Pathology Of Respiratory Disease

Question 1

What is a primary tumour?

Answer 1

It can be benign (rare) or malignant (v.common).
If it’s benign its a singular cancerous growth.
If it’s malignant its a cancerous growth that has spread but the primary malignant tumour is the origin site

Question 2

Is metastatic lung cancer common?

Answer 2

Yes very common

Question 3

Mortality of lung cancer?

Answer 3

90% mortality 1 year after diagnosis

Question 4

How common is lung cancer?

Answer 4

Commonest cause of cancer death (33%) in men.

Male incidence down 15%, female up 13% over 10 years

Question 5

Risk factors for lung cancer?

Answer 5

• smoking
• asbestos
• nickel
• chromates (not typically relevant but can be depending on the job e.g. mining)
• radiation
• atmospheric pollution
• genetics

Question 6

What is the simplest type of lung cancer classification?

Answer 6

-Small cell
&
-Non-small cell

Question 7

Which is worse; small cell lung cancer or non-small cell lung cancer?

Answer 7

Small cell
-almost all dead in one
year
But NB NSCLC is worse than squamous or adenocarcinoma

Question 8

Treatment of lung cancer?

Answer 8

Small cell=chemosensitive (but with rapidly emerging resistance)
Surgery=1st choice for other types

Question 9

Briefly explain new ‘targeted’ treatments based on pathologically identified abnormal DNA or other markers in tumour

Answer 9

Differing NSCLC regimens for squamous cell & adenocarcinoma
e.g. Pemetrxed
shouldn’t be used
to treat squamous
carcinoma
Problem: difficulty in subtyping tumours on small biopsies, immunohistochemistry helps

Question 10

What do we mean by immunohistochemistry?

Answer 10

Examples in NSCLC:

• adenocarcinoma expresses thyroid transcription factor 1 (TTF 1)
• SCC expresses nuclear antigen p63 and high molecular wt. cytokeratins