Respiratory: - Lecture 2. Pulmonary Neoplasia Flashcards
What are the types of Primary Lung Neoplasms ?
Benign
Malignant
What types of lung neoplasm are there?
Primary Neoplasms - the site at which they originated from
Metastic Neoplasma - Metastasis are secondaries of the primary tumour
What is a Neoplasm?
An Abnormal cell growth
What is contained in Tobacco smoke?
Polycyclic hydrocarbons Aromatic amines Phenols Nickel Cyanates
- All of these are carcinogens.
What percentage of smokes will die of lung cancer?
20%
Generally, what types of cancer is caused by tobacco smoke?
suffer laryngeal cervical, bladder mouth oesophageal colon cancer
-respiratory cancer
What are the other risk factors that can cause lung cancer?
Asbestos Nickel Chromates Radiation Atmospheric pollution (Genetics)
How can a tumour present ?
Local Effects
Systemic effects
What are the Local effects of a tumour?
Obstruction of the airway - Causes Pneumonia
Invasion of Chest wall - causes Pain
Ulceration - Haemoptyosis
What is Pneumonia?
Pneumonia is an inflammatory condition of the lung affecting primarily in the alveoli
What are secondary sites of cancer called?
Metastases
What are the common sites of metastases?
Nodes
Bones
Liver
Brain
What is the commonest brain cancer a metastases from?
Lung Cancer
What are the Systemic effects of a tumour
Weight Loss
Ectopic (abnormal) hormone production
What can hypercalcaemia be a systemic effect of?
Squamous cell cancers
-parathyroid hormone
What hormone is produced in excess to cause hypercalcaemia?
Parathyroid hormone
What hormone stimulates the cortex of the adrenal gland to produce steroids?
Adrenocorticotropic hormone
In squamous cancers what hormone can be produced in excess?
Parathyroid hormone
In what cancer can there be an increase in Adrenocorticotropic hormone?
Small cell cancers
small cell lung cancer
What are the common types of smoking-associated types of cancer?
Adenocarcinoma
Squamous Carcinoma
Small cell Carcinoma
Large Cell Carcinoma
What endocrine related cancers can form in the lung?
Neuroendocrine tumours
Bronchial gland tumours
What characterises Squamous Cell carcinoma?
Keratinising/production of keratin from the cells
What characterises Adenocarcinoma?
Presents in glandular epithelium and spread along pre-existing structures of the lung or gland-like structure.
Occasionally produces mucin which is see in the epithelium (STAINS BLUE)
What characterises Small cell carcinoma?
Darkly staining tumours
Very little cytoplasm
No attempt at glandular formation
Formed by small nuclei with homogeneous dark nuclei
What characterises Large cell carcinoma?
Defined by large cells with absence of squamous differentiation or glandular differentiation
How are lung cancers subtyped?
Standard histological staining
Protein expression within them.
Sometime: Analysis of the sputum. e.g. haemoptysis
What antigen is expressed in a squamous cell carcinoma?
P63 protein
What antigen is expressed in small cell carcinoma and adenocarcinoma?
TTF - 1 (Thyroid transcription factor)
Why are cancers subtyped?
Difference in Treatment.
Difference in Prognosis
Difference in Epidemiology
Difference in Pathogenesis
What cancers have the worst prognosis? (from worst to best)
Small cell
Large Cell
Squamous cell
Adenocarincoma
How are patients treated for small cell carcinoma?
Treated by chemotherapy
- Small cell carcinoma is chemosensitive, however grows back afterwards.
- Should still be given even in palliative situations
What are the Non-small cell carcinomas?
Adenocarcinoma
Squamous cell Carcinoma
Large Cell carcnoma
What Oncogenes are mutated in Small Cell Lung Cancer?
MYC gene
Where is the MYC oncogene located?
Chromosome 8
What Oncogenes are mutated in Non-small cell lung cancer?
K-Ras
EGFR
myc
What tumour supressor genes are switched off in SCLC?
p53
Rb
3p
What tumour suppressor genes are switched off in NSCLC?
p53 1q 3p 9p 11p Rb
What are most adneocarcinoma related to?
K Ras mutation
Wild-type EGFR gene
What tyrosine kinase inhibitor can be used for some NSCLC?
Gefitinib
How does Gefitinib work?
Tyrosine Kinase Inhibator
- interrupts signalling through the epidermal growth factor receptor (EGFR - oncogene) in target cells.
What is the pulmonary epithelium divided into?
Bronchial epithelium
Bronchioles/alveoli epithelium
What cells are in the Bronchial epithelium?
ciliated
mucous
neuroendocrine
reserve
What cells are in the Bronchiales and alveoli epithelium?
Clara cells
types 1 and 2 alveolar lining cells
Describe the process of a tumour formation in the large airways, or for bronchial tumours?
Squamous metaplasia
Dysplasia
Carcinoma in situ
Invasive malignancy
What tumours generally are large airway tumours/bronchial tumours?
Squamous cell
Small cell
Describe the pathogensis of basal cell hyperplasia and how it changes to a squamous metaplasia?
Cells begin to proliferate from the base due to tobacco smoking - hyerplasia.
Eventually works it way to the epithelium. It changes the epithelium cells to more skin-like epithelium - This is Squamous metaplasia
What is the definition of metaplasia?
Reversible replacement of one differentiated cell type with another mature differentiated cell type.
What is Dysplasia?
change in cell or tissue phenotype
Describe how a periperal adenocarcinomas forms?
Atypical adenomatous hyperplasia
- tumour spread along the alveolar walls. (Bronchioalveolar carcinoma)
What could a differential diagnosis of a Bronchioalveolar carcinoma be?
Pneumonia
What does the prognosis of the lung cancer depend on?
Tumour stage
Histological subtype
What staging is used for lung cancer?
TNM staging
What is a Carcinoid tumour?
Neuroendocrine neoplasma of low grade malignancy
Occurs in young people
What is a Bronchial gland neoplasm?
Tumours seen in salivary glands
What is a primary pleural neoplasia called?
Mesothelioma
They are generally maligant
