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Respiratory System > Pathology of Lung Cancer > Flashcards

Pathology of Lung Cancer Flashcards

1
Q

What is the most common cause of cancer-related death?

A

Lung cancer

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2
Q

What is the leading cause of lung cancer?

A

tobacco (smoking)

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3
Q

What is the second most common cause of lung cancer?

A

asbestos

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4
Q

What are some other causes of cancer apart from tobacco and asbestos?

(5)

A
  • Environmental radon
  • Other occupational exposure
    (e. g. Chromates, Hydrocarbons, Nickel)
  • Air pollution and Urban environment
  • Other radiation
  • Pulmonary fibrosis
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5
Q

How does smoking increase the risk of developing lung cancer, for males and females?

Who may be more susceptible? Explain this.

A

males: x22
females: x12

Females - may have something to do with inhalation and pack years.

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6
Q

How is pack years calculated?

A

No. smoked / pack / day / per

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7
Q

What are the two important groups of compounds in cigarettes that are thought to cause lung cancer?

A
  • polycyclic aromatic hydrocarbons (10)

- N-nitrosamines (7)

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8
Q

What type of lung cancer are the N-nitrosamines thought to cause?

A

adenocarcinomas in the periphery of the lungs

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9
Q

What type of lung cancer are the polycyclic aromatic hydrocarbons thought to cause?

A

squamous cell carcinoma

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10
Q

What is an adenocarcinoma?

A

a malignant tumour formed from glandular structures in epithelial tissue.

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11
Q

What are the two main pathways of carcinogenesis in the lung i.e. which areas of lung?

A
  • lung periphery

- central lung airways

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12
Q

In the lung periphery and central lung airways, describe cells transform and which type of cancer develops.

(4)

A

lung periphery:

  • bronchiolalveolar epithelial stem cells transform
  • develops adenocarcinoma

central lung airways:

  • bronchial epithelial stem cells transform
  • develops squamous cell carcinoma
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13
Q

Bronchioloalveolar carcinoma (BAC) is a relatively rare _________ that typically arises in the ______ ______ and grows along alveolar walls, without destroying the lung parenchyma.

A

adenocarcinoma

lung periphery

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14
Q

______ _______ ______ is more strongly associated with smoking than any other type of non-small cell lung cancer.

A

squamous cell carcinoma

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15
Q

___________________ usually occur in the central part of the lung or in one of the main airways (left or right bronchus).

A

Squamous cell lung tumors

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16
Q

What is squamous dysplasia?

A

Squamous dysplasia is defined as altered epithelium with an increased likelihood for progression to squamous cell carcinoma.

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17
Q

What is an adenoma?

A

a benign tumour formed from glandular structures in epithelial tissue.

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18
Q

What is a carcinoma?

3

A
  • start in epithelial tissues.
  • these cover the outside of the body as the skin.
  • there are different types of epithelial cells and these can develop into different types of carcinoma.
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19
Q

What is a squamous cell carcinoma?

2

A
  • starts in squamous cells.

- the flat, surface covering cells found in areas such as the skin or the lining of the trachea, bronchi or oesophagus.

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20
Q

What is an adenocarcinoma?

2

A
  • start in glandular cells called adenomatous cells.

- glandular cells produce fluids to keep tissues moist.

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21
Q

Would the developmental process of an invasive bronchogenic carcinoma be more associated with non-smokers or smokers?

A

Process strongly associated with smoking.

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22
Q

What is different about peripheral lung adenocarcinogenesis compared with a given squamous cell carcinoma affecting the bronchus?

(2)

A
  • The process of peripheral lung adenocarcinogenesis is less strongly but still associated with smoking compared to a SC carcinoma, which is heavily influenced by smoking.
  • The sequence of peripheral lung adenocarcinogenesis occurs in non-smokers also.
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23
Q

What is the multi-hit theory of carcinogenesis in lung cancer?

(2)

A
  • about 3-6 hits are required before a cancer forms.

- these mutations to important genes must be in the correct sequence also.

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24
Q

How might genetics affect the likelihood of cancer forming?

A
  • people may have polymorphisms that allow them to metabolise pro-carcinogens.
  • some people are more predisposed to higher nicotine addiction.
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25
Q

What sort of cells are the target for carcinogens?

A

stem cells

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26
Q

Which type of lung cancer is usually found in non-smokers?

A

peripheral lung adenocarcinoma

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27
Q

Outline a typical adenoma – carcinoma sequence for a peripheral lung adenocarcinoma.

(3)

A
  1. atypical adenomatous hyperplasia (benign)
  2. adenocarcinoma in situ
  3. invasive adenocarcinoma (malignant)
28
Q

What is oncogene addiction?

A
  • the phenomenon in which some cancers remain dependent on one or a few genes for both maintenance and cell survival.
29
Q

What is an addictive oncogene?

A
  • an oncogene that once inactivated will inhibit the future growth of the cancer.
30
Q

What is important about addictive oncogenes in terms of treatment?

(2)

A
  • molecular target therapy

- gene inactivation prevents cancer spread.

31
Q

What is the most common key driver mutation in lung cancer?

A

KRAS (35%)

32
Q

Name a key driver mutation which is smoking induced.

A

KRAS

33
Q

Which driver mutations are not smoking induced?

i.e. not related to tobacco carcinogenesis

(5)

A 
EGFR
BRAF
HER2
ALK rearrangements
ROS1 gene rearrangements
34
Q

Which four driver mutation targets have approved treatment agents for adenocarcinomas from the FDA?

A

EGFR mutation
ALK rearrangement
ROS1 rearrangement
BRAF mutation

35
Q

Give an example of a cause of a benign mass lesion in the lung?

A

pneumonia

36
Q

Outline some examples of some tumours in the lung which aren’t lung cancer.

i.e. they may be benign, or a cancer of another origin.

A
  • carcinoid tumour
  • tumour of bronchial glands
  • lymphoma
  • sarcoma
  • metastases
37
Q

Why are metastases so common in the lung?

A
  • all blood must pass through the lungs

- cancer can metastasise easily through blood

38
Q

What are the 4 main types of lung cancer?

i.e. the most common accounting for >90% of cases.

A
  • squamous cell (40%)
  • adenocarcinoma (41%)
  • small cell carcinoma (15%)
  • large cell carcinoma (4%)
39
Q

Histologically, what types of lung cancer are grouped together as non-small cell carcinomas (NSCLC)?

(4)

A
  • adenocarcinoma
  • squamous cell carcinoma
  • large cell carcinoma
  • others
40
Q

By the time that lung cancer presents symptomatically, is it possible to be treated completely?

A
  • Lung cancer presents late in its natural history.

- generally speaking, symptomatic lung cancer is fatal.

41
Q

What are the local effects of lung cancer in terms of bronchial obstruction?

(4)

A
  • collapse
  • endogenous lipoid pneumonia
  • infection/abscess
  • bronchiectasis
42
Q

What is endogenous lipoid pneumonia?

A
  • obstruction of the airway resulting in the accumulation of cellular breakdown debris, including cholesterol from destroyed alveolar cell walls.
  • these lipids are difficult to digest and the macrophages, which attempt to phagocytose them, accumulate within the alveolar spaces.
43
Q

What are the local effects of lung cancer in terms of the pleurae?

(2)

A
  • inflammation of the pleura (pleurisy)

- malignant spread to the pleura

44
Q

What are the local effects of lung cancer in terms of direct invasion?

A
  • invasion of the chest wall
  • invasion of the mediastinum (SVC, pericardium)
  • invasion of nerves ( phrenic, left recurrent laryngeal, brachial plexus, cervical sympathetic)
45
Q

If lung cancer spreads to the phrenic nerve, what happens?

A

paralysis of diaphragm

46
Q

If lung cancer spreads to the left recurrent laryngeal nerve, what happens?

(2)

A
  • innervation of voice box affected
  • hoarseness
  • bovine cough
47
Q

If lung cancer spreads to the brachial plexus, what happens?

2

A
  • pancoast T1 damage

- pain and weakness in the muscles of the arm and hand

48
Q

If lung cancer spreads to the cervical sympathetic nerve, what happens?

How does this present?

(4)

A
  • Horner’s syndrome:
  • constriction of one eye
  • loss of sweating on one side of the face
  • dropping of one eyelid
49
Q

What are the effects of a lung cancer on lymph nodes?

2

A
  • mass effect, many lymph nodes become cancerous

- lymphangitis carcinomatosa: interstitial cancer of lymph affecting drainage of lungs

50
Q

What are the common distant metastases in lung cancer?

5

A 
Liver
Adrenals
Bone
Brain
Skin
51
Q

Outline some of the skeletal non-Metastatic paraneoplastic effects of lung cancer.

(2)

A
  • finger clubbing

- HPOA inflammation

52
Q

Outline some of the endocrinal non-Metastatic paraneoplastic effects of lung cancer.

(3)

A
  • ACTH, SIADH, PTH
  • Carcinoid syndrome
  • Gynecomastia
53
Q

Outline some of the neurological non-Metastatic paraneoplastic effects of lung cancer.

(4)

A
  • Polyneuropathy
  • Encephalopathy
  • Cerebellar degeneration
  • Myasthenia
54
Q

Outline some of the cardiovascular non-Metastatic paraneoplastic effects of lung cancer.

(1)

A
  • Migratory thrombophlebitis
55
Q

Outline some of the renal non-Metastatic paraneoplastic effects of lung cancer.

(1)

A
  • nephrotic syndrome: passing too much protein in your urine.
56
Q

Which abnormal hormone productions are a likely cause of small cell carcinoma?

(2)

A
  • ACTH

- siADH

57
Q

Which abnormal hormone productions are a likely cause of squamous (non small) cell carcinoma?

(1)

A

PTH

58
Q

What are some investigations carried out to diagnose lung cancer?

(7)

A
  • CXR
  • sputum cytology (rare)
  • bronchoscopy
  • trans-thoracic fine needle aspiration
  • trans-thoracic core biopsy
  • pleural effusion cytology/biopsy
  • advanced imaging techniques (CT, MRI, PET)
59
Q

What factors determines the prognosis of Lung cancer?

3

A
  • Staging of cancer
  • classification of type
  • markers, oncogenes, gene expression profile
60
Q

What is the 5 year survival rate in patients with operable stage I and stage II lung cancer?

A

Stage I = >60%

Stage II = 35%

61
Q

Which type of lung cancer has the poorest prognosis?

A

small cell carcinoma

62
Q

What will help select a patient’s therapy after a diagnosis has been made?

A

predictive biomarkers

63
Q

Which predictive biomarkers will help decide the treatment of patients with adenocarcinoma?

(4)(2)

A
  • EGFR
  • HER2
  • KRAS
  • BRAF

ALK translocation
ROS1 translocations

64
Q

Which predictive biomarkers will help decide the treatment of patients with squamous cell carcinoma?

A

very few

65
Q

Which type of lug cancer can immunotherapy be used to treat?

A

NSCLC

66
Q

The _______ axis immune checkpoint in NSCLC:

  • A therapeutic target
  • An important biomarker
A

PD1/PD-L1

Respiratory System (26 decks)

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