Pathology of pulmonary neoplasia Flashcards
What type of cancer kills the most worldwide?
Lung cancer
What is the 3rd most common cancer?
Lung cancer
What % of all deaths in Scotland is due to lung cancer?
6%
What causes lung cancer?
Tobacco Asbestos Environmental radon Occupational exposure - chromates, nicker Air pollution Radiation Pulmonary fibrosis
What % of lung cancers are attributable to smoking?
85%
What % of smokers get lung cancer?
10%
How many recognised carcinogens are there is cigarette smoke?
60 e.g. polycyclic aromatic hydrocarbons
Which lung cancer is most associated with smoking and central lung pathogenesis?
Squamous cell carcinoma following transformation of bronchial epithelial cells
What are some key gene mutations in lung cancer?
KRAS (smoking induced)
EGFR
BRAF/HER2
ALK rearrangements
What type of lung cancer is more likely to cause bronchial obstruction?
Squamous carcinoma
What can result from bronchial obstruction by a tumour?
Collapse Endogenous lipoid pneumonia Infection Abscesses Bronchiectasis
What can result from tumour invasion of the phrenic nerves?
Diaphragmatic paralysis
What can result from tumour invasion of the left recurrent laryngeal nerve?
hoarse voice, bovine cough
What can result from tumour invasion of the brachial plexus?
Pancoast T1 damage, neurological symptoms of the affected arm
What can result from tumour invasion of the cervical sympathetic ganglion?
Horners syndrome - drooping eyelid (ptosis), constricted pupil, no sweating on affected side
Name some skeletal non-metastatic paraneoplastic effects of lung cancer
Finger clubbing with soft nail beds
Hypertrophic pulmonary osteoarthropathy
What is hypertrophic pulmonary osteoarthropathy?
Clubbing and periostitis (inflammation of periosteum, outer layer of all bones) which is most noticeable on wrists and ankles
Name some endocrine non-metastatic paraneoplastic effects of lung cancer
ACTH
SIADH - syndrome of inapp. ADH secretion
Carcnoid syndrome
Gynecomastia
What is carcinoid syndrome?
Flushing, diarrhoea, HF and bronchoconstriction caused by endogenous secretion of serotonin and kallikrein
Name some neurological non-metastatic paraneoplastic effects of lung cancer
Polyneuropathy
Encephalopathy
Cerebral degeneration
Lambert Eaton syndrome
Name some cutaneous non-metastatic paraneoplastic effects of lung cancer
Acanthosis nigricans - dark spots, in folds
Dermatomyositis - inflam. muscles and skin
Name some haematological non-metastatic paraneoplastic effects of lung cancer
Granulocytosis
Eosinophilia
Disseminated intravascular coagulation
Name a cardiovascular non-metastatic paraneoplastic effects of lung cancer
Thrombophlebitis migrans: vein inflammation
Name a renal non-metastatic paraneoplastic effects of lung cancer
Nephrotic syndrome: signs of nephrosis, particularly proteinuria, hypoalbuminaemia and oedema
Name 3 checkpoint inhibitors and their targets
Nivolumab - anti-PD1
Ipilimumab - anti-CTLA4
Atezolizumab - anti-PDL1
