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Respiratory > Respiratory pathology of lung cancer > Flashcards

Respiratory pathology of lung cancer Flashcards

1
Q

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

A

40,000

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2
Q

What are the causative factors of lung cancer

A

Tobacco
Radon/therapeutic radiation
Asbestos exposure
Genetic predisposition (but familial lung cancers are rare)
Heavy metals e.g. chromates, arsenic, nickel

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3
Q

Explain the significance of the P35 gene

A

P53 gene can prevent the growth of the cell. Smoking can inhibit the P53 gene

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4
Q

What are the clinical features of lung cancer

A

Haemoptysis (coughing up blood)
Unexplained or persistent (>3 weeks) cough
Chest/shoulder pain
Weight loss
Dyspnoea
Hoarseness
Finger clubbing (angle between nail and nail bed becomes more obtuse)

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5
Q

How is lung cancer diagnosed

A

Chest X-ray
Cytology - look for malignant cells shed in sputum or washed/brushed off airways at bronchoscopy
Histology - biopsy tumour at bronchoscopy or via CT guidance
Gene profiling

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6
Q

Describe staging for lung cancer

A

CT scan - thorax, liver and adrenals for staging
Bone scans, or PET scan
Radio-labelled glucose
Tran-thoracic CT biopsy

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7
Q

What are the advantages and disadvantages of a trans-thoracic CT biopsy

A

Advantages - real time, sensitive

Disadvantages - risk of pneumothorax, small sample size, bleeding

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8
Q

Describe the TNM staging system

A

T= Tumour - the tumour size or extent of local invasion
N = Nodes - no. of lymph nodes involved
M = Metastases - presence of distant metastases
Grade = how differentiated is the tumour?
Stage = how far has the tumour spread?
Stage is more important

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9
Q

Describe the basic pathogenesis of carcinomas

A

Consequence of accumulation of mutations of genes in epithelial cells and stem cells (Regulate cell proliferation, invasion, angiogenesis and senescence)

Disordered growth
Loss of cell adhesion
Invasion of tissue by tumours
Stimulation of new vessel formation around tumours

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10
Q

What proportion of lung cancers do non-small cell cancers count for

A

75%

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11
Q

Give examples of non-small cell lung cancers

A 
Squamous cell carcinoma
Large cell carcinoma
Adenocarcinoma
Anaplastic carcinoma
Bronchiolo-alveolar cell carcinoma
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12
Q

Describe squamous cell carcinoma

A

20-40% of NSCC
Associate with smoking
Mainly around the central airways (metastasise late)
Changes under metaplasia as a reaction to smoking.
Mucous does not clear the carcinogens.
Eventual dysplasia.

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13
Q

Describe adenocarcinoma

A

25-40% of NSCC
Non-smokers
Peripheral development (metastasise early)
Can become invasive
Proliferation of atypical cells lining the alveolar walls (Atypical adenomatous hyperplasia)

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14
Q

Which mutations are involved in non-small cell carcinomas

A

Smokers- KRAS mutation
Non-smokers - EGFR mutation
ROS gene + ALK gene

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15
Q

Describe small cell carcinoma

A

25% of lung cancers
Smoking, aggressive behaviour
Mainly local spread, often near the bronchi (central)
Very chemosensitive
Shorter life expectancy (2-4 months)
80% present with advanced disease
e.g. squamous cell carcinoma, paraneoplastic syndrome

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16
Q

Describe the development of a precursor lesion to a squamous cell carcinoma

A
  1. precursor lesion
  2. squamous metaplasia
  3. dysplasia
  4. carcinoma-in-situ
  5. squamous cell carcinoma
17
Q

Describe the histology of large cell carcinomas

A

Poorly differentiated tumours composed of large cells
No histological evidence of glandular or squamous differentiation
Shown on microscopy
Poorer prognosis

18
Q

What is paraneoplastic syndrome

A 
Small cell carcinoma
The immune system attacks the brain, spinal cord, peripheral nerves or muscle. 
Endocrine or non-endocrine
ADH (hyponatraemia) -> small cell
ACTH (Cushings) -> small cell
PTH (hypercalcaemia) -> squamous
19
Q

What are the symptoms of paraneoplastic syndrome

A

Problems with muscle movement/coordination, sensory perception, memory
Limbic encephalitis
Myasthenia gravis
Lambert-eaton myasthenic syndrome
Abnormal expression of substances e.g. hormones not usually expressed

20
Q

What is mesothelioma

A

Cancer that develops in the lining/pleura
Linked to asbestos exposure.
Asbestos fibres lodge in the lungs and damage them (DNA mutations)
Long lag time
Males>females
50-70

21
Q

What are the symptoms of mesothelioma

A 
Chest pain
Fatigue
Shortness of breath
Cough
Loss of appetite
Clubbed nails
22
Q

Why may some smokers not get lung cancer

A

Polymorphisms in certain genes affect risk of developing lung cancer

23
Q

What is AGFR

A

Receptor tyrosine kinase that regulates angiogenesis, proliferation, apoptosis and migration
Mutation is seen in non-smokers and females (mainly far east asian)
Adenocarcinoma more common

24
Q

What is choice of lung cancer treatment based on

A

Histological cell type
Stage of lung cancer
Performance status of the patient

25
Q

Give an example of immunemodulatory therapy

A

Inhibition of PD-L1 and therefore cytotoxic T cells can attack the tumour cells (otherwise inhibited)

26
Q

Describe the treatment for small cell cancers

A

Highly responsive to chemotherapy and radiotherapy
Combination chemo with cisplatin
Cisplatin and etoposide > cyclophosphamide, doxorubicin, vincristine

27
Q

Describe the treatment for non-small cell cancer

A

Surgery
Unresectable stage 3 - multi-modality treatment offers better survival
Neoadjuvant chemo
At least 3 cycles of chemo with sequential or concomitant radiotherapy

28
Q

What are the tumour initiators in cigarettes

A

Carcinogens, polycyclic aromatic hydrocarbons

29
Q

What are the local complications of lung cancer

A

Bronchial obstruction
Invasion of local structures
Inflammation/irritation/invasion of pleura or pericardium

30
Q

Describe bronchial obstruction by lung cancer

A

Collapse of distal lung -> dyspnoea

Impaired drainage -> pneumonia, abscess

31
Q

Describe the invasion of local structure by lung cancer

A

Local airways and vessels -> haemoptysis, cough

Large vessels 
SVC syndrome = congestion of head and arm oedema 
Oesophagus = dysphagia
chest wall = pain
nerves = Horners
32
Q

Describe inflammation/irritation/invasion by lung cancer

A

Pleuritis or pericarditis with effusions
Breathlessness
Cardiac compromise

33
Q

What are the systemic complications of lung cancer

A

Brain - fits
Liver - liver pain, jaundice
Bones - bone pain, fracture
Skin - lumps

34
Q

Give an approximate value for the survival rate or patients 5 years after the initial diagnosis

A

Non-small cell
early - 60%
late - 5%

Small cell
untreated - 2-4 months
treated - 10-20 months

Respiratory (16 decks)

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