Respiratory Neoplasia Flashcards
What are the different types of lung tumours?
Carcinomas - arise from the epithelium (90-95%)
Bronchial carcinoids - neuroendocrine (5%)
Mesenchymal or other miscellaneous neoplasms including sarcomas and lymphomas (2-5%)
What the risk factors of lung tumours?
Smoking, industrial hazards, family history, immunodeficiency
What are the presenting complaints associated with lung tumours?
cough, weight loss, chest pain, dyspnoea
What is the pathological basis behind pneumonia, abscess, lobar collapse
Obstruction of the airway
What is the pathological basis behind pleural effusion?
Spread of the pleura
What is the pathological basis behind hoarseness?
Recurrent laryngeal nerve invasion
What is the pathological basis behind diaphragm paralysis?
phrenic nerve invasion
What is the pathological basis behind rib destruction?
Chest wall invasion
What is the pathological basis behind Superior Vena Cava (SVC) syndrome?
SVC compression by tumour
What is the pathological basis behind Horner syndrome?
Sympathetic ganglia invasion
What is the pathological basis behind pericarditis, tamponade?
pericardial invasion
How do lung tumours metastase?
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
What are paraneoplastic syndromes?
When ectopic hormone is secreted by the tumour (1-10% of all lung cancer patients)
What are the hormones involved in paraneoplastic syndrome?
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
What are the stagings of lung carcinoma?
T- primary tumour size/degree of invasion
N - lymph node presentation or not
M- Distant metastasis or not
What is small cell carcinoma?
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
What is squamous cell carcinoma?
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.
What is adenocarcinoma?
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.
What is large cell carcinoma?
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
Describe lung metastases
Cancer spreading TO the lungs. How does it spread?
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
What are the common primary sites for lung metastases?
Bowel, prostate, kidney, breast
What are pleural tumours?
Tumours found in the pleural space - cavity between lungs and chest wall
What is malignant mesothelioma?
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.
What is pleural effusion?
Build up of fluid between the layers of pleura outside the lungs (“water on the lungs”)
