Pathology of Lung Cancers

Question 1

Which cancer has the highest mortality rate of any cancer, despite not being the most common?

Answer 1

Lung cancer.

Question 2

How many deaths does lung cancer account for in scotland?

Answer 2

6%

Question 3

How many cases of lung cancer does tobacco account for?

Answer 3

Around 85%

1 in 10 smokers will get lung cancer.

Question 4

Other than smoking, what are three other reasons why someone might get lung cancer?

Answer 4

Asbestos exposure
Environmental radon (e.g from granite)
Air pollution and urban environment.

Question 5

How many carcinogens and chemicals are in tobacco?

Answer 5

4000 chemicals. 60 recognised carcinogens.

Question 6

What carcinogen in tobacco is thought to be responsible for causing squamous cell carcinoma lung cancer?

Answer 6

Polycyclic aromatic hydrocarbons.

Question 7

What carcinogen in tobacco is thought to be responsible for adenocarcinomas (getting more common in modern cigarettes)?

Answer 7

N - nitrosamines.

Question 8

Explain the multi-hit theory in skin cancer.

Answer 8

must get 3 molecular changes (in the right order) to get a malignant phenotype.

Question 9

How do genetics play a part in the development of lung cancer?

Answer 9

genetic plays a part in how your body deals with the chemical. Different people are affected differently by nicotine addiction.

Question 10

What is it that can be activated by the liver, when the liver in trying to break it down?

Answer 10

pro carcinogens - becomes carcinogens.

Question 11

What cell type is likely to be affected, and what cancer is likely to form in the peripheries of the lung?

Answer 11

bronchiolalveolar epithelia stem cells transform. causes adenocarcinomas.

Question 12

What cell type is likely to be affected, and what cancer is likely to form in the central lung airways of the lung?

Answer 12

bronchial epithelial stem cells transform. Squamous cell carcinoma.

Question 13

Have any drugs been developed for preventing lung cancer?

Answer 13

YEs - but not for the most common mutation, KRAS - 35%, which is caused by smoking.

Question 14

give some examples of tumours in the lungs that aren’t lung cancer.

Answer 14

benign cause of mass lesion (e.g organising pneumonia)
carcinoid tumour (neuroendocrine system)
Bronchial gland tumour
Lymphoma
Sarcoma (connective tissue)
Metastasis also common.

Question 15

What are the four main types of primary carcinoma in the lung?

Answer 15

Squamous cell carcinoma - 40%
Adenocarcinoma - 41%
Small Cell Carcinoma - 15%
Large Cell Carcinoma - 4%

Question 16

Which type of primary cancer in the lung is very aggressive?

Answer 16

Small cell carcinoma.

Question 17

What are squamous cell, adenocarcinoma, and large cell carcinoma often referred too as?

Answer 17

non - small cell carcinomas

NSCLC

Question 18

Does primary lung cancer often have any symptoms?

Answer 18

Usually not - it is a ‘silent disease’. By the time you get symptoms it is often fatal.

Question 19

What is blood in spit a sign off?

Answer 19

Bleeding into the bronchi. - Lung cancer

Question 20

what could a bronchial obstruction cause?

Answer 20

lung collapse, endogenous liquid pneumonia, infection/abscess, bronchiectasis

Question 21

what is bronchiectasis?

Answer 21

a long term condition where the airways of the lungs become abnormally widened, leading to a build up of excess mucous. Can occur due to lung cancer if the upper airways are obstructed.

Question 22

what two types of involvement can pleura have with lung cancer?

Answer 22

Inflammation involvement.

Malignant involvement - when the cancer spreads to the pleura, much worse.

Question 23

is it worse for lung cancer to spread to the chest wall or to the mediastinum?

Answer 23

MEDIASTINUM

Question 24

what could be damaged if the disease spreads to the mediastinum?

Answer 24

lots of things including nerves. can give you very strange symptoms. 
e.g Phrenic nerve,
L recurrent laryngeal nerve 
Brachial Plexus 
Cervical sympathetic nerve.