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Respiratory > Pathology of Pulmonary Neoplasia > Flashcards

Pathology of Pulmonary Neoplasia Flashcards

1
Q

What is the most common cause of death by cancer?

A

Lung Cancer

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2
Q

What are the Aetiologies for lung cancer?

A
  • Tobacco
  • passive smoking
  • Asbestos
  • other occupational exposure (chromates, hydrocarbons, Nickel)
  • air pollution
  • Radiation (environmental radon
  • Diesel exhaust
  • pulmonary fibrosis
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3
Q

How much of lung cancer is attritable to tobacco?

A

Over 85%

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4
Q

What percentage of smokers get lung cancer?

A

10%

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5
Q

What percentage of non-smoking lung cancers are caused by passive smoking?

A

At least 25%

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6
Q

Why does tobacco smoke cause lung cancer?

A
  • Epithelial effects
  • Multi-hit theory in carcinogenesis
  • Host activation of pro-carcinogens
  • Inherited polymorphisms predispose to metabolism of pro-carcinogens, nicotine addiction
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7
Q

How does adenocarcinoma arise in the lung?

A

Bronchoalveolar epithelial stem cells transform

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8
Q

How does squamous cell carcinoma arise from?

A

Bronchial epithelial stem cells transform

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9
Q

Where about do you see adenocarcinoma and squamous cell carcinoma?

A

Adenocarcinoma - Lung periphery

Squamous cell carcinoma - Central lung airways

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10
Q

Which oncogene is activated by smoking?

A

KRAS

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11
Q

What are the other important oncogenes that give rise to lung cancer?

A

EGFR BRAF HER2 ALK rearrangements

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12
Q

What are the common tumours of the lung?

A
  • Carcinoid tumour (less than 5% of lung neoplasms, low grade malignancy)
  • Benign causes of mass lesion
  • Tumours of bronchial glands (V RARE, adenoid cystic carcinoma, mucoepidermoid carcinoma, benign adenomas)
  • Lymphoma
  • Sarcoma
  • Metastesis to lung are common
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13
Q

What are the 4 main types of lung cancer?

A
  • Squamous cell
  • Adenocarcinoma
  • Small cell carcinoma
  • Large cell carcinoma
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14
Q

What is an adenocarcinoma in situ?

A

Bronchioalveolar cell carcinoma (subtype of adenocarcinoma)

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15
Q

What are carcinoid tumours?

A

Rare cancer of neuroendocrine system (system that produces hormones)

Tumour usually grows in bowels or appendix, can be found in stomach, pancreas, lung, breast, kidney, ovaries, testicles.

Grows very slowly

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16
Q

What is the difference in incidence between Small cell carcinoma and Non-small cell carcinoma

A

Small cell carcinoma - 15%

Non-small cell carcinoma - 85%

(Non-small cell carcinoma - adenocarcinoma, squamous cell carcinoma, large cell carcinoma)

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17
Q

What does symptomatic lung cancer indicate?

A

Late presentation, if symptomatic Usually fatal

18
Q

When does primary lung cancer present itself?

A

Late in natural history, grows clinically silent for many years

19
Q

What are the local effects of bronchial obstruction caused by lung cancer?

A
  • Lung Collapse
  • Endogenous lipoid pneumonia
  • Infection / abscess
  • Bronchiestasis
20
Q

What is endogenous lipoid pneumonia?

A

Lipids enter bronchial tree (result of localised accumulation of lipid laden macrophages within alveolar spaces distal to an obstructed airway)

21
Q

What are the local pleural effects caused by lung cancer?

A
  • Inflammation (fibrosis, irritation, effusion)
  • Malignant invasion
22
Q

What are the direct invasions caused by lung cancer?

A
  • Into chest wall
  • Nerves
  • Madiastinum (superior vena cava and pericardium)
  • Lymph nodes
23
Q

What are the local effects of cancer on the nerves?

A
  1. Phrenic – diaphragmatic paralysis
  2. L Recurrent laryngeal – Hoarse, Bovine cough
  3. Brachial plexus – Pancoast T1 damage
  4. Cervical Sympathetic - Horner’s syndrome
  5. Phrenic n. (C3-C5)-> diaphragm paralysis
  6. Left recurrent laryngeal nerve in left central lung cancer – hoarseness
  7. Brachial plexus (C5-T1) in Pancoast tumour- apices- hand symptoms
  8. Cervical sympathetic ganglia – Horner’s syndrome (anhidrosis, ptosis, miosis)
24
Q

What is Horner’s syndrome?

A

Disruption of nerve pathway from brain to face and eye on one side of body

Decreases pupil size, drooping eyelid, decreased sweating on affected side

25
Q

What are the local effects of cancer on the mediastinum?

A
  1. SVC obstruction- veins in upper limb engorged when raised above heart height- risk of cerebral oedema
  2. Pericardium
26
Q

What is the outcome from lymph node metastasis?

A

Lymphangitis carcinomatosa

(hilar, Bronchial LN)

27
Q

What are the distant effects of lung cancer?

A

Distant metastases (liver, adrenals, bone, brain, skin)

Secondary to local effects (neural, vascular)

Non- metastatic effects

28
Q

What are the symptoms of paraneoplastic syndromes?

A
  • Chronic cough (> 3 weeks)
  • Wheeze
  • Sob
  • Hoarseness
  • Haemoptysis
  • Difficulty swallowing
  • Chest/bone pain (hypertrophic pulmonary osteoarthropathy)
  • Unexplained weight loss
  • Nail clubbing
29
Q

What are the signs of paraneoplastic syndromes

A
  • Clubbing
  • Supraclavicular lymphadenopathy
  • Horner’s syndrome
  • SVC obstruction
  • Hepatomegaly
  • Skin nodules
30
Q

What are the non-metastaic paraneoplastic effects of lung cancer?

A
31
Q

What are the non-metastatic paraneoplastic effects of lung cancer, that are endocrine and caused by small cell cancers?

A

ACTH

siADH

32
Q

What are the non-metastatic paraneoplastic effects of lung cancer, that are endocrine and caused by squamous cell cancers?

A

PTH

33
Q

What are the lung cancer investigations?

A
  • CXR
  • Sputum Cytology (rarely used)
  • Bronchoscopy - Bronchial biopsy, brushings and Washings–Endobronchial US-guided aspiration (EBUS)
  • Trans-thoracic Fine Needle Aspiration
  • Trans-thoracic Core Biopsy
  • Pleural effusion cytology and Biopsy
  • Advanced Imaging Techniques - CT scanning, MRI, PET scanning, Other imaging
34
Q

What are the proognostic factors in lung cancer?

A

Stage of disease

Classification: Type of Disease

  • Markers / Oncogenes / Gene expression profiles

Prognostic markers MIGHT be used to select patients for ADJUVANT therapy

35
Q

What percentage of patients in Scotland with Lung cancer get surgical treatment?

A

10%

36
Q

What is 5 year survival rate for non-small cell carcinomas?

A

10-25%

37
Q

What is the 5 year survival rate of small cell carcinomas?

A

4%

38
Q

What is the average survival rate for small cell carcinoma?

A

9 months

39
Q

What is used after the diagnosis to select patients for therapy?

A

Predictive biomarkers:

  • Adenocarcinoma
  • EGFR, KRAS, HER2, BRAF mutations
  • ALK translocations, ROS1 translocations

Squamous Cell

  • Little or no effective molecular targeted therapy
40
Q

What is an immune checkpoint inhibitor?

A

Drug that prevents passage past checkpoint, immune checkpoints control immune reactions

41
Q

Give examples of how cancer cells avoid immune destruction

A

PD1, PD-L1

Respiratory (30 decks)

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