Respiratory neoplasia

Question 1

Lung tumours

Answer 1

benign andd malignant 
mainly carcinomas (arising for lining epithelium)

Question 2

Lung carcinomas

Answer 2

second most common cancer in the UK
incidence increased in females
risk factors: family history, smoking, immunodeficiency, industrial hazards eg. exposure to ionising radiation, asbestos, diesel, air pollution
symptoms = cough, chest pain, weight loss, dyspnoea
can metastasise - extension into pleural cavity = pericardium, tracheal/bronchial nodes
> distant spread to adrenls, liver, brain & bone

Question 3

What are the local effects of lung tumour spread?

Answer 3

pneumonia, pleural effusion, dysphagia, rib destruction, pericarditis

Question 4

What is a paraneoplastic syndrome?

Answer 4

ectopic hormone secretion by tumour
hormones include:
- ADH - hyponatraemia
- ACTH - cushing's syndrome
- parathyroid hormone, prostaglandins hypercalcaemia
- calcitonin - hypocalcaemia

Question 5

Small cell carcinoma

Answer 5

strong relationship to smoking
Occur in major bronchi and at periphery
Rapidly invade bronchial wall and parenchyma; early lymphatic and blood-borne spread = mostly incurable by surgery
Most responsive to chemo – but worst prognosis as relapses early
HISTOPATHOLOGY: small, tightly packed, darkly stained ovoid tumour cells
Cells with little cytoplasm, absent nucleoli
Can be pure or cobined

Question 6

Squamous cell carcinoma

Answer 6

Most commonly affects men
Closely correlated with smoking history
Arises close to hilum, usually in area of squamous metaplasia (due to cigarette smoke)

HISTOPATHOLOGY: well differentiatied resembles stratified squamous epithelium; characterised by keratin formation and/or inercellular bridges

Question 7

Adenocarcinoma

Answer 7

Most common type in women and non-smokers
peripherally located
Grow more slowly than SCC but metastasize early and widely
Sometimes associated with scarring e.g. healed TB

HISTOPATHOLOGY: well differentiated have obvious glandular element 80% contain mucin

Question 8

Large cell carcinoma

Answer 8

Undifferentiated malignant epithelial tumour
HISTOPATHOLOGY: large, anaplastic epithelial cells growing in islands and sheets
Neuroendocrine variant – highly malignant; nests and islands of tumour cells with granular cytoplasm, central necrosis, peripheral palisading

Question 9

Lung metastases

Answer 9

Most common site of metastatic neoplasms
Arrive by blood, lymphatics or direct continuity
Usually multiple discrete nodules (cannonball lesions) scattered thoughout all lobes
Peripheral lesions
Common primary sites- bowel, prostate, breast, kidney

Question 10

Pleural tumours

Answer 10

Secondary metastatic involvement more common than primary tumour
Most frequently lung or breast
Serous effusion often present containing neoplastic cells
Primary tumour
Malignant mesothelioma

Question 11

What is malignant mesothelioma?

Answer 11

Increased incidence in people with exposure to asbestos
Latent period of 25-45 years
spreads widely in the pleural space
symptoms = chest pain, dyspnoea, pleural effusions
50% die within 12 months of diagnosis
can spread to other organs
Treatment:
- Extra-pleural pneumonectomy, chemo, radiotherapy
Doesn’t often improve prognosis

Question 12

What is dyspnoea?

Answer 12

Diffucult/laboured breathing.

Question 13

What is dysphagia?

Answer 13

Difficulty swallowing

Question 14

What is tachypnea?

Answer 14

Rapid breathing