Pulmonary carcinoma Oct16 M1 Flashcards
T-F all lung cancers are carcinomas
F. Vast majority are pulmonary carcinomas but there are other types too
Lung cancer prognosis
Bad. High chance of dying from it if get it.
Carcinoma appearance on CT
node
old carcinoma (that is gone) appearance on CT
opacity
4 main causes of pulmonary carcinoma
tobacco smoke, minerals, chemicals, radiation
incidence of carcinoma in smokers vs non smokers + a number
greater in smokers.
15-30 to 1 incidence in heavy smokers vs non smokers
what % of lung carcinomas are found in non-smokers
10-15%
how epidemiological studies related smoking to cancer?
found relationship between number and type of cigarettes smoked and the incidence of carcinoma
how risk changes with how much you smoke and how long you smoke
The more you smoke and the longer you smoke, the greater the risk
what minerals associated with pulm CA
asbestos. risk is dose related and risk of pulm CA is x50 if smoke cigarettes too
Arsenic, nickel, silica, chromium, cadmium
disease caused by silica exposure associated with developing cancer
silicosis
asbestos in mesothelioma vs pulm carcinoma
very important in mesothelioma but numbers in pulm CA are more important
What kind of radiations can cause pulm CA
radiations of atom bomb
radon and radon-daughters (radon decay products)
Uranium and other mines
Personal dwellings
how atom bomb influences pulm CA risk
Survivors of atom bomb have 3-4x risk of pulm CA
Lung CA risk factor other than environmental
genetic
Common mutations in lung CA (3)
25-30% have K-RAS mut.
Some have EGFR mut.
Some have ALK mut.
Function of K-RAS, EGFR and ALK genes
Involved in proliferation and reducing cell death.
EGFR on surface sends signal to via proteins. K-ras in signal transduction. Alk inhibits K ras
Drugs for lung CA, what they act on
act on prots upstream of K-Ras
act to inhibit Alk action on K-Ras.
What is deduced if lung CA patient has K-Ras mutation (2)
1) Bad prognosis
2) No benefit from tyrosine kinase inhibitor (TKI) therapy
What is deduced if lung CA patient has EGFR mutation (2)
1) Adenocarcinoma
2) Exon 19, 21 mutations predict response to tyrosine kinase inhibitors
What ALK stands for
anaplastic lymphoma kinase
What is deduced if lung CA patient has ALK mutation (2)
1) Adenocarcinoma
2) High resp rate and increased progression free survival with critoztinib
5 categories of lung cancer, similar to other organs
epithelial tumours, mesenchymal tumours, lymphohistiocytic tumours, tumours of ectopic origin, metastatic tumours
4 types of carcinomas that make up 98-99% of lung CAs
Squamous cell carcinoma
Adenocarcinoma
Neuroendocrine tumours
Large cell carcinoma
squamous cell carcinoma where
proximal lung (main, lobar, segmental bronchi)
squamous cell carcinoma what problem it creates
replaces resp epithelium, tends to go on lumen and obstruct bronchus (no more air going in or substances drained out)
squamous cell carcinoma what happens when it grows
invades through wall and through adjacent lung tissue, becomes a great mass
squamous cell carcinoma: what happens to central portion
necrotizes and drained out (coughed or swallowed) and creates cavity
squamous cell carcinoma: microscopy features (3)
Keratinization, intracellular bridges, IHC (CK 5/6)
squamous cell carcinoma: name when fills bronchus
Polypoid intrabronchial squamous cell carcinoma
squamous cell carcinoma: name of obstruction created
obstructive pneumonitis
obstructive pneumonitis: what we see on CXR
opacity
squamous cell carcinoma: cytology
hyperchromatic, large nuclei, variable nuclear size of cells
unusual but possible location of squamous cell carcinoma
near pleura (peripheral), even though these are usually adenocarcinomas
squamous cell carcinoma: CXR findings
One or both hilum enlarged
Neuroendocrine tumours: 2 types
Small cell carcinoma
Carcinoid tumour
Small cell carcinoma: location
proximal airways: main, lobar bronchi
Small cell carcinoma: how it grows
grows in IS tissue (non parenchymal IS) rather than in lumen
Small cell carcinoma: where invades and metastasizes
Regional lymph nodes and visceral metastases (brain, liver, bones, adrenals)
Small cell carcinoma: cytology
small cells, high N/C ratio, dispersed chromatin
Small cell carcinoma: which histological layer it grows in and consequence on bronchus
in submucosa, creates compression on bronchus lumen
Small cell carcinoma: how resp epithelium is affected
intact
Neuroendocrine tumours microscopy appearance
neurosecretory granules
Neuroendocrine tumours: what they release
neuropeptides, hormone or hormone-related things
carcinoid tumour location when invades and consequence
bronchial lumen. distal atelectasis and lumenitis
carcinoid tumour: risk increase with smoking
not related to smoking
carcinoid tumour: worse scenario and consequence
metastasize to regional lymph nodes but no significant problems
carcinoid tumour cytology
smaller nuclei, vary less in size and shape, no hyperchromia
most common lung CA
adenocarcinoma (40-50% lung CA)
adenocarcinoma appearance on CXR and CT
appears as nodules
T-F: adenocarcinoma obstructs airways
doesn’t obstruct airways
3 types of adenocarcinoma to know
acinar, lepidic, adenocarcinoma in situ
adenocarcinoma location
peripheral, subpleural
acinar adenocarcinoma: histological charact
irregularly shaped clusters of malignant cells, surround empty gland-like spaces
what can see around acinar adenocarcinoma
fibroblastic (desmoplastic) CT (stroma)
what acinar adenocarcinoma looks like and what structures of the lung remain
looks like glands. no lung parenchyma remains
best adenocarcinoma to have and why
in situ adenocarcinoma: didn’t metastasize, by definition
adenocarcinoma in situ where it grows
along alveolar walls
lepidic adenocarcinoma def
combination of in situ pattern and invasive pattern
what lepidic adenocarcinoma is thought to be
a step between adenocarcinoma growth from in situ to acinar
in situ adenocarcinoma appearance on histology
Normal alveoli except enlarged alveolar walls
in situ adenocarcinoma: why alveolar septum enlarged
because of inflammation
in situ adenocarcinoma: where neoplastic cells are
on lining of alveolar surface
large cell carcinoma location and features
peripheral/subpleural
large, LOT OF NECROSIS, well circumscribed
large cell carcinoma on microscopy
large cells. undifferentiated
large cell carcinoma: why cells are large + nucleus size compared to small cell CA nucleus
Bc lot of cytoplasm. Nucleus is same size as small cell CA nucleus
large cell carcinoma nucleolus features
easily visible
