Pathology of lung cancers Flashcards by Michael Alcorn

What is the incidence of lung cancer, compared to other cancers?

3rd most common cancer

How well did you know this?

Not at all

Perfectly

What is the relative mortality of lung cancer?

Highest mortality rate of all cancers

How well did you know this?

Not at all

Perfectly

What is the 5 year survival rate for someone diagnosed with lung cancer?

9.8%

How well did you know this?

Not at all

Perfectly

What is the main cause of lung cancer?

Smoking

How well did you know this?

Not at all

Perfectly

What are the other causes of lung cancer, besides smoking?

Asbestos

Environmental radon + other forms of background radiation

Occupational exposure - chromates, hydrocarbons, nickel etc

Air pollution (urban environment)

Pulmonary fibrosis

Passive smoking

How well did you know this?

Not at all

Perfectly

What percentage of lung cancers are attributable to tobacco?

> 85%

How well did you know this?

Not at all

Perfectly

What percentage of smokers get lung cancer?

10%

How well did you know this?

Not at all

Perfectly

Roughly how long does it take after quitting smoking, for the risk of developing cancer decrease to ‘normal’?

15+ years

variable

How well did you know this?

Not at all

Perfectly

Cigarettes contain over 400 chemicals, of which 60ish are carcinogenic

What are the 2 main groups of chemicals that are carcinogenic?

N-nitrosamines

Polycyclic aromatic hydrocarbons

How well did you know this?

Not at all

Perfectly

What two types of lung cancers are associated with the chemicals found in cigarettes?

Adenocarcinomas

Squamous cell carcinomas

How well did you know this?

Not at all

Perfectly

Which chemical group causes adenocarcinomas?

N-nitrosamines

How well did you know this?

Not at all

Perfectly

What chemical group causes squamous cell carcinomas?

Polycyclic aromatic hydrocarbons

How well did you know this?

Not at all

Perfectly

What area of the lungs are you more likely to find adenocarcinomas in?

Peripheries

How well did you know this?

Not at all

Perfectly

Transformation of what type of cell gives rise to adenocarcinomas?

Bronchioalveolar epithelial stem cells

How well did you know this?

Not at all

Perfectly

Where would you tend to find squamous cell carcinomas?

Central lung airways

nearer to the hilla

How well did you know this?

Not at all

Perfectly

What is the multi-hit theory of carcinogenesis?

Must have at least 3 - 6 ‘hits’ (genetic mutations/alterations) of specific genes in order for a cancer to be able to form/grow

These must happen in a specific order

How well did you know this?

Not at all

Perfectly

Specific ‘key driver mutations’ must happen in order for adenocarcinogenesis to take place

What genes most commonly mutate to allow this?

KRAS - 35%

EGFR - 15%

BRAF, HER2 - 1-2%

ALK - 2%

ROS1 - 1%

What 4 adenocarcinoma oncogenes have targeted treatments available in the UK?

EGFR
ALK
ROS1
BRAF

Why are there not really any targeted oncogene treatments for Squamous cell carcinomas?

SCC has very few addictive oncogenes

Not really any suitable targets

What are the 4 main types of carcinomas of the lung?

Adenocarcinoma

Squamous cell carcinoma

Small cell carcinoma

Large cell carcinoma

The frequency of squamous and small cell carcinomas has ______ in recent years

Plateaued

The frequency of adenocarcinomas has _______ in recent years

Risen

Why is primary lung cancer described as “generally fatal” whereas lung cancer from metastasis has higher survival rates?

Lung cancer is generally asymptomatic until later stages

If primary, theres a good chance the person won’t know until it’s too late

Metastasis to the lungs is common, so if someone already has cancer then it is ‘looked for’ and can often be found in earlier stages of development

What are the main local effects of lung cancer?

Bronchial obstruction

Pleural effects

Direct invasion

Lymph node metastasis

What are potential effects of bronchial obstruction?

Collapse Endogenous lipoid pneumonia (mucous etc) Infection/abscess Bronchiectasis

What is bronchiectasis?

long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection

What potential effects can lung cancer have on the pleura?

Inflammation Malignancy

There is a possibility that a lung cancer can directly invade a nearby part of the body/ Where potentially can the cancer locally invade?

Chest wall Nerves Mediastinum

What symptoms would show if a lung cancer had invaded the phrenic nerve?

Diaphragmatic paralysis

Would symptoms would show if a cancer invaded the L recurrent laryngeal nerve?

Hoarse, bovine cough

Lung cancers can potentially invade the brachial nerve plexus. What specific type of tumour would be responsible for this?

Pancoast tumour | tumour in apex of lung

What symptoms would show if a lung cancer directly invaded cervical sympathetic nerves?

Horner's syndrome | half of your face doesn't work properly

What potential effects of lung cancers involve lymph node metastasis?

Mass effect metastasis Lymphangitis carcinomatosa

What distant locations in the body are common for lung cancer to metastasise to?

Liver Adrenals Bone Brain Skin

What neoplastic effects can lung cancer have on the skeleton?

Clubbing Hyertrophic osteoarthropathy

What 'key river mutation' is induced by smoking?

KRAS most common mutation seen

Some lung cancers can be treated using targeted therapies What type of lung cancer is treated by targeting the mutations of EGFR, BRAF, ROS1 (rearrangement) and ALK (rearrangement)?

Adenocarcinomas

What non-metastatic paraneoplastic effects can lung cancers have? (what areas can be affected)

``` Skeletal Endocrine Neurological Cutaneous Haematological Cardiovascular Renal ```

Cancers are classified based on what?

The type of cancer Stage of development (TNM) (Biomarkers)

What is the 5 year survival rate for stage 1 operable lung cancer?

> 60%

What is the 5 year survival rate for a stage 2 operable lung cancer?

35%