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Respiratory System > Resp 6 - Respiratory Pathology > Flashcards

Resp 6 - Respiratory Pathology Flashcards

1
Q

What is mutational compensation?

A

House keeping genes (p53) induces apoptosis - prevents immortal cancer cells

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2
Q

What are the clinical features of lung cancer?

A
  1. Haemoptysis.
  2. Unexplained/persistent cough/chest pain/chest signs/dyspnoea/hoarseness/finger clubbing
  3. Nail bed should be less than 180 degrees.
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3
Q

First, we determine if its small cell or non-small cell cancer. Then, TNM classification is used. Explain how TNM classification works.

A
  1. Tumour (1-4)- location, size and proximity to other organs. If tumour close to mediastinum or chest wall, it has a higher T staging,
  2. Nodes (1-4)- has it spread to lymph nodes
  3. Metastases - has it metastasised?
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4
Q

What can be used to sample a few cells of a tumour to be examined by pathologists?

A

Fine needle aspiration

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5
Q

How can PET scans be used for tumours?

A

Radiolabelled glucose given to patient. Radiolabelled glucose taken up by metabolically active tissues - show up very clearly (i.e. identify tumours)

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6
Q

What is the treatment algorithm for non-small cell lung cancer?

A

Diagnose -> Stage -> Test

Treatment based on cell type of tumour, extent of tumour, how fit the patient is.

Small lung cancers grow rapidly and metastasise early.

If the disease is advanced, give chemotherapy initially and try to minimise spread

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7
Q

What is the earliest point in time when you can diagnose lung cancer?

A

When the tumour is around 10mm

Most tumours diagnosed around 30mm

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8
Q

How many cases of lung cancer are there in the UK?

A

40,000

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9
Q

What factors are involved in diagnosing the lung tumour?

A
  1. Cell type
  2. Subgroup
  3. Molecular phenotype (for targeted treatments)
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10
Q

How many lobes are in the right and left lung?

A 
Right = 3 lobes
Left = 2 lobes
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11
Q

Name 5 contributors to lung cancer.

A
  1. Smoking
  2. Asbestos exposure
  3. Radiation
  4. Genetic predisposition
  5. Heavy metals
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12
Q

Describe benign lung tumours.

A
  1. Do not metastasise
  2. Can cause local complications (e.g. airway obstruction)

e.g. chondroma

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13
Q

Describe malignant lung tumours.

A
  1. Are able to metastasise
  2. Invade adjacent tissues

e.g. epithelial tumours

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14
Q

What are the 3 types of Non-small cell carcinomas?

A

1, Squamous cell carcinoma

  1. Adenocarcinoma
  2. Large cell carcinoma (uncommon)
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15
Q

What are features of small cell carcinoma?

A

Much worse prognosis. Its rare to find a small cell carcinoma - they grow rapidly and metastasise early.

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16
Q

What is the most common form of lung cancer amongst non smokers?

A

Adenocarcinoma (rising in incidence whereas squamous cell carcinoma is decreasing in incidence)

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17
Q

Where do squamous cell carcinomas tend to arise?

Where do adenocarcinomas tend to arise?

A

Squamous cell = near mediastinum

Adenocarcinoma = in the periphery

18
Q

What is the general multistep pathway for carcinoma development?

A
  1. Metaplasia
  2. Dysplasia
  3. Carcinoma in situ
  4. Invasive carcinoma
19
Q

Describe how a squamous cell carcinoma develops

A

Tends to occur in airways

  1. Cigarette smoke irritation causes epithelium to become tougher.
  2. Ciliated epithelium is delicate. Repeated exposure to smoke changes it to squamous epithelium.
  3. Lack of cilia means mucus stays in lungs - smokers cough
  4. Squamous epithelia acquire mutations which alters the normal pattern of growth - becomes carcinoma in situ as disordered dysplasia.
  5. Further mutations make it invasive - invades neighbouring tissues and lymphatics.
20
Q

Traditionally, squamous epithelium carcinomas have been central but recently they are more peripheral. Why?

A

People have been inhaling the smoke more deeply.

The carcinomas spread distally in the lungs before spreading to lymph nodes.

21
Q

What do irregular squamous cell cancers have?

A

Irregular cells have large nuclei and keratin in cytoplasmic,

22
Q

Where does an adenocarcinoma come from?

A

Forms from glandular epithelium.

23
Q

What is atypical adenomatous hyperplasia?

A

Proliferation of atypical cells lining the alveolar walls.

24
Q

How do atypical adenomatous hyperplasia progress into an adenocarcinoma?

A
  1. Atypical adenomatous hyperplasia causes alveolar walls to thicken and be lined by atypical cells.
  2. Some of the atypical cells will grow larger but not invasive yet.
  3. Eventually, cells mutate. They form enzymes that breakdown stroma.
  4. Stromal breakdown forms fibrous scars and is accompanied by inflammation.
  5. Invasive adenocarcinoma can become invasive and breakdown elastin in the basement membrane - forming pink fibrous stroma.
25
Q

What are some cytological features of adenocarcinoma?

A

Shows evidence of glandular differentiation.

Glandular epithelium often produces mucin - blue on the outside of the cell shows big atypical nuclei

26
Q

Which cancer is often multi focal in the lungs?

A

Adenocarcinoma

27
Q

Why are molecular pathways important in adenocarcinomas?

A

2 pathways.
Smoker = K ras mutation. They WONT be receptive to targeted therapy.

Non smoker = EGFR mutation/amplification. Must determine if responder/resistance mutation.

(Some people have shown almost complete regression with targeted therapies).

28
Q

Describe large cell carcinomas.

A
  1. They are poorly differentiated tumours comprising large cells.
  2. No histological evidence of glandular or squamous differentiation. E- microscopy may show differentiation.
  3. Poorer prognosis

LARGE CELL CARCINOMAS ARE MOST LIKELY POORLY DIFFERENTIATED ADENOCARCINOMA/SQUAMOUS CELL CARCINOMA

29
Q

Histology of small cell carcinoma?

A

20-25% lung cancer

  1. Tend to be central near bronchi
  2. Close association with smoking
  3. 80% cases present with advanced disease
  4. Despite being very chemosensitive, they have awful prognosis.
  5. Have many paraneoplastic syndromes
30
Q

Why does necrosis often occur in small cell carcinomas?

A

Tumour often outgrows the blood supply

31
Q

Compare and contrast small cell carcinomas vs non-small cell carcinomas.

A

Small cell carcinoma:
Chemoradiotherapy, survival is very short (a few months)

Non-small cell carcinoma:
decent survival rate if picked up early enough, less chemosenstive

32
Q

Some patients develop fatal haemorrhage with Bevacizumab treatment. Which cancer?

A

Squamous cell carcinoma

Some chemo works better in adenocarcinomas (e.g. pemetrexed), though molecular therapeutic treatment more common for adenocarcinomas (e.g. EGFR/ALK)

33
Q

Tumour staging can be clinical, radiological or pathological. Which is the most accurate and gold standard?

A

Pathological

34
Q

How does EGFR targeted treatment work?

A

EGFR targets membrane receptor tyrosine kinase.

EGFR regulates angiogenesis, proliferation, apoptosis, migration.

EGFR mutations/amplifications common in female non smokers.

EGFR IS TARGET OF TYROSINE KINASE INHIBITOR

35
Q

How can PDL1 inhibition be used to treat tumour growth?

A

Tumours may express PDL1 which prevents cytotoxic T cells from attacking the tumour.

Inhibiting PDL1 has shown success

36
Q

What things can be looked at to determine the diagnosis/subtype of the tumour?

A
  1. Sputum
  2. Bronchial washings/brushings
  3. Pleural fluid
  4. Endoscopic fine needle aspiration of tumour/enlarged lymph

(THESE ARE ALL CYTOLOGICAL)

37
Q

What histologically can be looked at to diagnose/subtype a tumour?

A
  1. Biopsy

2. Surgical biopsy

38
Q

What are the local effects of lung cancer?

A
  1. Bronchial obstruction - leading to collapse of distal lung and impaired drainage of the bronchus
  2. Invasion of local structures - e.g. vessels/oesophagus/chest wall/nerves
  3. Inflammation of pleura
39
Q

What is a paraneoplastic syndrome?

A

Systemic effect of a tumour due to abnormal expression of factors that are not normally expressed by the tissue from which the tumour arose.

Can be endocrine/non endocrine

40
Q

What is the 5 year survival rate if non small cancer diagnosed in stage 1? What about stage 5?

A

Stage 1 - 5 years = 60%

Stage 4 - 5 years = 5%

Respiratory System (16 decks)

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