Pathology of Lung Cancer Flashcards
1
Q
List the risk factors for lung cancer [7]
A
- Smoking (major)
- Ionising radiation - radon, uranium
- Air pollution
- Asbestos
- Other, e.g.
- Fibrosing conditions of lung
- Human papilloma virus (HPV)
- Hereditary (polymorphisms in cytochrome p450)
2
Q
What are the general symptoms of lung cancer? [8]
A
- Cough (that doesn’t go away or long-standing cough that gets worse)
- Haemoptysis
- Shortness of breath (can be due to lobar/lung collapse, particularly in patients with co-exisiting COPD)
- Chest and/or shoulder pain
- Unexplained weight loss/anorexia
- General malaise
- Recurrent infections
- Hoarse voice
3
Q
What are the clinical signs that may be associated with lung cancer? [7]
A
- Finger clubbing
- Signs of lobar collapse or a pleural effusion
- Stony dull percussion
- Reduced expansion
- Reduced breath sounds
- From metastases - hepatomegaly, cervical lymphadenopathy, bony tenderness
- Cachexia (muscle wasting)
4
Q
What are the common CXR changes that occur as a result of lung cancer? [5]
A
- Mass lesion
- Lobar or lung collapse
- Pleural effusion
- Mediastinal widening or hilar lymph nodes
- Slowly resolving consolidation
5
Q
What are the signs & symptoms specific to a…
- central lung cancer? [5]
- peripheral lung cancer? [2]
A
- Central
- Haemoptysis
- Bronchial obstruction
- Shortness of breath
- Retention pneumonia
- Cough
- Peripheral
- May have few symptoms
- Pain if pleura or chest wall is involved
6
Q
Where can lung cancer spread to locally and what can this result in? [6]
A
- Pleura
- Haemorrhagic effusion
- Hilar lymph nodes
- Adjacent lung tissue
- May involve large blood vessel leading to haemoptysis
- Pericardium
- Pericardial effusion with subsequent involvement of pericardium
- Mediastinum
- Superior vena caval obstruction
- Recurrent laryngeal nerve compression as it hooks under arch of the aorta and travels up side of larynx
- Phrenic nerve paralysis - hemidiaphragm paralysis
- Pancoast tumour
- Involvement of brachial plexus giving sensory and motor symptoms
- Horner’s syndrome/Oculosympathetic palsy (cervical sympathetic chain)
7
Q
What are the signs [3] and symptoms [4] of superior vena caval obstruction?
A
- Symptoms
- breathless,
- dysphagia,
- stridor,
- swollen oedematous face and right arm
- plethoric face - headache worse on stooping
- Signs
- venous congestion in the neck,
- dilated veins on chest wall and the arm
- raised JVP
8
Q
How do you treat superior vena caval obstruction? [4]
A
- high dose steroids,
- vascular stents,
- anti-coagulation,
- radiotherapy or chemotherapy
9
Q
How can phrenic nerve paralysis be seen on CXR and why does it present in this manner? [2]
A
- The diaphragm is controlled by the phrenic nerve so if the phrenic nerve gets infiltrated by a tumour, it leads to diaphragmatic paralysis
- This can be seen on CXR as the right hemidiaphragm going up
10
Q
What are the symptoms that arise as a result of a Pancoast tumour? [3]
A
- Severe pain in the shoulder or the scapula
- Pain in the arm and weakness of the hand on the affected side
- Horner’s syndrome (due to invasion of cervical sympathetic chain)
- Ptosis - drooping of upper eyelid
- Enophthalmos - posterior displacement of the eyeball within the orbit
- Miosis - constriction of the pupil
- Anhidrosis - loss of sweating on one side
11
Q
Where and how can lung cancer spread distally? [5]
A
- Haematogenous
- Common due to invasion of pulmonary veins
- It can spread by this method to several organs such as:
- Liver
- Bone
- Brain
- Adrenals
- Lymphatic
- To the cervical lymph nodes
12
Q
What are the non-metastatic effects of lung cancer? [9]
A
- ACTH secretion
- Adrenal hyperplasia → Raised blood cortisol → Cushing’s syndrome
- ADH secretion
- Retention of water → Dilutional hyponatraemia (SIADH)
- Parathyroid hormone related peptide (PTHrP) secretion
- Osteoclastic activity → Hypercalcaemia
- Encephalopathy
- Cerebellar degeneration
- Neuropathy
- Myopathy
- Eaton Lambert myasthenia-like syndrome
- Cancer associated retinopathy
13
Q
Lung cancer can be histologically classified into 2 groups. Name these 2 groups [2]
A
- small cell lung cancer
- non-small cell lung cancer
14
Q
Name the other types of lung cancer [5]
A
- Tumours of mesenchymal tissues
- Inflammatory myofibroblastic tumour
- Salivary gland-type tumours
- Adenoid cystic carcinoma
- Tumours of ectopic origin
- Germ cell tumours
- Tumours of neuroendocrine cells
- Carcinoid
- Tumours of the lymphatic system
- Lymphoma
15
Q
What investigations must be done for diagnosis and assessing fitness for treatment of lung cancer? [6]
A
- Routine bloods
- FBC,
- U&Es,
- LFTs,
- serum calcium,
- bone profile (check for possible metastases to bone resulting in hypercalcaemia)
- CRP
- CT chest and upper abdomen looking for:
- lymph nodes,
- evidence of liver or adrenal metastases
- Fine needle biopsy
- Bronchoscopy
- will detect more central lesions
- Full lung function tests
- If considering surgery (need an FEV1 >1.5L)
- ECG & Echo
- To investigate evidence of cardiac disease
16
Q
Describe the features of small cell carcinoma [8]
A
- Most aggressive form of lung cancer
- Metastasizes early and widely
- Often initial good response to chemotherapy - but most patients relapse
- Appearance
- small oval to spindle shaped epithelial cells
- ill-defined cell borders
- inconspicuous nucleoli
- scant cytoplasm
- high mitotic count
- nuclear moulding (more prominent in cytology)
17
Q
Name the 3 sub-types of non-small cell carcinoma [3]
A
- adenocarcinoma
- squamous cell carcinoma
- large cell carcinoma
18
Q
Describe the features of squamous cell carcinoma [7]
A
- Tend to arise centrally from major bronchi
- Often within dysplastic epithelium following squamous metaplasia
- Slow growing and metastasize late therefore may be good candidate for surgery
- May undergo cavitation
- May block bronchi leading to retention pneumonia or collapse
- Appearance
- A malignant epithelial tumour showing keratinization and/or intercellular bridges
- In situ squamous cell carcinoma may seen in the adjacent airway mucosa
19
Q
Describe the features of adenocarcinoma [5]
A
- Common tumour in females
- Also seen in non-smokers (but also associated with smoking)
- Two thirds arise in the periphery sometimes in relation to scarring
- Appearance
- Glandular, solid, papillary or lepidic
- Mucin production
20
Q
Describe the features of large cell carcinoma [3]
A
- A diagnosis of exclusion
- Usually arises centrally
- An undifferentiated malignant epithelial tumour that lacks the cytological features of SCLC and glandular or squamous differentiation
21
Q
Describe the features of carcinoid tumour [4]
A
- Tumour of neuroendocrine cells
- Central or peripheral
- Classified as typical or atypical
- Can metastasise but much better prognosis than other conventional lung cancers (5yrs for typical 85-90%; atypical 5yrs 50-75%)
22
Q
Describe the features of mesothelioma [4]
A
- Primary pleural tumour (also occurs in peritoneum, pericardium and tunica vaginalis testis)
- Almost always due to asbestos exposure
- Very long lag period before disease develops
- Tumour had either an epithelial or sarcomatoid appearance or a mixture of both (biphasic)
23
Q
What are the signs [1] and symptoms [2] of spinal cord compression?
A
- Symptoms
- leg weakness and numbness,
- reduced bladder and bowel control
- Signs
- upper motor neurone signs in legs at sensory level
24
Q
How do you treat spinal cord compression? [3]
A
- high dose steroids,
- urgent oncology input (radiotherapy) and/or neurosurgical input
