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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
Q

What are some pre-invasive features of adenocarcinomas?

A

A continuum:
- atypical adenomatous hyperplasia (AAH)
- adenocarcinoma in situ
- minimally invasive adenocarcinoma

All 3 entities are less than 3 cm

26
Q

What are some molecular biomarkers of adenocarcinoma?

A

3 genes: EGFR, ALK, ROS1
Mutations in these genes are linked with adenocarcinoma

PD-L1 expression is associated with response to immunotherapy

27
Q

What mainly determines the prognosis of adenocarcinoma?

A

The prognosis is mainly linked with the pTNM stage of the adenocarcinoma

28
Q

What can increase the risk of local recurrence of adenocarcinoma? What type of procedure should be prioritized in these cases?

A

Solid and micropapillary patterns
(surgeons should choose lobectomy over wedge resection)

29
Q

What are the 2 most aggressive patterns of adenocarcinoma?

A

Micropapillary pattern and solid pattern

30
Q

For poorly differentiated carcinomas, how do we differentiate adenocarcinoma from large cell carcinoma or squamous cell carcinoma?

A

We need to identify immunohistochemical markers of glandular differentiation like pneumocyte TTF1 and Napsin A

31
Q

Name two cancers characterized by neuroendocrine tumours

A

Small cell carcinoma
Carcinoid tumours

Note that they are not associated - one does not lead to another

32
Q

What are neuroendocrine tumours?

A

Diverse group of neoplasms that originate from neuroendocrine cells (distinct family of tumours with shared morphological, immunohistochemical and molecular features)

33
Q

What are the 4 categories of neuroendocrine tumours?

A
  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
Q

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

A

Small cell carcinoma: high grade tumour
Typical carcinoid tumour: low grade tumour

35
Q

Define small cell carcinoma

A

Malignant epithelial tumour that consists of small cells with scant cytoplasm, finely dispersed chromatin and absent or inconspicuous nucleoli.

36
Q

What type of lung cancer has the strongest association with smoking?

A

Small cell carcinoma

37
Q

Describe what you would see in imaging/macroscopy for small cell carcinoma (tumour features) (4)

A
  • 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
Q

Name 3 paraneoplastic syndromes seen in small cell carcinoma

A
  1. Hyponatremia (excessive production of antidiuretic hormone)
  2. Cushing’s syndrome (abnormal production of ACTH)
  3. Lambert-Eaton Myasthenic syndrome (autoimmune reaction)
39
Q

Why is small cell carcinoma so aggressive? What allows it to spread (metastasize) so rapidly?

A

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
Q

What are the complications and outcomes of small cell carcinoma? How is it treated?

A
  • 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
Q

How do tumour cells of small cell carcinomas compare to non-small cell carcinomas?

A

Small cell carinomas have smaller tumour cells

42
Q

What are some immunohistochemical markers of small cell carcinoma?

A

CD56
Chromogranin
Synaptophysin

43
Q

Do small cell carcinomas arise from carcinoid tumours?

A

No! Most DO NOT.

44
Q

Define carcinoid tumours

A

Low/intermediate grade neuroendocrine malignancies with two subcategories:
- typical carcinoids
- atypical carcinoids

45
Q

What lung cancer type has no clear relation with tabacco?

A

Pulmonary carcinoid tumours

46
Q

Describe what you would see in imaging/macroscopy for pulmonary carcinoid tumours (tumour features) (3)

A
  • Tumours mainly arise in central airways (but 1/3 are peripheral)
  • Tumours are well circumscribed
  • Tumours may invade the lumen, resulting in obstruction
47
Q

What are some symptoms of bronchial obstruction by pulmonary carcinoid tumours? (3)

A
  • Cough
  • Hemoptysis
  • Recurrent obstructive pneumonitis
48
Q

Describe the characteristic architecture of carcinoid tumours (2)

A
  • Trabecular
  • Rosettes with vascular stroma
49
Q

Describe the chromatin of carcinoid tumour cells

A

Uniform, finely granular nuclear chromatin

50
Q

What are some immunohistochemical markers of carcinoid tumours?
Hint: they are the same as those for small cell carcinoma

A

CD56
Chromogranin
Synaptophysin

51
Q

Atypical carcinoids have a higher number of… and more…

A

Higher number of mitosis
More necrosis

52
Q

Which of the 2 types of carcinoid tumour is more likely to invade the mediastinal lymph nodes and metastatize?

A

Atypical carcinoid tumours

53
Q

What are some pre-invasive features of carcinoid tumours? (2)

A
  • Tumorlets: Neuroendocrine cell precursors to carcinoid tumours
  • DIPNECH: Diffuse idiopathic pulmonary neuroendocrine hyperplasia (abnormal proliferation of neuroendocrine cells)
54
Q

What is the most frequent mutation in smokers?

A

KRAS

55
Q

What are the main molecular aberrations (biomarkers) tested in lung cancer?

A

KRAS
EGFR
ALK
ROS1

56
Q

How is lung cancer staged?

A

Based on the pTNM principles:

T: Tumour size/extent
N: Node involvement
M: Metastasis

BLOCK B - RESPIRATION (31 decks)

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