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BLOCK B - RESPIRATION > Pulmonary Carcinoma > Flashcards

Pulmonary Carcinoma Flashcards

1
Q

What is the second most common cancer in Canada?

A

Lung cancer

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2
Q

What is the leading cause of cancer death in both males and females? How many males and females will suffer from this disease?

A

Lung cancer

1/11 males 1/15 females will have lung cancer in their lifetime

1/13 males and 1/18 females will die from lung cancer

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3
Q

The incidence rate of lung cancer is higher in….
a) men
b) women

A

a) men

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4
Q

How has the incidence rate of lung cancer changed over the years?

A

In men, IR decreased since the mid 80s
In women, IR increased until 2006

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5
Q

What is the main cause of lung cancer?

A

Cigarette smoking (tobacco): the proportion of lung cancer cases attributable to smoking is of the order of 85-90%

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6
Q

What percentage of lung cancer cases occurs in non-smokers?

A

10-15%

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7
Q

Other than smoking, what are some other risk factors for lung cancer? (4)

A

Air pollution
Radon
Asbestos
Other chemicals (arsenic, nickel)

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8
Q

What are the two main types of lung cancer? What are the subtypes?

A
  1. Small cell carcinoma (15% of all lung cancers)
  2. Non-small cell carcinoma (85% of all lung cancers)
    * Adenocarcinoma
    * Squamous cell carcinoma
    * Large cell carcinoma
    * Pulmonary carcinoid tumours
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9
Q

Define squamous cell carcinoma

A

Malignant epithelial tumour that either shows keratinization or intercellular bridges (or expresses immunohistochemical markers of squamous differentiation p40 and CK5/6)

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10
Q

Squamous cell carcinoma is strongly associated with…

A

Smoking

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11
Q

What can decrease incidence of squamous cell carcinoma?

A

Change in smoking patterns

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12
Q

Describe what you would see in imaging/macroscopy for squamous cell carcinoma (tumour features) (3)

A
  • Tumours grow proximally, near bronchi
  • Tumour may grow intraluminally resulting in airway obstruction
  • Locally aggressive, large tumours with central necrosis and cavitation
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13
Q

Squamous cell carcinoma tumours may grow and invade… (2)

A

other organs of the mediastinum and the chest wall soft tissue

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14
Q

What is the hallmark of squamous cell carcinoma? How can we recognize poorly differentiated squamous cell carcinoma?

A

The hallmark of well-differentiated squamous cell carcinomas is keratinization (malignant squamous cells produce keratin) and intercellular bridges.

If the carcinoma is poorly differentiated (non-keratinizing, esp. in small biopsies and cytology specimens), we look for immunohistochemical markers of squamous differentiation: p40, CK5/6

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15
Q

What is the biomarker of squamous cell carcinoma?

A

The only biomarker is not associated with the development of the disease in itself. We only know that expression of PD-L1 is associated with a positive response to immunotherapy.

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16
Q

When are the immunohistochemical markers used to identify squamous cell carcinoma? What are they

A

To detect poorly differentiated carcinomas (non keratinizing, especially in small biopsies and cytology specimens). The immunohistochemical markers of squamous cell carcinomas are p40 and CK5/6.

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17
Q

What are some pre-invasive features of squamous cell carcinomas?

A

A continuum: dysplasia (abnormal cell growth), followed by carcinoma in situ (confined to the epithelial layer without breaching the basement membrane).

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18
Q

Define adenocarcinoma

A

Malignant epithelial tumour involving glands in the lung (glandular differentiation), characterized by mucin production (or pneumocyte marker expression TTF-1 and Napsin A)

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19
Q

What is the most common type of lung carcinoma (and most common type of non-small cell carcinoma)?

A

Adenocarcinoma

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20
Q

What percentage of adenocarcinomas is seen in non-smokers?

A

In North America, less than 15% of adenocarcinomas is seen in non-smokers. However, in Asia, close to 50% of adenocarcinomas is seen in non-smokers.

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21
Q

What would we see in imaging/macroscopy of adenocarcinoma (tumour features)? (2)

A
  • Tumours occur on the periphery of the lungs (away from the hilum)
  • Tumours have grey nodules with scarring, anthracotic (black) pigmentation and a poorly defined border
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22
Q

What is a characteristic pattern of non-invasive adenocarcinoma in situ?

A

Lepidic architecure (may be difficult to discern o macroscopy)

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23
Q

When an adenocarcinoma becomes invasive, what structure is usually first invaded by adenocarcinoma?

A

Visceral pleura

24
Q

Name the 5 characteristic patterns associated with adenocarcinoma tumours

A
  1. Acinar
  2. Papillary
  3. Micropapillary
  4. Lepidic
  5. Solid
25
What are some pre-invasive features of adenocarcinomas?
A continuum: - atypical adenomatous hyperplasia (AAH) - adenocarcinoma in situ - minimally invasive adenocarcinoma All 3 entities are less than 3 cm
26
What are some molecular biomarkers of adenocarcinoma?
3 genes: EGFR, ALK, ROS1 Mutations in these genes are linked with adenocarcinoma PD-L1 expression is associated with response to immunotherapy
27
What mainly determines the prognosis of adenocarcinoma?
The prognosis is mainly linked with the pTNM stage of the adenocarcinoma
28
What can increase the risk of local recurrence of adenocarcinoma? What type of procedure should be prioritized in these cases?
Solid and micropapillary patterns (surgeons should choose lobectomy over wedge resection)
29
What are the 2 most aggressive patterns of adenocarcinoma?
Micropapillary pattern and solid pattern
30
For poorly differentiated carcinomas, how do we differentiate adenocarcinoma from large cell carcinoma or squamous cell carcinoma?
We need to identify immunohistochemical markers of glandular differentiation like pneumocyte TTF1 and Napsin A
31
Name two cancers characterized by neuroendocrine tumours
Small cell carcinoma Carcinoid tumours *Note that they are not associated - one does not lead to another*
32
What are neuroendocrine tumours?
Diverse group of neoplasms that originate from neuroendocrine cells (distinct family of tumours with shared morphological, immunohistochemical and molecular features)
33
What are the 4 categories of neuroendocrine tumours?
1. Small cell carcinoma 2. Large cell neuroendocrine carcinoma 3. Typical carcinoids 4. Atypical carcinoids *1 and 2 are high grade tumours, while 3 and 4 are intermediate/low grade tumours*
34
Associate the cancer with the correct description Small cell carcinoma a) high grade tumour b) low grade tumour Typical carcinoid tumour a) high grade tumour b) low grade tumour
Small cell carcinoma: high grade tumour Typical carcinoid tumour: low grade tumour
35
Define small cell carcinoma
Malignant epithelial tumour that consists of small cells with scant cytoplasm, finely dispersed chromatin and absent or inconspicuous nucleoli.
36
What type of lung cancer has the strongest association with smoking?
Small cell carcinoma
37
Describe what you would see in imaging/macroscopy for small cell carcinoma (tumour features) (4)
* Tumours occur proximally (large hilar tumours, i.e. near hilum) * Bulky mediastinal lymph nodes * Metastases * Paraneoplastic syndromes linked with abnormal secretion of hormones, peptides or cytokines OR with an autoimmune process
38
Name 3 paraneoplastic syndromes seen in small cell carcinoma
1. Hyponatremia (excessive production of antidiuretic hormone) 2. Cushing's syndrome (abnormal production of ACTH) 3. Lambert-Eaton Myasthenic syndrome (autoimmune reaction)
39
Why is small cell carcinoma so aggressive? What allows it to spread (metastasize) so rapidly?
An important feature of small cell carcinoma (SCLC) is its early invasion of mediastinal lymph nodes. This significantly contributes to the cancer's ability to spread (metastasis) throughout the body.
40
What are the complications and outcomes of small cell carcinoma? How is it treated?
* Poor prognosis with a 2-year survival rate (10%) * Usually non-resectable (must be treated by chemotherapy) * Can result in distant metastases (brain, bone, adrenal glands)
41
How do tumour cells of small cell carcinomas compare to non-small cell carcinomas?
Small cell carinomas have smaller tumour cells
42
What are some immunohistochemical markers of small cell carcinoma?
CD56 Chromogranin Synaptophysin
43
Do small cell carcinomas arise from carcinoid tumours?
No! Most DO NOT.
44
Define carcinoid tumours
Low/intermediate grade neuroendocrine malignancies with two subcategories: - typical carcinoids - atypical carcinoids
45
What lung cancer type has no clear relation with tabacco?
Pulmonary carcinoid tumours
46
Describe what you would see in imaging/macroscopy for pulmonary carcinoid tumours (tumour features) (3)
* Tumours mainly arise in central airways (but 1/3 are peripheral) * Tumours are well circumscribed * Tumours may invade the lumen, resulting in obstruction
47
What are some symptoms of bronchial obstruction by pulmonary carcinoid tumours? (3)
* Cough * Hemoptysis * Recurrent obstructive pneumonitis
48
Describe the characteristic architecture of carcinoid tumours (2)
* Trabecular * Rosettes with vascular stroma
49
Describe the chromatin of carcinoid tumour cells
Uniform, finely granular nuclear chromatin
50
What are some immunohistochemical markers of carcinoid tumours? *Hint: they are the same as those for small cell carcinoma*
CD56 Chromogranin Synaptophysin
51
Atypical carcinoids have a higher number of... and more...
Higher number of mitosis More necrosis
52
Which of the 2 types of carcinoid tumour is more likely to invade the mediastinal lymph nodes and metastatize?
Atypical carcinoid tumours
53
What are some pre-invasive features of carcinoid tumours? (2)
* Tumorlets: Neuroendocrine cell precursors to carcinoid tumours * DIPNECH: Diffuse idiopathic pulmonary neuroendocrine hyperplasia (abnormal proliferation of neuroendocrine cells)
54
What is the most frequent mutation in smokers?
KRAS
55
What are the main molecular aberrations (biomarkers) tested in lung cancer?
KRAS EGFR ALK ROS1
56
How is lung cancer staged?
Based on the pTNM principles: T: Tumour size/extent N: Node involvement M: Metastasis

BLOCK B - RESPIRATION (31 decks)

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