Respiratory Neoplasia

Question 1

What are the different types of lung tumours?

Answer 1

Carcinomas - arise from the epithelium (90-95%)
Bronchial carcinoids - neuroendocrine (5%)
Mesenchymal or other miscellaneous neoplasms including sarcomas and lymphomas (2-5%)

Question 2

What the risk factors of lung tumours?

Answer 2

Smoking, industrial hazards, family history, immunodeficiency

Question 3

What are the presenting complaints associated with lung tumours?

Answer 3

cough, weight loss, chest pain, dyspnoea

Question 4

What is the pathological basis behind pneumonia, abscess, lobar collapse

Answer 4

Obstruction of the airway

Question 5

What is the pathological basis behind pleural effusion?

Answer 5

Spread of the pleura

Question 6

What is the pathological basis behind hoarseness?

Answer 6

Recurrent laryngeal nerve invasion

Question 7

What is the pathological basis behind diaphragm paralysis?

Answer 7

phrenic nerve invasion

Question 8

What is the pathological basis behind rib destruction?

Answer 8

Chest wall invasion

Question 9

What is the pathological basis behind Superior Vena Cava (SVC) syndrome?

Answer 9

SVC compression by tumour

Question 10

What is the pathological basis behind Horner syndrome?

Answer 10

Sympathetic ganglia invasion

Question 11

What is the pathological basis behind pericarditis, tamponade?

Answer 11

pericardial invasion

Question 12

How do lung tumours metastase?

Answer 12

Local extension of the tumour within the pleural cavity to the pericardium.
Spread to tracheal, bronchial and mediastinal nodes found in most cases.
Most common distant spread: adrenals, liver, brain, bone

Question 13

What are paraneoplastic syndromes?

Answer 13

When ectopic hormone is secreted by the tumour (1-10% of all lung cancer patients)

Question 14

What are the hormones involved in paraneoplastic syndrome?

Answer 14

ADH - hyponatraemia,
Adrenocorticotrophic hormone (ACTH) - Cushing’s syndrome,
Parathormone, parathyroid-related peptide, prostaglandin E, cytokines - hypercalcaemia
Calcitonin - hypocalcaemia
Gonadotropins - gynaecomastia
Serotonin and bradykinin - Carcinoid syndrome

Question 15

What are the stagings of lung carcinoma?

Answer 15

T- primary tumour size/degree of invasion
N - lymph node presentation or not
M- Distant metastasis or not

Question 16

What is small cell carcinoma?

Answer 16

20-25%
strong relationship to smoking.
Occur in major bronchi and periphery.
Rapidly invade bronchial wall and parenchyma - early lymphatic and blood-borne spread (mostly incurable by surgery). Treatable by chemo

Question 17

What is squamous cell carcinoma?

Answer 17

24-40% - non-small cell.
Most commonly affect men.
Closely related with smoking.
Arises close to hilum, usually in area of squamous metaplasia (due to cigarette smoking)
Usually arise centrally from the bronchi.

Question 18

What is adenocarcinoma?

Answer 18

25-40% - non-small cell.
Most common type in women and non-smokers.
Tend to be peripherally located. Grow more slowly that SCC but metastasise early and wide.
Sometimes associated with scarring e.g. healed TB.

Question 19

What is large cell carcinoma?

Answer 19

10-15% non-small cell.
Undifferentiated SCC and adenocarcinoma with no discernible features by light microscopy.
Neuroendocrine variant - highly malignant; nests and islands of tumour cells with granular cytoplasm, central necrosis, peripheral palisading

Question 20

Describe lung metastases

Cancer spreading TO the lungs. How does it spread?

Answer 20

Most common site of metastatic neoplasms. Arrives by the blood, lymphatics or direct continuity.
Usually multiple discrete nodules (cannonball lesions) scattered throughout all lobes. Peripheral lesions

Question 21

What are the common primary sites for lung metastases?

Answer 21

Bowel, prostate, kidney, breast

Question 22

What are pleural tumours?

Answer 22

Tumours found in the pleural space - cavity between lungs and chest wall

Question 23

What is malignant mesothelioma?

Answer 23

Example of a primary pleural tumour.
There is increased incidence in people with exposure to asbestos. Diffuse lesions that spreads widely in the pleural space - associated with extensive pleural effusion and direct invasion of thoracic structures.
Plaques resulting from asbestos exposure can be found on the pleural surfaces.

Question 24

What is pleural effusion?

Answer 24

Build up of fluid between the layers of pleura outside the lungs (“water on the lungs”)