Pathology of Lung Cancers Flashcards
Why is lung cancer one of the most common worldwide cancers
Due to the consumption of tobacco
How many people died due to lung cancer in 2012
1.59 million
How many new cases of lung cancer were there in 2015 (Scotland)
5052
How many deaths from lung cancer were there in 2016 (Scotland)
4035
What is the most common and important cause of lung cancer
Tobacco smoking
Name 7 causes of lung cancer from most important to least important
Tobacco
Asbestos
Environmental radon – from ground (granite rock)
Other occupational exposure (Chromates, Hydrocarbons, Nickel)
Air pollution and Urban environment
Other radiation
Pulmonary fibrosis
How many lung cancers are due to tobacco
Over 85%
How many smokers get lung cancers
10%
What is the risk of obtaining lung cancer in male and female smokers
Males = 22 times higher Females = 12 times higher
Are male or female smoker more susceptible to lung cancer
Females
What is the risk of obtaining lung cancer linked to
Amount of tobacco consumed but there is no safe smoking threshold
What is the risk of a passive smoker obtaining lung cancer
50-100% increased risk
How many non-smoking lung cancers is caused by passive smokers
25%
How many males and females in the UK smoke
1/3
How many men and female smoke worldwide
50% men
12% female
In which countries is tobacco consumption soaring
China
South and South East Asia
South America
How many chemical compounds are found in tobacco smoke
Over 4000
How many recognised carcinogens are there in tobacco smoke
60
What type of cancers do the polycyclic aromatic hydrocarbons (PAH) found in cigarette smoke seem to be causing
Cancers in the large central bronchial airways
What type of effects can tobacco smoke have
Epithelial effects
What type of theory is behind the carcinogenesis of lung cancer
Multi-hit theory
What can the genetics of the host activate
Pro-carcinogens
What can inherited polymorphisms predispose
Metabolism of pro-carcinogens
Nicotine addiction
Which cells transform in the lung periphery and what type of lung cancer do they cause
Bronchioloalveolar epithelial stem cells transform
Adenocarcinoma
Which cells transform in the central lung airways and what type of lung cancer do they cause
Bronchial epithelial stem cells transform
Squamous cell carcinoma
Which type of lung cancer are women more susceptible to
Adenocarcinoma
Which type of lung caner is increasing and which is decreasing
Squamous cell carcinoma = decreasing
Adenocarcinoma = Increasing
What is invasive bronchogenic carcinoma associated with
Smoking
How do peripheral lung adenocarcinomas develop
Start with:
Atypical adenomatous hyperplasia (AAH) then develop into
Adenocarcinoma in situ before becoming
Invasive adenocarcinoma
Which type of lung cancer is less strongly associated with smoking and seen in non-smokers
Peripheral lung adenocarcinomas
Name 5 adenocarcinoma oncogenes
KRAS - approx. 35% EGFR - approx. 15% BRAF - approx. 2% HER2 - approx. 2% ALK rearrangements - approx. 2%
What is the process of adenocarinogenesis dependent on and how can this help treatment
Oncogene signalling
If signalling is blocked this could terminate the growth of cancer
Which of the adenocarcinoma oncogenes are smoking induced
KRAS
Which oncogene targets have agents approved by the FDA and EMA
EGFR
ALK rearrangements
ROS1 rearrangements BRAF mutations
Why are metastases common in the lung
As it is the only organ in the body to receive the entire blood flow
What types of tumours can be found in the lung
Benign causes of mass lesions
Bronchial gland tumors (rare)
Lymphomas
Sarcomas
What type of bronchial glad tumors are there
Adenoid Cystic Carcinoma
Mucopidermoid carcinomas
Benign adenomas
Name the 4 main lung cancer cell types
Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
What are the two histological types of lung carcinomas
Small cell carcinomas (SCLC)
Non-small cell carcinomas (NSCLC)
What does Non-small cell carcinomas (NSCLC) consist of
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinomas
Others
Do primary lung cancers grow with signs and symptoms or clinically silent
Clinically silent
When do primary lung cancers tend to present
Late in its natural history
What types of symptoms do primary lung cancers tend to have
Very few (if any) signs or symptoms Symptoms could be from changes in the character of cough or coughing up blood
When do symptoms of primary lung cancer tend to show
When the disease has become very advanced
When can primary lung cancer be found
Incidentally during an investigation for something unreleated
What type of obstruction can lung cancer cause
Bronchial obstruction
What can brocnical obstruction lead to
Collapse
Endogenous Lipoid Pneumonia
Infection / Abscess
Bronchiectasis
What can lung cancer case
Bronchial obstruction
Pleural invasion
Direct Invasion
Lymph Node metastases
What can pleural invasion cause
Inflammation of pleura
Malignancy of pleura
Where can be directly invaded by lung cancer
Chest wall
Mediastinum
What can be affected in the mediastinum is invaded (be specific)
Nerves: Phrenic – diaphragmatic paralysis Left Recurrent laryngeal – Hoarse, Bovine cough Brachial plexus – Pancoast T1 damage Cervical Sympathetic - Horner’s syndrome
What does Horner’s syndrome cause
Pinpoint pupil
Droopy eyelid
Prevents sweating on affected side of the face
What can lymph node metastases cause
Mass effect
Lymphangitis carcinomatosa
