Pathology of Lung Cancer

Question 1

Number of deaths due to lung cancer worldwide

Answer 1

Around 1.59 million

Question 2

By how much is the number of deaths expected to increase over the next 20 years

Answer 2

More than 1.8 times over

Question 3

Lung cancer aetiology

Answer 3

Tobacco
Asbestos
Environmental radon
Occupational exposure
Air pollution and urban environment 
Other radiation
Pulmonary fibrosis

Question 4

What percentage of smoking attributes to tobacco

Answer 4

> 85%

Question 5

What percentage of smokers get lung cancer

Answer 5

10%

Question 6

Are females or males more susceptible to lung cancer

Answer 6

Females

Question 7

What percentage of non-smoking lung cancers are due to passive smoking

Answer 7

25%

Question 8

Passive smoking increases the risk of lung cancer by what percentage

Answer 8

50-100%

Question 9

Tobacco smoke and lung cancer

Answer 9

Epithelial effects
Multi-hit theory of carcinogenesis
Host activation of pro-carcinogens

Question 10

Multi-hit theory of carcinogenesis

Answer 10

Several genetic changes need to to occur in a specific sequence in one cell in order for cancer to occur

Question 11

Two main pathways of carcinogenesis occur in which areas of the lung

Answer 11

In the lung periphery

In the central lung airways

Question 12

Carcinogenesis in the lung periphery

Answer 12

Bronchiolalveolar epithelial stem cells transform - adenocarcinoma

Question 13

Carcinogenesis in the central lung airways

Answer 13

Bronchial epithelial stem cells transform - squamous cell carcinoma

Question 14

Key mutations in adenocarcinogenesis (biomarkers)

Answer 14

KRAS
EGFR
BRAF
HER2
ALK rearrangements
ROS1 gene rearrangements

Question 15

Smoking induced key driver mutations in adenocarcinogenesis

Answer 15

KRAS

Question 16

Key mutations in squamous cell carcinoma

Answer 16

FGFR1
DDR2
PIK3CA
MET
BRAF

Question 17

Tumours of the lung

Answer 17

Benign
Carcinoid tumour
Tumours of bronchial glands
Lymphoma
Sarcoma
Metastases

Question 18

5 main types of carcinomas of the lungs

Answer 18

Non-small cell:
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
Alveolar carcinoma
Small cell:
Small cell carcinoma

Question 19

Small cell carcinomas account for what percentage of carcinomas

Answer 19

15%

Question 20

Non-small cell carcinomas account for what percentage of carcinomas

Answer 20

85%

Question 21

Primary lung cancers are asymptomatic until

Answer 21

Disease is very advanced and metastatic

Question 22

Local effects of lung cancer

Answer 22

Bronchial obstruction
Pleural
Direct invasion
Lymph node metastases

Question 23

Bronchial obstruction effects

Answer 23

Collapse
Endogenous lipoid pneumonia
Infection/abscess
Bronchiectasis

Question 24

Pleural effects

Answer 24

Inflammation

Malignancy

Question 25

Direct invasion into

Answer 25

Chest wall Nerves Mediastinum

Question 26

Nerves that can be effected by direct invasion

Answer 26

Phrenic L recurrent laryngeal Brachial plexus Cervical sympathetic

Question 27

Lymph node metastases effect

Answer 27

Mass effect | Lymphangitis carcinomastosa

Question 28

Lung cancer can directly metastasise to

Answer 28

``` Liver Adrenals Bone Brain Skin ```

Question 29

Distant effects

Answer 29

Distant metastases Secondary to local effects Non-metastatic effects

Question 30

Effects secondary to local effects

Answer 30

Neural | Vascular

Question 31

Examples of non-metastatic effects

Answer 31

Finger clubbing | HPOA

Question 32

Hormones secreted in excess by small cell carcinoma

Answer 32

ACTH | siADH

Question 33

Hormone secreted in excess by squamous carcinoma

Answer 33

PTH

Question 34

Excess PTH hormone results in

Answer 34

Hypercalcemia

Question 35

Lung cancer investigations

Answer 35

``` Chest x-ray Sputum cytology Bronchoscopy Trans-thoracic fine needle aspiration Trans-thoracic core biopsy Pleural effusion cytology and biopsy Advanced imaging techniques ```

Question 36

Advanced imaging techniques

Answer 36

CT, MRI, PET

Question 37

Prognostic factors in lung cancer

Answer 37

Stage of disease Type of disease Markers/oncogenes/gene expression profiles

Question 38

Percentage of people with lung cancer that get surgical treatment in Scotland

Answer 38

10-12%

Question 39

5 year survival rate of non-small cell carcinomas

Answer 39

10-25%

Question 40

5 year survival rate of small cell carcinoma

Answer 40

4%

Question 41

Immune checkpoints examples (biomarker)

Answer 41

PD1/PD-L1 | CTLA4

Question 42

Immunotherapy effect

Answer 42

Causes immune system to switch back on

Question 43

Immune checkpoint inhibitors

Answer 43

Drugs that work against immune checkpoints

Question 44

Immune checkpoints

Answer 44

Control immune reactions