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Respiratory system > Pathology of lung cancer > Flashcards

Pathology of lung cancer Flashcards

1
Q

what is the most common cause of cancer-related death?

A

lung cancer

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2
Q

what is the eading cause of lung cancer?

A

tobacco

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3
Q

what is the second most common cause of lung cancer?

A

asbestos

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4
Q

what are some other causes of cancer apart from tobacco and asbestos?

A
  • Environmental radon
  • Other occupational eg. exposure, chromates, hydrocarbons, nickel
  • Air pollution and Urban environment
  • Other radiation
  • Pulmonary fibrosis
  • (passive smoking)
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5
Q

what are the two important groups of compounds in cigarettes that are thought to cause lung cancer?

A
  • ploycyclic aromatic hydrocarbons

- N-nitrosamine

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6
Q

what type of lung cancer are the N-nitrosamines thought to cause?

A

adenocarcinomas in the periphery of the lungs

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7
Q

what type of lung cancer are the poly cyclic hydrocarbons thought to cause?

A

squamous cell carcinoma

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8
Q

what is the multi-hit theory of carcinogenesis in lung cancer?

A

about 3-6 “hits” are required before a cancer forms. these mutations to important genes must be in the correct order too

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9
Q

how may genetics affect the likelyhood of cancer forming?

A
  • people may have polymorphisms that allow them to metabolise pro-carcinogens
  • or may be more easily addicted to nicotine
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10
Q

what sort of cells are the target for carcinogens?

A

stem cells

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11
Q

which type of lung cancer is usually found in non-smokers?

A

peripheral lung adenocarcinoma

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12
Q

what is the most common driver mutation in lung cancer?

A

KRAS

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13
Q

give an example of a driver mutation which is smoking induced?

A

KRAS

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14
Q

which driver mutations are not smoking induced?

A

EGFR
BRAF
HER2
ALK rearrangements

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15
Q

what is an addictive oncogene?

A

an oncogene that when inactivated will stop the growth of the cancer

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16
Q

what is important about addictive oncogenes in terms of treatment?

A

may allow molecular target therapy to inactivate this gene and stop the cancer from spreading

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17
Q

give an example of a cause of a benign mass lesion in the lung?

A

pneumonia

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18
Q

give some examples of some tumours in the lung which arent lung cancer

A
  • carcinoid tumour
  • tumour of bronchial glands
  • lymphoma
  • sarcoma
  • metastases
19
Q

why are metastases so common in the lung?

A

all the blood in the body passes through them so a cancer can easily metastasise through the blood

20
Q

what are the 4 main types of lung cancer?

A

squamous cell
adenocarcinoma
small cell carcinoma
large cell carcinoma

21
Q

historically what types of lung cancer were grouped together as non-small cell carcinomas

A

any cancers that are not small cell carcinoma.

  • adenocarcinoma
  • squamous cell carcinoma
  • large cell carcinoma
  • others
22
Q

by the time that lung cancer becomes symptomatic is it possible to be treated completely?

A

no, symptomatic lung cancer is usually fatal

23
Q

what are the local effects of lung cancer in terms of bronchial obstruction?

A
  • collapse
  • endogenous lipoid pneumonia
  • infection/abscess
  • bronchiectasis
24
Q

what is endogenous lipoid pneumonia?

A

cancer stops muco-ciliary escalator and mucous and macrophages build up below the cancer

25
Q

what are the local effects of lung cancer in terms of pleura?

A
  • inflammation of the pleura (pleurisy)

- malignant spread to the pleura

26
Q

what are the local effects of lung cancer in terms of direct invasion?

A
  • invasion of the chest wall
  • invasion of the mediastinum (superior vena cava, pericardium
  • invasion of nerves eg. phrenic, left recurrent plexus, brachial plexus, cervical sympathetic
27
Q

if lung cancer spreads to the phrenic nerve what happens?

A

diaphragmatic paralysis

28
Q

if lung cancer spreads to the left recurrent laryngeal nerve what happens?

A

hoarse, bovine cough (not sudden exhalation)

29
Q

if lung cancer spreads to the brachial plexus what happens?

A

Pancoast T1 damage,

pain and weakness in the muscles of the arm and hand

30
Q

if lung cancer spreads to the cervical sympathetic nerve what happens?

A

Horner’s syndrome.

constriction of one eye, loss of sweating on one side of the face, dropping of one eyelid

31
Q

what are the effects of a lung cancer on lymph nodes?

A
  • mass effect, many lymph nodes cancerous

- lymphangitis carcinomatosa- interstitial cancer of lymph drainage of lungs, it blocks this drainage blocks it.

32
Q

what are the distant effects of lung cancer?

A

distant metastases in liver, adrenals, bone, brain, skin.
secomdary to local effects: neural or vascular.
non-metastatic effects- eg. hormone production, fnger clubbing and hypertrophic pulmonary osteoarthropathy- inflammation of periosteum

33
Q

what are some investigations carried out to diagnose lung cancer?

A
  • chest x-ray
  • sputum cytology (examining sputum for cells) (rarely used)
  • bronchoscopy (bronchial biopsy, brushings and washings and endobronchial US-guided aspiration)
  • trans-thoracic fine needle aspiration
  • trans-thoracic core biopsy
  • pleural effusion
  • advanced imaging techniques (CT, MRI, PET)
34
Q

what determines the prognosis of Lung cancer?

A
  • stage of disease
  • classification: type of disease
  • markers, oncogenes, gene expression profiles.
35
Q

what is the five year survival rate of lung cancer patients?

A

<9.8% in scotland

36
Q

what is the 5 year survival rate in patients with operable stage I lung cancer?

A

> 60%

37
Q

what is the 5 year survival rate in patients with operable stage II lung cancer?

A

35%

38
Q

what is the 5 year survival rate of patients with non-small cell carcinomas?

A

10-15%

39
Q

what is the 5 year survival rate of patients with small cell carcinomas?

A

4%

median survival 9 months

40
Q

what will help select a patient’s therapy after a diagnosis has been made?

A

predictive biomarkers

41
Q

which predictive biomarkers will help decide the treatment of patients with adenocarcinoma?

A

EGFR, HER2, KRAS, BRAF

ALK translocation, ROS1 translocations

42
Q

which predictive biomarkers will help decide the treatment of patients with squamous cell carcinoma?

A

very few as very little effective molecular targeted therapy

43
Q

which type of lug cancer can immunotherapy be used to treat?

A

non-small cell lung cancer

Respiratory system (38 decks)

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