Pathology of Pulmonary Neoplasia Flashcards
What is the aetiology of lung cancer?
- Tobacco (85%)
- Asbestos
- Environmental radon
What percentage of smokers get lung cancer?
10%
What molecules are found in tobbaco smoke?
Pro-carcinogens
what cells do procarcinogens have an effect on?
Epithelial cells
How does tobacco smoke cause cancer?
- Epithelial effects
- Multi-hit theory in carcinogenesis
- Host activation of pro-carcinogens - Inherited polymorphisms predispose (metabolism of pro-carcinogens, nicotine addiction)
Where are the two main stem cell populations in the lungs?
- Large arease of the bronchi
- Peripheral lung epithelium of the small bronchioles and the alveolar epithelium.
How does adenocarcinoma arise in the lung?
Bronchoalveolar epithelial stem cells transform
How does squamous cell carcinoma arise from?
Bronchial epithelial stem cells transform
Where is adenocarcinoma found?
In the periphery of the lung.
Where is squamous carcinoma found?
Central parts of the lung
What are other types of cancer that are found in the lungs?
- Carcinoid Tumour
- Tumours of bronchial glands
- Lymphoma
- Sarcoma
- Metastases from somewhere else to the lung
What are the fpur main types of primary lung carcinoma?
- Squamous cell
- Adenocarcinoma
- Small cell carcinoma
- Large cell carcinoma
How are the four types of lung cancer catergorised?
- Small cell carcinoa is in one group
- All other types of cancer are in another group.
How does primary lung cancer grow?
It grows silently for many years, presents late in its natural history, may have few signs until the disease is very advanced. Symptomatic lung cancer is very fatal.
What are the local effects lung cancer?
- Bronchial obstruction (collapse, endogenous lipoid pneumonia, infection, abscess, bronchiectasis)
- Pleural (inflammatory, malignant)
- Direct invasion (chest wall)
- Direct Invasion (nerves: phrenic - diaphragmatic paralysis, L recurrent laryngeal: Hoarse + Bovine cough, Brachial plexus - Pancoat T1 damage, Cervical sympathetic - Horner syndrome)
- Mediastinum (SVC, Pericardium)
- Lymph node Metastatases (Mass effect and Lymphangitis carcinomatosa)§
What are the distant effects of lung cancer?
- Distant metastases: liver, adrenals, bone, brain, skin
- Secondary to local effects: Neural and vascular
- Non metastatic effects
What are non-metastatic effects of lung cancer?
- Finger clubbing
What are small cell carcinoma characterised by?
Neuroendocrine differentiation
How do you investigate lung cancer?
- Chest X-Ray
- Sputum Cytology
- Bronchoscopy
- Trans-thoracic Fine Needle Aspiration
- Transthoracic Core Biopsy
- Pleural effusion cytology and biopsy
- Advanced imaging techniques: CT scanning, MRI, PET,
What are the prognostic factors in lung cancer?
- Stage of disease
- Classification of disease: Markers/Oncogenes/Gene expression profiles.
What can the prognostic factors tell us?
They can tell us about the growth rate of the tumour, cell proliferation, Immune cell infiltration
What are the therapy predicitve factors in lung cancer?
- Adenocarcinoma
- EGFR, KRAS, HER2, BRAF mutations
- ALK translocations, ROS1 translocations
- Squamous cell: little effective in molecular therapy
What oncogene is activated by smoking?
KRAS
What is an adenocarcinoma in situ?
Bronchioalveolar cell carcinoma (subtype of adenocarcinoma)
What are carcinoid tumours?
A carcinoid tumour is a rare cancer of the neuroendocrine system – the body system that produces hormones. The tumour usually grows in the bowels or appendix, but it can also be found in the stomach, pancreas, lung, breast, kidney, ovaries or testicles. It tends to grow very slowly
What is endogenous lipoid pneumonia?
when lipids enter the bronchial tree
What is horner’s syndrome?
Disruption of a nerve pathway from the brain to the face and eye on one side of the body. Typically, Horner syndrome results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face.
What is horner’s syndrome?
Disruption of a nerve pathway from the brain to the face and eye on one side of the body. Typically, Horner syndrome results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face.
What is used after the diagnosis to select patients for therapy?
Predictive biomarkers,
What is an immune checkpoint inhibitor?
A drug which prevents passage past a checkpoint, immune checkpoints control immune reactions
Give examples of how cancer cells avoid immune destruction
PD1, PD-L1
