Pathology of lung cancer

Question 1

What is the predominant aetiology of lung cancer?

Answer 1

Tobacco

Question 2

What are the lung cancer aetiology

Answer 2

TOBACCO
Asbestos 
Environmental radon 
Other occupational exposure 
Chromates, Hydrocarbons, Nickel
Air pollution and Urban environment
Other radiation
Pulmonary fibrosis

Question 3

What kind of effect does combining tobacco and asbestos exposure give?

Answer 3

Multiplicative effect

Question 4

Is there a safe smoking threshold?

What percentage of smokers get Lung cancer?

Answer 4

No

10%

Question 5

Which type of cancer found in usage of N-nitroamines?

Answer 5

Adenocarcinoma

Question 6

Which type of cancer found in usage of PAH?

Answer 6

Squamous

Question 7

What are the two main pathways of carcinogenesis in lung?

Answer 7

In the lung periohery and central lung airways

Question 8

Describe the pathway of carcinogenesis of central lung airways

Answer 8

Bronchial epithelial stem cells transform

Squamous cell carcinoma

Question 9

Describe the pathway of carcinogenesis of lung periphery

Answer 9

Bronchioloalveolar epithelial stem cells transform

Adenocarcinoma

Question 10

What type of cancer do non smokers get?

Answer 10

Adenocarcinoma

Question 11

What are examples of oncogene addiction mutations in adenocarcinogensis?

Answer 11

KRAS – approx 35%
EGFR – approx 15%
BRAF, HER2 – approx 1-2% each
ALK rearrangements – approx 2%
ROS1 gene rearrangements - ~1%

Question 12

Which oncogene addiction is smoking induced?

Answer 12

KRAS – approx 35%

Question 13

Which four targets and therapy for adenocarcinomas have been approved?

Answer 13

EGFR mutation
ALK rearrangement
ROS1 rearrangement
BRAF mutation

Question 14

What are the tumours of the lung?

Answer 14

Benign causes of mass lesion
Carcinoid Tumour
 <5% of Lung Neoplasms			
 Low Grade Malignancy
Tumours of Bronchial Glands : VERY RARE	
Adenoid Cystic carcinoma				
Mucoepidermoid carcinoma			
Benign adenomas
Lymphoma	
Sarcoma
METASTASES to lung are common

Question 15

What are the 4 types of cells for the carcinoma of lung?

Answer 15

Squamous cell 40%
Adenocarcinoma 41%
Small cell carcinoma 15%
Large cell carcinoma 4%

Question 16

What are some of the local pathological effects of lung cancer?

Answer 16

Bronchial Obstruction : 
Collapse						      	      	       
Endogenous Lipoid Pneumonia
Infection / Abscess						
Bronchiectasis 

Pleural
Direct Invasion
Lymph Node Metastases

Question 17

Describe the direct invasion of lung cancer?

Answer 17

Chest Wall
Nerves
Phrenic – diaphragmatic paralysis
L Recurrent laryngeal – Hoarse, Bovine cough
Brachial plexus – Pancoast T1 damage
Cervical Sympathetic - Horner’s syndrome
Mediastinum ( SVC, Pericardium )

Question 18

Which non metastatic paraneoplastic effect of lung cancer can squamous cancer cause? cause

Answer 18

Endocrine PTH release that can cause hyperclasemia

Question 19

Which non metastatic paraneoplastic effect of lung cancer can Small cell cancer cause?

Answer 19

Endocrine:

ACTH, siADH

Question 20

Which predictive biomarkers are associated with adenocarcinoma

Answer 20

EGFR, KRAS, HER2, BRAF mutations,