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Respiratory System > Pathology of Pulmonary Neoplasia > Flashcards

Pathology of Pulmonary Neoplasia Flashcards

1
Q

What is the most common death by cancer worldwide?

A

Lung cancer

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2
Q

What is the biggest cause of lung cancer?

A

Tobacco

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3
Q

What are causes of lung cancer apart from tobacco?

A
  • Asbestos
  • Environmental radon
  • Occupational exposure
  • Air pollution and urban environment
  • Other radiation
  • Pulmonary fibrosis
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4
Q

What is the increased risk of lung cancer caused by smoking in males and females?

A

RISK of cancer INCREASED 22 times in males and 12 times in females

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5
Q

How does passive smoking increase risk of lung cancer?

A

-50-100% increased risk
- Causes at least 25% of so-called non-smoking
lung cancers

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6
Q

Does stopping smoking stop your risk of lung cancer?

A

NO

- Risk reduces with abstinence but only slowly.

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7
Q

What is the main carcinogen in tobacco likely to give you Adenocarnomas?

A

N-nitrosamines

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8
Q

What is the main carcinogen in tobacco likely to give you Squamous SCLC?

A

Polycyclic aromatic hydrocarbons (PAH)

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9
Q

What are the 2 main pathways of carcinogenesis in the lung?

A

In the lung periphery and in the central lung airways

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10
Q

How does carcinogenesis occur in the lung periphery?

A

Bronchioalveolar epithelial stem cells transform causing Adenocarcinoma.

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11
Q

How does carcinogenesis occur in the central lung airways?

A

Bronchial epithelial stem cells transform causing Squamous cell carcinoma.

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12
Q

What kind of cancer is most lung cancers?

A

They are an adenocarcinoma in the peripheral of the lung

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13
Q

What is the carcinoma sequence of peripheral lung adenocarcinogenesis?

A

Atypical adenomatous hyperplasia (AAH) > Adenocarcinoma in situ > Invasive adenocarcinoma

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14
Q

What oncogene is mainly smoking induced?

A

KRAS

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15
Q

Which oncogenes are not related to tobacco carcinogenesis?

A
  • EGFR
  • BRAF, HER2
  • ALK rearrangements
  • ROS1 gene rearrangements
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16
Q

What are the different types of tumours of the lung?

A
  • Benign causes of mass lesion
  • Carcinoid tumour
  • Tumours of bronchial glands: very rare
  • Lymphoma
  • Sarcoma
  • METASTASES to lung are common
17
Q

What are the 4 main types of carcinoma?

A
  • Squamous cell
  • Adenocarcinoma (most likely)
  • Small cell carcinoma
  • Large cell carcinoma
18
Q

Which carcinomas are non-small cell carcinomas (NSCLC)?

A
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell carcinomas
  • Others
19
Q

Which carcinoma has increased in number of cases in Scotland?

A

Adenocarcinoma

20
Q

Features of primary lung cancer

A
  • Probably grows ‘clinically silent’ for many years
  • Presents late in its natural history
  • Generally speaking, symptomatic lung cancer is fatal.
21
Q

Small cell carcinoma

A
  • Comprises about 10-15% of lung cancers.
  • This type is the most aggressive and rapidly growing.
  • It is strongly related to cigarette smoking.
22
Q

Local effects of lung cancer

A
  • Bronchial Obstruction
  • Pleural
  • Direct Invasion
  • Lymph node metastases
23
Q

Features of bronchial obstruction local effects

A
  • Collapse
  • Endogenous lipoid pneumonia
  • Infection/abscess
  • Bronchiectasis
24
Q

Features of pleural local effects

A
  • Inflammatory

- Malignant

25
Q

Features of direct invasion local effects

A
  • Chest wall
  • Nerves:
    Phrenic-diaphragmatic paralysis

L recurrent laryngeal -hoarse, bovine cough

Brachial plexus-pancoast T1 damage

Cervical Sympathetic-horner’s syndrome

-Mediastinum (SVS, Pericardium)

26
Q

Features of lymph node metastases local effects

A
  • Mass effect

- Lymphangitis carcinomatosa

27
Q

Distant effects of lung cancer

A
  • Distant metastases: liver, adrenals, bone, brain, skin.
  • Secondary to local effects: Neural, vascular.
  • Non-metastatic effects
28
Q

Non-Metastatic Paraneoplastic Effects of small cell carcinoma

A
  • ACTH, SIADH
29
Q

Non-Metastatic Paraneoplastic Effects of squamous cell carcinoma

30
Q

Non-metastatic effects of lung cancer

A

Finger clubbing and Hypertrophic pulmonary osteoartgropathy (HPOA)

31
Q

Investigation techniques for lung cancer

A
  • Chest X-ray
  • Sputum Cytology rarely used
  • Bronchoscopy
  • Trans-thoracic Fine Needle Aspiration
  • Trans-thoracic Core Biopsy
  • Pleural effusion cytology and Biopsy
  • Advanced imaging techniques e.g. CT scan
32
Q

What can prognostic markers be used for?

A

TO select patients for ADJUVANT therapy

33
Q

What is the PD1/PD-L1 axis immune checkpoint in NSCLC?

A
  • A therapeutic target

- An important biomarker

34
Q

What are predictive biomarkers used for after diagnosis?

A

They will increasingly be used to select patients for therapy

  • Adenocarcinoma e.g. EGFR, KRAS, HER2, BRAF mutations, ALK translocations etc.
  • Squamous cell
  • Immunotherapy in NSCLC has transformed practice.
35
Q

What are the immune checkpoints adopted by tumours to avoid immune destruction?

A

PD1
PD-L1
CTLA4

Respiratory System (28 decks)

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