small cell

Question 46

In terms of endocrine complications due to lung disease, what type of carcinoma causes PTH?

Answer 46

Squamous

Question 47

List some investigations used for the diagnosis of lung cancer

Answer 47

Chest X-Ray Bronchoscopy Trans-thoracic Fine Needle Aspiration Trans-thoracic Core Biopsy Pleural effusion cytology and Biopsy CT MRI PET

Question 48

Name the common way top stage lung cancer.

Answer 48

TMN Tumour Node Metastsis

Question 49

How do tumours evade immune responses?

Answer 49

They inhibit immune checkpoints

Question 50

What type of therapeutic treatment is being used more to try and fight lung cancer?

Answer 50

Immune checkpoint inhibitors