Pathology of Lung Cancer Flashcards
What is the most common aetiology of lung cancer?
TOBACCO (duh)
What is the second most common cause of lung cancer?
Asbestos
What is the third most common cause of lung cancer?
Environmental radon
What are the two main pathways for carcinogenesis in the lung?
In the lung periphery=Adenocarcinoma
In the central lung airways = Squamous cell carcinoma
What type of cell is found in lung periphery?
Bronchioloalveolar epithelilal stem cells
What type of cell is found in the central lung airway?
Bronchial epithelial stem cells
Describe the evolution of bronchogenic Carcinoma
- Squamous Dysplasia to
- Carcinoma (In situ) to
- Invasive bronchogenic carcinoma
Describe the evoltution of Adenocarcinoma
Aytpical Adenomatous Hyperplasia (AAH) to
- Adenocarcinoma in situ to
- Invasive Adenocarcinoma
Name the key driver mutations of adenocarcinogenesis and the % of cases.
-KRAS (35%)-Smoking induced
-EGRF (15%)
-BRAF, HER2 (2%)
ALK rearrangements (2%)
What is a benign mass of cartilage
Chondroma
What are the four main types of lung carcinoma?
Squamous Cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
What is NSCLC?
Non-small cell carcinomas = A GROUP OF LUNG CARCINOMAS
What is a pneumonectomy?
Removal of lung
What are the local effects of lung cancer?
- Bronchial Obstruction
- Pleural
- Direct invasion
- Lymph Node Metastases
Describe how the Bronchi/bronchioles can be obstructed?
- Collapse
- Endogenous Lipoid pneumonia
- Bronchiectasis
What happens during endogenous lipoid pneumonia?
Normal cells cannot be removed to due tumour blocking bronchiole. Muco ciliary elevator blocked. Build up of lung debris mostly made of lipids.
What happened to pleura form local effects of cancer?
- Inflammation
- Malignant (worse)
What happens if direct invasion happens?
-Chest walls
-Nerves
Mediastinum
What nerves are often affected by direct invasion and what is the outcome of this?
- Phrenic=diaphragmatic paralysis
- L Recurrent Laryngeal= Hoarse, Bovine cough
- Brachial Plexus= pancoast T1 damage
- Cervical sympathetic- Horners syndrome
What causes Horners syndrome?
Sympathetic ganglion had been destroyed
Symptoms of Horners?
Lid lag
Veins will not drain
What are the locations of distant metastases?
- Liver
- Adrenals
- Bone
- Brain
- Skin
What are the non- metastatic paraneoplastic effects of Lung cancer?
Skeletal Endocrine Neurological Cutaneous Haematological Cardiovascular Renal
Describe the skeletal affects of lung cancer?
- Clubbing
- (Hypertrophic pulmonary osteoarthropathy (HPOA)
Describe the Neurological affects of lung cancer?
- Polyneuropathy
- Encephalopathy
- Cerebellar degeneration
- Myasthenia
Describe the Cutaneous affects of lung cancer?
- Acanthosis nigricans
- Dermatomyositis
Describe the haematologic affects of lung cancer?
- Granulocytosis
- Eosinophilia
- DIC
Describe the cardiovascular affects of lung cancer?
-Thrombophlebitis migrans
Describe the renal affects of lung cancer?
-Nephrotic syndrome
Describe the Endocrine affects of lung cancer?
- ACTH (molecule similar in shape produced can lead to cushings disease)
- siADH (lead to diabetes)
- PTH ( hyper calcaemia)
- Carcinoid syndrome
- Gynecomastia
What are the investigations used to diagnosis lung cancer?
- Chest X-ray
- Sputum cytology (rarely)
- Bronchoscopy
- Trans-thoracic Fine needle aspiration
- Trans-thoracic Core biopsy
- Pleural effusion
- Advanced imaging
What types of bronchoscopy are available?
- Bronchial biopsy
- Bronchial brushings and Washings
- Endobronchial US-Guided aspiration
What are the predictive factors for Adenocarcinoma?
EGFR, KRAS,HER2, BRAF
ALK Translocation
What are the predictive factors for squamous cells?
FGFR1 gene copy number, DDR2 & FGFR2 mutations
What immune check point do most drugs act upon in fighting cancer?
Drugs prevent PD-L1 reaction taking place.
