Pathology of Pulmonary Neoplasia

Question 1

Give 3 causes of lung cancer

Answer 1

• Tobacco
• asbestos/occupational exposure
• environmental radon/radiation/pollution
• pulmonary fibrosis

Question 2

What pulmonary epithelium does tobacco smoke affect?

Answer 2

• Central bronchial epithelium

- Peripheral lung epithelium

Question 3

Inherited polymorphisms predispose what?

Answer 3

• Metabolism of pro-carcinogens

- nicotine addiction

Question 4

How many main pathways of carcinogenesis are there in the lung?

Answer 4

2

Question 5

What are the main pathways of carcinogenesis in the lung?

Answer 5

• lung periphery

- central lung airways

Question 6

What cells are transformed in the carcinogenesis of the lung periphery?

Answer 6

Bronchioloalveolar epithelial stem cells

Question 7

What cells are transformed in the carcinogenesis of the central lung airways?

Answer 7

Bronchial epithelial stem cells

Question 8

What are the most common type of lung cancer in non-smokers?

Answer 8

Adenocarcinoma

Question 9

What type of lung cancer is strongly associated with smoking?

Answer 9

Squamous cell carcinoma

Question 10

What gene is commonly smoking induced in Adenocarcinogenesis?

Answer 10

KRAS

Question 11

What 3 genes are mutated in adenocarcinogenesis that are not related to tobacco carcinogenesis?

Answer 11

• BRAF
• HER2
• ALK

Question 12

Carcinoid tumours are tumours with a low grade

Answer 12

malignancy

Question 13

Are metastases to the lung common or uncommon?

Answer 13

Common

Question 14

What four main cell types are mutated in carcinoma of the lung?

Answer 14

• squamous cell
• adenocarcinoma
• small cell carcinoma
• large cell carcinoma

Question 15

What histological type of lung carcinoma is most common?

Answer 15

Non-small cell carcinoma (NSCLC)

Question 16

Primary lung cancer presents when in its natural history?

Answer 16

Late

Question 17

Signs and symptoms of primary lung cancer may not show until the disease is very

Answer 17

advanced

Question 18

Give an effect that lung cancer might cause

Answer 18

• Bronchial obstruction
• Pleural
• Direct invasion
• Lymph node metastases

Question 19

Give an example of a bronchial obstruction

Answer 19

• collapse
• endogenous lipoid pneumonia
• infection/abscess
• bronchiectasis

Question 20

Pleural involvement in lung cancer is more likely to be treated and curable with surgery if it is

Answer 20

Inflammatory

Question 21

Give a nerve that is likely to be affected by direct invasion of lung cancer

Answer 21

• phrenic
• left recurrent laryngeal
• brachial plexus
• cervical sympathetic

Question 22

Distant metastases from the lung is most likely to spread where?

Answer 22

• liver
• adrenal glands
• bone
• brain
• skin

Question 23

Give 3 classes of non-metastatic paraneoplastic effects of lung cancer

Answer 23

• skeletal
• endocrine
• neurological
• cutaneous
• haematologic
• cardiovascular
• renal

Question 24

Other than imaging techniques, what investigations can be done in suspected lung cancer?

Answer 24

• bronchoscopy
• trans-thoracic fine needle aspiration
• trans-thoracic core biopsy

Question 25

What are the two main prognostic factors in lung cancer?

Answer 25

Stage and classification of disease

Question 26

Rather than curing cancer, non-operable treatment

Answer 26

prolongs life

Question 27

How do tumours avoid destruction by our immune system?

Answer 27

Tumours “switch off” immune system using immune checkpoints