Pathology of pulmonary neoplasia

Question 1

What type of cancer kills the most worldwide?

Answer 1

Lung cancer

Question 2

What is the 3rd most common cancer?

Answer 2

Lung cancer

Question 3

What % of all deaths in Scotland is due to lung cancer?

Answer 3

6%

Question 4

What causes lung cancer?

Answer 4

Tobacco
Asbestos
Environmental radon
Occupational exposure - chromates, nicker
Air pollution
Radiation 
Pulmonary fibrosis

Question 5

What % of lung cancers are attributable to smoking?

Answer 5

85%

Question 6

What % of smokers get lung cancer?

Answer 6

10%

Question 7

How many recognised carcinogens are there is cigarette smoke?

Answer 7

60 e.g. polycyclic aromatic hydrocarbons

Question 8

Which lung cancer is most associated with smoking and central lung pathogenesis?

Answer 8

Squamous cell carcinoma following transformation of bronchial epithelial cells

Question 9

What are some key gene mutations in lung cancer?

Answer 9

KRAS (smoking induced)
EGFR
BRAF/HER2
ALK rearrangements

Question 10

What type of lung cancer is more likely to cause bronchial obstruction?

Answer 10

Squamous carcinoma

Question 11

What can result from bronchial obstruction by a tumour?

Answer 11

Collapse
Endogenous lipoid pneumonia 
Infection
Abscesses
Bronchiectasis

Question 12

What can result from tumour invasion of the phrenic nerves?

Answer 12

Diaphragmatic paralysis

Question 13

What can result from tumour invasion of the left recurrent laryngeal nerve?

Answer 13

hoarse voice, bovine cough

Question 14

What can result from tumour invasion of the brachial plexus?

Answer 14

Pancoast T1 damage, neurological symptoms of the affected arm

Question 15

What can result from tumour invasion of the cervical sympathetic ganglion?

Answer 15

Horners syndrome - drooping eyelid (ptosis), constricted pupil, no sweating on affected side

Question 16

Name some skeletal non-metastatic paraneoplastic effects of lung cancer

Answer 16

Finger clubbing with soft nail beds

Hypertrophic pulmonary osteoarthropathy

Question 17

What is hypertrophic pulmonary osteoarthropathy?

Answer 17

Clubbing and periostitis (inflammation of periosteum, outer layer of all bones) which is most noticeable on wrists and ankles

Question 18

Name some endocrine non-metastatic paraneoplastic effects of lung cancer

Answer 18

ACTH
SIADH - syndrome of inapp. ADH secretion
Carcnoid syndrome
Gynecomastia

Question 19

What is carcinoid syndrome?

Answer 19

Flushing, diarrhoea, HF and bronchoconstriction caused by endogenous secretion of serotonin and kallikrein

Question 20

Name some neurological non-metastatic paraneoplastic effects of lung cancer

Answer 20

Polyneuropathy
Encephalopathy
Cerebral degeneration
Lambert Eaton syndrome

Question 21

Name some cutaneous non-metastatic paraneoplastic effects of lung cancer

Answer 21

Acanthosis nigricans - dark spots, in folds

Dermatomyositis - inflam. muscles and skin

Question 22

Name some haematological non-metastatic paraneoplastic effects of lung cancer

Answer 22

Granulocytosis
Eosinophilia
Disseminated intravascular coagulation

Question 23

Name a cardiovascular non-metastatic paraneoplastic effects of lung cancer

Answer 23

Thrombophlebitis migrans: vein inflammation

Question 24

Name a renal non-metastatic paraneoplastic effects of lung cancer

Answer 24

Nephrotic syndrome: signs of nephrosis, particularly proteinuria, hypoalbuminaemia and oedema

Question 25

Name 3 checkpoint inhibitors and their targets

Answer 25

Nivolumab - anti-PD1
Ipilimumab - anti-CTLA4
Atezolizumab - anti-PDL1