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IMED3001 > Respiratory System Neoplasia > Flashcards

Respiratory System Neoplasia Flashcards

1
Q

What is the estimated number of deaths from lung cancer every year?

A

9198 (5229 males and 3969 females)

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2
Q

What percentage of deaths are caused by lung cancer?

A

18.9%

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3
Q

What is the rank of lung cancer as a cause of death in people?

A

It is the number 1 cause of death by cancer for both men and women

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4
Q

What are the causes of lung cancer?

A

80% of lung cancers occur in smokers or recently stopped smokers.

Industrial exposure (asbestos, arsenic, chromium, uranium)

Radiation

Air pollution risk is unclear

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5
Q

How much does asbestos increase risk of lung cancer?

A

5x

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6
Q

How much does the combination of smoking and asbestos increase the risk of lung cancer?

A

55x

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7
Q

How much does the risk of lung cancer increase for people that smoke 2 packs of cigarrettes a day?

A

60x

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8
Q

What percentage of people that smoke develop cancer?

A

10 - 15% of smokers

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9
Q

What does the knudson hypothesis state?

A

Cancer is a multi-step process of mutations that influence growth, cell division, apoptosis progression, treatment and resistance.

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10
Q

What do cells/tissues have to block/slow cancer development?

A

intrinsic barriers to cancer development

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11
Q

What are the sequential histological abnormalitiws involved in pathogenesis of squamous cell carcinoma?

A

Hyperplasia -> Squamous metaplasia -> Squamous dysplasia -> Carcinoma in situ -> Invasive squamous cell carcinoma

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12
Q

What are glandular lesions?

A

Discrete parenchymal lesion arising in alveoli close to terminal and respiratory bronchioles.

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13
Q

What is atypical adenomatous hyperplasia?

A

The first stage of a simple adenocarcinoma. (Commonly seen in cancers with extensive lepidic pattern)

However the pattern is more complex in other instances

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14
Q

Why do squamous cells form?

A

They are protective of lining of respiratory epithelium.

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15
Q

What are the underlying effects that lead to lung cancer?

A

Many different genetic mutations identified for both squamous cell and adenocarcinomas.

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16
Q

What are the genetic mutations that cause squamous cell carcinoma?

A

chromosomal losses (3p, 9p (CDKN2), 17p (TP53) losses)

p53 overexpression (TP53)

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17
Q

What percentage of squamous cell carcinomas of the lung are caused by CDKN2/p16 loss?

A

65%

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18
Q

What mutations cause adenocarcinoma?

A

Many mutations of receptor tyrosine kinases: EGFR, ALK, ROS, MET, and RET

ALK and KRAS mutations have a bad prognosis

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19
Q

What are the pathological findings in lung cancer?

A

Mass in the lung which can be central or peripheral

Pleural effusion

Paraneoplastic syndromes

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20
Q

What tissue can be affected by a mass in the lung?

A

Pleura

Bronchi

Lymph nodes (direct or lymphatic spread)

Chest wall

Nerve involvement

Diaphragm

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21
Q

What are the symptoms of a lung cancer?

A

Lethargy

Tiredness

Weight loss

Breathlessness

Cachexia

Haemoptysis

Hoarse voice

Recurrent chest infections

Liver/brain/bone pain symptoms are in the late stages

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22
Q

How is a lung cancer diagnosed?

A

Sputum cytology (low sensitivity)

Pleural fluid cytology (moderate to high sensitivity and specificity)

Fine needle aspirate under CT guidance

Bronchoscopy

Biopsies of tumout

Resection

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23
Q

What percentage of lung cancer patients develop paraneoplastic syndromes?

A

1 - 10%

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24
Q

What are the paraneoplastic syndromes that can be caused by lung cancer?

A

May include hormone-like factors mimicking effects of:

ADH (hyponatremia)

ACTH (cushing syndrome)

Parathormone

Calcitonin

Gonadotropins

Serotonin

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25
What other conditions can be caused by paraneoplastic syndromes of the lung?
Lambert-Eaton myasthenic syndrome Peripheral neuropathy Dermatological manifestations Hypertrophic pulmonary osteoarthropathy
26
Why can lambert-Eaton myasthenic syndrome be caused by lung cancer?
Paraneoplastic syndrome can result in auto-antibodies to neuronal calcium channels
27
How are respiratory neoplasms classified?
Lower vs upper tract Benign vs malignant Primary vs secondary Tissue of origin
28
What kind of tissues can be an origin for a tumour of the respiratory tract?
Epithelium (99% of tumours in the lung are epithelial) Cartilage Smooth muscle Blood vessels Fibrous tissue Lymphoid tissue
29
What type of tumours commonly are primary tumours?
Solitary tumours They can be either benign or malignant
30
What type of metastases spread to the lungs?
Commonly carcinomas, melanomas, and sarcomas. Any tumour that spreads via haematogenous route can end up in the lungs
31
What morphology do secondary malignant tumours commonly take in the lungs?
Multiple and bilateral
32
What are the common epithelial lung tumours?
Squamous cell carcinoma Adenocarcinoma Neuroendocrine: Small cell carcinoma, large cell neuroendocrine carcinoma, and carcinoid tumours Large cell (undifferentiated) carcinoma
33
Why is it important to make the distinction between small cell and non small cellcarcinomas?
Small cell carcinoma can't be operated on whereas all the others can
34
Why is it important to distinguish between squamous cell carcinoma and adenocarcinoma in the non-small cell carcinoma group?
Treatments for adenocarcinoma can cause problems in people with squamous cell carcinoma thus shortening their lives
35
What are characteristic features of adenocarcinomas?
They are peripherally located More common in women than men Most common epithelial carcinoma in non-smokers Forms glands
36
What are the different patterns of adenocarcinomas of the lung?
Lepidic Acinar Papillary Micropapillary Solid Mucinous Others
37
Why are adenocarcinomas so important to detect early?
They grow slowly but metastasize early and widely.
38
What mutations can trigger adenocarcinomas of the lung?
EGFR mutations (survival can be prolonged with EGFR inhibitors) KRAS or ALK mutations (Have bad prognoses)
39
What shape do squamous cell carcinomas often take?
Enlarged cells with atypical nuclei and prominent dense eosinophilic cytoplasm with intracellular bridges and dyskeratosis (whorls)
40
Where are squamous cell carcinomas of the lung typically found?
Central location (bronchocentric)
41
What kind of spread is common for squamous cell carcinomas of the lung?
Lymphatic spread more common than haematogenous spread
42
What kind of damage do squamous cell carcinomas cause?
They are locally aggressive and often necrotic tumours
43
What do large cell undifferentiated carcinomas look like?
No differentiating features by light microscopy Marked atypia Multinucleation, giant cells and frequent mitoses.
44
What percentage of lung cancers are small cell carcinomas?
20%
45
Where in the lung do small cell carcinomas typically occur?
Nearly always central
46
How do small cell carcinomas spread?
Lymphatic spread and metastasize early
47
Do small cell carcinomas cause ectopic hormone production?
Yes, they are neuroendocrine carcinomas
48
How are small cell carcinomas treated?
Chemoradiotherapy
49
Who most often gets small cell carcinomas?
99% of cases are in smokers
50
What do the cells in small cell carcinomas look like?
Large nuclei but not much cytoplasm and fine chromatin
51
What is a carcinoid?
Low grade neuroendocrine tumours. They are malignant but grow slowly.
52
Who most often gets carcinoid tumours?
Young (<40yo) males and females equally get it
53
Where are carcinoid tumours located?
Can be central or peripheral and can be typical and atypical (mitotic count and necrosis)
54
What is the survival rate for carcinoid tumours?
80% 10 year survival rate for resected typical carcinoids and 50% 5 year survival for atypical carcinoid tumours
55
What is grading of tumours?
The extent to which neoplastic parenchymal | cells resemble the corresponding normal parenchymal cells, both morphologically and functionally (worse = higher grade)
56
What determines prognosis in adenocarcinomas besides grading?
In adenocarcinoma, prognosis is also determined by architectural pattern (lepidic, acinar, papillary, solid)
57
How are tumours staged? Why is this useful?
How far has the tumour spread? Enables comparison of cases for research and risk stratification
58
What systems are used for staging of lung cancers?
AJCC system TNM system
59
How is lung cancer approached prior to treatment?
Prevention (Stop people smoking, help people stop smoking, help people addicted to smoking quit and prevent complications) Early detection: Difficult
60
How is lung cancer treated?
Surgery Radiotherapy (Slow down growth of tumour but not curative) Chemotherapy (slow down growth of tumour but is not curative) Immunotherapy
61
What targets are there for immunotherapy?
EGFR-specific antibodies EGFR -TKIs mTOR inhibitors
62
What is the prognosis like for immunotherapy treatment?
Depends on type and stage Only 15 - 30% are diagnosed at early stage 75% of NSCLC are inoperable and survival is only 12 - 18 months SCLC: median survival is 11 months
63
What are some issues with managing lung cancer?
Appropriate early referral to accessible high quality diagnosis and treatment (variability with access to PET scan, thoracic surgery units, CT guided core biopsy, pathology, molecular testing) – Multidisciplinary collaboration in the consideration of treatment options • Safe delivery of effective care • Different regimens of chemotherapy and radiotherapy for different tumours • Laser therapy • Improved palliative options • National guidelines for the management of lung cancer
64
How does asbestos increase chances of lung disease?
Causes localised pleural plaques Pleural effusions Asbestos-interstitial fibrosis Bronchiogenic carcinoma Mesothelioma Laryngeal and colonic carcinoma
65
What is the main cancer that affects pleura?
Pleural tissue is lined by mesothelium. The cancer is called mesothelioma
66
What other cancers affect the pleura?
Lymphomas, mesenchymal tumours and metastases
67
What aetiological factors increase chance of mesothelioma?
Asbestos Chronic inflammation, smoking, and other inhaled lung disease
68
How long is the latency period of mesothelioma?
20 - 30 years
69
Pathology of mesothelioma:
``` Infiltrative tumour, tracks along pleural surfaces o Often florid ‘desmoplastic’ response (dense fibrosis) o Epithelioid, sarcomatoid and biphasic types o Often presents with chest pain, pleural effusion o Poor prognosis (12-18 month survival) o Limited treatment efficacy ```

IMED3001 (46 decks)

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