Pathology of Pulmonary Neoplasia Flashcards
What is the most common cause of death by cancer?
Lung Cancer
What are the Aetiologies for lung cancer?
Tobacco Asbestons Environmental Radon Other occupational exposure (chromates, hydrocarbons, Nickel) Air pollution and urban environment Other radiation Pulmonary firosis
How much of lung cancer is attritable to tobacco?
Over 85%
What percentage of smokers get lung cancer?
10%
What percentage of non-smoking lung cancers are caused by passive smoking?
At least 25%
Why does tobacco smoke cause lung cancer?
Epithelial effects Multi-hit theory in carcinogenesis Host activation of pro-carcinogens - Inherited polymorphisms predispose (metabolism of pro-carcinogens, nicotine addiction)
How does adenocarcinoma arise in the lung?
Bronchoalveolar epithelial stem cells transform
How does squamous cell carcinoma arise from?
Bronchial epithelial stem cells transform
Where about do you see adenocarcinoma and squamous cell carcinoma?
Adenocarcinoma - In the lung periphery Squamous cel carcinoma - Central lung airways
Which oncogene is activated by smoking?
KRAS
What are the other important oncogenes that give rise to lung cancer?
EGFR BRAF HER2 ALK rearrangements
What are the common tumours of the lung?
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
What are the 4 main types of lung cancer?
Squamous cell Adenocarcinoma Small cell carcinoma Large cell carcinoma
What is an adenocarcinoma in situ?
Bronchioalveolar cell carcinoma (subtype of adenocarcinoma)
What are carcinoid tumours?
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
What is the difference in incidence between Small cell carcinoma and (Adenocarcinoma, squamous cell carcinoma, large cell carcinoma)
15% - 85%
What does symptomatic lung cancer indicate?
Usually fatal
When does primary lung cancer present itself?
Late in its natural history, grows clinically silent for many years
What are the local effects of bronchial obstruction caused by lung cancer?
Bronchial obstruction: - Collapse - Endogenous lipoid pneumonia - Infection / abscess - Bronchiestasis
What is endogenous lipoid pneumonia?
when lipids enter the bronchial tree (the result of localised accumulation of lipid laden macrophages within alveolar spaces distal to an obstructed airway?)
What are the local pleural effects caused by lung cancer?
Inflammation Malignancy
What are the direct invasions caused by lung cancer?
Into the chest wall Nerves Madiastinum (superior vena cava and pericardium) Lymph nodes
What are the local effects of cancer on the nerves?
Diaphragmatic paralysis (phrenic nerve) Hoarse bovine cough (L recurrent laryngeal) Pancoast 1 damage - brachial plexus Horner’s syndrome - cervical sympathetic nerves
What is Horner’s syndrome?
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.
What is the outcome from lymph node metastasis?
Lymphangitis carcinomatosa
What are the distant effects of lung cancer?
Distant metastases (liver, adrenals, bone, brain, skin) Secondary to local effects (neural, vascular) Non- metastatic effects
What are the non-metastaic paraneoplastic effects of lung cancer?
What are the non-metastatic paraneoplastic effects of lung cancer, that are endocrine and caused by small cell cancers?
What are the non-metastatic paraneoplastic effects of lung cancer, that are endocrine and caused by squamous cell cancers?
What are the lung cancer investigations?
What are the proognostic factors in lung cancer?
Stage of disease
Classification: Type of Disease
Markers / Oncogenes / Gene expression profiles
•Prognostic markers MIGHT be used to select patients for ADJUVANT therapy
What percentage of patients in Scotland with Lung cancer get surgical treatment?
10%
What is 5 year survival rate for non-small cell carcinomas?
Anywhere betweeen 10-25%
What is the 5 year survival rate of small cell carcinomas?
4%
What is the average survival rate for small cell carcinoma?
9 months
What is used after the diagnosis to select patients for therapy?
Predictive biomarkers,
What is an immune checkpoint inhibitor?
A drug which prevents passage past a checkpoint, immune checkpoints control immune reactions
Give examples of how cancer cells avoid immune destruction
PD1, PD-L1
