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RC-Respiratory illnesses > Pathology of Lung Cancer > Flashcards

Pathology of Lung Cancer Flashcards

1
Q

What is the most common cancer to cause death?

A

Lung cancer

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2
Q

What is the aetiology of lung cancer?

A

Tobacco

Asbestos

Environmental radon

Other occupational exposure (chromates, hydrocarbons, nickel)

Air pollution and urban environment

Other radiation

Pulmonary fibrosis

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3
Q

What chemicals can lead to lung cancer?

A

Chromates

Hydrocarbons

Nickel

Asbestos

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4
Q

What percentage of lung cancer is due to smoking?

A

85%

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5
Q

What percentage of smokers get lung cancer?

A

10%

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6
Q

How does smoking affect the risk of getting lung cancer in males and females?

A

Males are 22x more at risk and females are 12x more at risk

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7
Q

What is the risk of smoking and causing lung cancer proportionate to?

A

Packs per day per year

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8
Q

How does passive smoke increase the risk of lung cancer?

A

50-100% increased risk

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9
Q

What percentage of non-smoking lung cancers does passive smoke cause?

A

25%

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10
Q

What is passive smoking?

A

Involuntary inhaling of smoke from other people’s cigarettes

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11
Q

How does stopping smoking change your risk of getting lung cancer?

A

Risk slowly decreases

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12
Q

What does abstinence mean?

A

Practice of restraining oneself from indulging in something

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13
Q

What percentage of males and females in the UK smoke?

A

33%

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14
Q

What percantage of males and females in the world smoke?

A

50% of men

12% of woman

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15
Q

What does tobacco smoke do that leads to lung cancer?

A

Epithelial effects

Multi-hit theory of carcinogenesis

Host activation of pro-carcinogens

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16
Q

What are the 2 main pathways of carcinogenesis in the lung?

A

Squamous cell carcinoma in the central lung airways

Adenocarcinoma in the lung periphery

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17
Q

Where does squamous cell carcinoma occur?

A

Central lung airways

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18
Q

Where does adenocarcinoma occur?

A

Lung periphery

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19
Q

What happens during adenocarcinoma?

A

Bronchioloalveolar epithelial stem cells transform

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20
Q

What happens during squamous cell carcinoma?

A

Bronchial epithelial stem cells transform

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21
Q

What is a squamous dysplasia becoming an invasive bronchogenic carcinoma strongly linked with?

A

Smoking

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22
Q

What are the key driver mutations for adenocarcinoma?

A

KRAS (35%)

EGFR (15%

BRAF, HER2 (1-2%)

ALK rearrangements (2%)

ROS1 gene rearrangements (1%)

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23
Q

What mutational driver for lung cancer is smoking induced?

A

KRAS

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24
Q

What mutations linked to adenocarcinomas has therapy been approved for targeting?

A

EGFR mutation

BRAF mutation

ALK rearrangement

ROS1 rearrangement

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25
Q

What therpies that target mutations linked to squamous cell carcinomas has been approved?

A

Very few suitable targets

Commonest alterations are inactivating mutations in tumour suppresor genes

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26
Q

What are some examples of tumours of the lungs>

A

Benign causes of mass lesion

Carcinoid tumour

Tumours of bronchial glands

Lymphoma

Sarcoma

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27
Q

What is a carcinoid tumour?

A

One originating in the neuroendocrine system

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28
Q

What are tumours originating in the neuroendocrine system called?

A

Carcinoid tumours

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29
Q

What is the malignancy of carcinoid tumours?

A

Low grade malignancy

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30
Q

What percentage of lung neoplasms are carcinoid tumours?

A

<5%

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31
Q

What are examples of tumours of the bronchial glands?

A

Adenoid cystic carcinoma

Mucoepidermoid carcinoma

Benign adenoma

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32
Q

How common are metastasis to the lung?

A

Common

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33
Q

What are the different kinds of lung cell carcinoma?

A

Squamous cell (40%)

Adenocarcinoma (41%)

Small cell carcinoma (15%)

Large cell carcinoma (4%)

34
Q

What percentage of lung carcinomas are squamous cells?

A

40%

35
Q

What percentage of lung carcinomas are adenocarcinomas?

A

41%

36
Q

What percentage of lung carcinomas are small cell carcinomas?

A

15%

37
Q

What percentage of lung carcinomas are large cell carcinomas?

A

4%

38
Q

What is bronchioloalveolar cell carcinoma subtype of?

A

Adenocarcinoma

39
Q

What is bronchioloalveolar cell carcinoma also called?

A

Alveolar cell carcinoma

Now called adenocarcinoma in situ

40
Q

What does NSCLC stand up for?

A

Non-small cell carcinomas

41
Q

What are examples of non-small cell carcinomas (NSCLC)?

A

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

42
Q

How has the prevalance of squamous, small cell and adenocarinomas changed?

A

Squamous and small cell has plateued or fallen

Adenocarcinomas has risen

43
Q

What can be said about the years before a lung cancer diagnosis?

A

Lung cancer grows clinically silent for many years

44
Q

When does a lung cancer clinically present in its history?

A

Late

45
Q

What are the symptoms of lung cancer like as it progresses?

A

Initially may have few if any symptoms until the disease is very advanced

46
Q

Generally speaking, what is symptomatic lung cancer?

A

Fatal

47
Q

What local effects does lung cancer have?

A

Bronchial obstruction

Pleural

Direct invasion

Lymph node metastasis

48
Q

What effects may lung cancer have on bronchial obstruction?

A

Collapse

Endogenous lipid pneumonia

Infection/abscess

Bronchiectasis

49
Q

What effect may lung cancer have on the pleura?

A

Inflammatory

Malignant

50
Q

What may lung cancer directly invade?

A

Chest wall

Nerves

Mediastinum

51
Q

What nerves may lung cancer directly invade?

A

Phrenic

L recurrent laryngeal

Brachial plexus

Cervical sympathetic

52
Q

What does lung cancer invading the phrenic nerve cause?

A

Diaphragmatic paralysis

53
Q

What does lung cancer invading the L recurrent laryngeal nerve cause?

A

Hoarse

Boving cough

54
Q

What does lung cancer invading the brachial plexus cause?

A

Pancoast T1 damage

55
Q

What does lung cancer invading the cervical sympathetic nerves cause?

A

Horner’s syndrome

56
Q

What effects can lung cancer have on lymph nodes?

A

Mass effect

Lymphangitis carcinomatosa

57
Q

What distant effects does lung cancer have?

A

Distant metastasis

Secondary to local effects

Non-metastatic effects

58
Q

What distant metastasis can lung cancer cause?

A

Liver

Adrenals

Bone

Brain

Skin

59
Q

What distant effects can be secondary to local effects?

A

Neural

Vascular

60
Q

What systems can lung cancer have non-metastatic effects on?

A

Skeletal

Endocrine

Neurological

Cutaneous

Haemoatologic

Cardiovascular

Renal

61
Q
A
62
Q

What are some examples of non-metastatic effects that lung cancer can have?

A

Finger clubbing

Hypertrophic pulmonary osteoarthropathy (HPOA)

63
Q

What investigations can be done for lung cancer?

A

Chest X-ray

Sputum cytology rarely used

Bronchoscopy

Trans-thoracic fine needle aspiration

Trans-thoracic core biopsy

Pleural effusion cytology and biopsy

Advanced imaging techniques

64
Q

What are examples of advanced imaging techniques?

A

CT

MRI

PET

65
Q

What are examples of bronchoscopy?

A

Bronchial biopsy

Bronchial brushings and washings

Endobronchial US-guided aspiration (EBUS)

66
Q

What are prognostic factors in lung cancer?

A

Stage of disease

Classification (type of disease)

Markers/oncogenes/gene expression profiles

Growth rate

Cell proliferation

DNA aneuploidy

Immune cell infiltration

67
Q

How would you describe the prognosis of lung cancer?

A

Generally terrible

68
Q

What percentage of people with lung cancer surcive 5 years in Scotland?

A

<9.8% (>15% in USA)

69
Q

What percentage of people with stage 1 lung cancer survive more than 5 years?

A

>60%

70
Q

What percentage of people with stage 2 lung cancer survive more than 5 years?

A

35%

71
Q

In Scotland, what percentage of people with lung cancer get surgical treatment?

A

10-12%

72
Q

What percentage of people with non-small cell carcinomas survive more than 5 years?

A

10-25% (some types do badly)

73
Q

What percentage of people with small cell carcinoma survive more than 5 years?

A

4%

74
Q

What is the median survival time for people with small cell carinomas?

A

9 months

75
Q

Do non-small cell or small cell carinomas have a better prognosis?

A

Non-small cell carinomas

76
Q

What can be used after the diagnosis to select patients for therapy?

A

Predictive biomarkers

77
Q

What has transormed practice in non-small cell carcinomas?

A

Immunotherapy

78
Q

What does immunotherapy do?

A

Target immune checkpoints such as PD1/PD-L1 in NSCLC

79
Q

What immune checkpoint is targeted in non-small cell carcinomas?

A

PD1/PD-L1

80
Q

What do immune checkpoints do?

A

Control immune reactions

81
Q

What can tumours do to immune checkpoints?

A

Adapt them to avoid immune destruction

82
Q

What can target immune checkpoints to help treat cancer?

A

Immune checkpoint inhibitors

RC-Respiratory illnesses (15 decks)

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