Pathology of Pulmonary Neoplasia

Question 1

What is the most common cause of death by cancer?

Answer 1

Lung Cancer

Question 2

What are the Aetiologies for lung cancer?

Answer 2

Tobacco Asbestons Environmental Radon Other occupational exposure (chromates, hydrocarbons, Nickel) Air pollution and urban environment Other radiation Pulmonary firosis

Question 3

How much of lung cancer is attritable to tobacco?

Answer 3

Over 85%

Question 4

What percentage of smokers get lung cancer?

Answer 4

10%

Question 5

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

Answer 5

At least 25%

Question 6

Why does tobacco smoke cause lung cancer?

Answer 6

Epithelial effects Multi-hit theory in carcinogenesis Host activation of pro-carcinogens - Inherited polymorphisms predispose (metabolism of pro-carcinogens, nicotine addiction)

Question 7

How does adenocarcinoma arise in the lung?

Answer 7

Bronchoalveolar epithelial stem cells transform

Question 8

How does squamous cell carcinoma arise from?

Answer 8

Bronchial epithelial stem cells transform

Question 9

Where about do you see adenocarcinoma and squamous cell carcinoma?

Answer 9

Adenocarcinoma - In the lung periphery Squamous cel carcinoma - Central lung airways

Question 10

Which oncogene is activated by smoking?

Answer 10

KRAS

Question 11

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

Answer 11

EGFR BRAF HER2 ALK rearrangements

Question 12

What are the common tumours of the lung?

Answer 12

Carcinoid tumour (less than 5% of lung neoplasms, low grade malignancy) Benign causes of mass lesion Tumours of bronchial glands (VV RARE) (Includes adenoid cystic carcinoma, mucoepidermoid carcinoma, benign adenomas) Lymphoma Sarcoma Metasteses to the lung are common

Question 13

What are the 4 main types of lung cancer?

Answer 13

Squamous cell Adenocarcinoma Small cell carcinoma Large cell carcinoma

Question 14

What is an adenocarcinoma in situ?

Answer 14

Bronchioalveolar cell carcinoma (subtype of adenocarcinoma)

Question 15

What are carcinoid tumours?

Answer 15

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

Question 16

What is the difference in incidence between Small cell carcinoma and (Adenocarcinoma, squamous cell carcinoma, large cell carcinoma)

Answer 16

15% - 85%

Question 17

What does symptomatic lung cancer indicate?

Answer 17

Usually fatal

Question 18

When does primary lung cancer present itself?

Answer 18

Late in its natural history, grows clinically silent for many years

Question 19

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

Answer 19

Bronchial obstruction: - Collapse - Endogenous lipoid pneumonia - Infection / abscess - Bronchiestasis

Question 20

What is endogenous lipoid pneumonia?

Answer 20

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

Question 21

What are the local pleural effects caused by lung cancer?

Answer 21

Inflammation Malignancy

Question 22

What are the direct invasions caused by lung cancer?

Answer 22

Into the chest wall Nerves Madiastinum (superior vena cava and pericardium) Lymph nodes

Question 23

What are the local effects of cancer on the nerves?

Answer 23

Diaphragmatic paralysis (phrenic nerve) Hoarse bovine cough (L recurrent laryngeal) Pancoast 1 damage - brachial plexus Horner’s syndrome - cervical sympathetic nerves

Question 24

What is Horner’s syndrome?

Answer 24

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.

Question 25

What is the outcome from lymph node metastasis?

Answer 25

Lymphangitis carcinomatosa

Question 26

What are the distant effects of lung cancer?

Answer 26

Distant metastases (liver, adrenals, bone, brain, skin) Secondary to local effects (neural, vascular) Non- metastatic effects

Question 27

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

Answer 27

Question 28

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

Answer 28

Question 29

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

Answer 29

Question 30

What are the lung cancer investigations?

Answer 30

Question 31

What are the proognostic factors in lung cancer?

Answer 31

Stage of disease

Classification: Type of Disease

Markers / Oncogenes / Gene expression profiles

•Prognostic markers MIGHT be used to select patients for ADJUVANT therapy

Question 32

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

Answer 32

10%

Question 33

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

Answer 33

Anywhere betweeen 10-25%

Question 34

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

Answer 34

4%

Question 35

What is the average survival rate for small cell carcinoma?

Answer 35

9 months

Question 36

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

Answer 36

Predictive biomarkers,

Question 37

What is an immune checkpoint inhibitor?

Answer 37

A drug which prevents passage past a checkpoint, immune checkpoints control immune reactions

Question 38

Give examples of how cancer cells avoid immune destruction

Answer 38

PD1, PD-L1