Pathology of lung cancer

Question 1

which type of cancer is the most common cause of death worldwide (out of all other cancers)

Answer 1

lung cancer

Question 2

main cause of lung cancer

Answer 2

tobacco smoke HOWEVER not everyone that smokes get lung cancer and just because they do it doesn’t mean that smoking is the cause

Question 3

true or false: there is a gradual decline in lung cancer incidences

Answer 3

TRUE due to decrease in men having lung cancer. Pretty much the same for women though

Question 4

Cure rate for lung cancer

Answer 4

under 10%

Question 5

Causes of lung cancer (6)

Answer 5

tobacco 
asbestos
environmental radon
other occupational exposure
air pollution and urban environment
pulmonary fibrosis 
passive smoking

Question 6

what is environmental radon

Answer 6

radon is naturally occuring

comes about from radioactive decay of other radioactive isotopes in naturally occurring rock like granite

Question 7

what happens if you stop smoking?

Answer 7

your risk decreases but VERY slowly… >15 years and even still may not be enough

Question 8

N-nitrosamines give rise to which type of cancer

Answer 8

adenocarcinomas

Question 9

occupational exposure to polycyclic aromatic hydrocarbons (PAH) give rise to which type of cancer?

Answer 9

squamous SCC

Question 10

N-nitrosamines modern day cigarettes

Answer 10

more common in modern cigarettes

and these modern cigarettes have caused a shift in the types of cancers present now compared to in the past

Question 11

in order to develop lung cancer from smoking you most likely need to have had at least one of which 3 things?

Answer 11

epithelial effects

multi-hit ie a number of genetic alterations - in a sequence

inherited genetic polymorphisms that increase chance of lung cancer

Question 12

what are the two main pathways of carcinogenesis in the lungs

Answer 12

in the lung periphery - bronchioloalveolar epithelial stem cells transform - adenocarcinoma

in the central lung airways - bronchial epithelial stem cells transform - squamous cell carcinoma

Question 13

what are the 4 main cell type in lung cancers

Answer 13

most common are:-
Squamous Cell
Adenocarcinoma

less common:-
Small Cell Carcinoma
Large Cell Carcinoma

Question 14

primary lung cancer and detection of symptoms

Answer 14

presents LATE in its natural history
as can grow ‘clinically silent’ for many years

symptomatic lung cancer is fatal- by the time it shows symptoms, cannot be cured

Question 15

how can tumours be undetected in CT or scan?

Answer 15

sometimes they can grow behind the heart

Question 16

why might you get haemoptysis or internal bleeding in tumours that grow into central bronchi

Answer 16

may be bleeding as it ulcerates into the airway

Question 17

local effects of lung cancer (7)

Answer 17

Bronchial Obstruction : 
Collapse						      	      	       
Endogenous Lipoid Pneumonia
Infection / Abscess						
Bronchiectasis 
Direct invasion - chest wall
pleural - inflammatory or malignant (if in periphery)

Question 18

what is bronchiectasis?

Answer 18

a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

Question 19

what local neural effects can lung cancer have if it spreads further into the mediastinum (4)

Answer 19

• Phrenic – diaphragmatic paralysis
• L Recurrent laryngeal (Hoarse, Bovine cough)
• Brachial plexus- neurological conditions in hands
• Cervical Sympathetic (in neck) - Horner’s syndrome - damage to the sympathetic nerves of the face

Question 20

signs of Horner’s syndrome

Answer 20

unresponsive pupil
drooping of upper eyelids
absence of facial sweating

Question 21

lymph node metastases

Answer 21

spreads into mediastinum and can then spread elsewhere

Question 22

most common place in the body that lung cancer lymph node metastases spreads to

Answer 22

neck

Question 23

other distant metastases of lung cancer

Answer 23

Liver 
adrenals
bone 
brain 
skin

Question 24

what signs do you look for in the hands for lung cancer

Answer 24

finger clubbing

Question 25

what is TNM staging

Answer 25

the staging mechanism in place to stage tumour growth

Question 26

how many stages are there in TNM

Answer 26

stages 1-4

treatment depends on which stage

Question 27

when is PET scan used

Answer 27

patients who are in stage`1 or 2 (localised cancer of the lung- only spread to 1 side of the lymph glands) are offered surgery to remove tumour
but before they go for surgery they have a PET scan done

Question 28

what happens in PET scan

Answer 28

Inject glucose tag with radioactive element in PET scan

tumour- very metabolically active, glucose dye shows up

Question 29

management/ treatment options

Answer 29

Performance status
Patient wishes
Histological type and
stage
Multidisciplinary team meeting
Aims of treatment e.g.
radical or palliative

Question 30

radical radiotherapy means?

Answer 30

treatment with the intention to cure

radiotherapy, surgery

Question 31

main types of lung cancer names

Answer 31

carcinoma of the bronchus (most common) cigarette smoke biggest cause also asbestos, radiation etc

bronchial adenoma - rare, mainly carcinoid tumours (slow growing)

malignant mesothelioma - rare, cancer in the lining of the lung (pleura). Associated with asbestos exposure

Question 32

if you have never smoked and get lung cancer then it is extremely likely that it will be what type of lung cancer?

Answer 32

adenocarcinoma

Question 33

What are the 2 main types of lung cancer?

Answer 33

non-small cell carcinoma

small cell carcinoma

Question 34

non-small cell carcinoma covers which cell types?

Answer 34

adenocarcinomas
squamous cell carcinoma
large cell carcinoma

Question 35

what is oncogene addiction?

Answer 35

growth of cancer at molecular level is driven by an abnormality in one particular gene. Not to say there aren’t others. Growth is driven by intercellular signaling of one gene

If you can identify this gene and you can target the protein that is making that then you can have a better treatment

these abnormalities are independent of tobacco carcinogens

Question 36

Oncogene targets for adenocarcinoma therapy

Answer 36

EGFR mutation
ALK rearrangement
ROS1 rearrangement
BRAF mutation

Question 37

oncogene addiction is virtually never present in which type of lung cancer

Answer 37

squamous cell carcinomas

Very few suitable targets – very few addictive oncogenes

Question 38

Bronchioloalveolar cell carcinoma can also be called what?

Answer 38

adenocarcinoma in situ