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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
Q

What other conditions can be caused by paraneoplastic syndromes of the lung?

A

Lambert-Eaton myasthenic syndrome

Peripheral neuropathy

Dermatological manifestations

Hypertrophic pulmonary osteoarthropathy

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26
Q

Why can lambert-Eaton myasthenic syndrome be caused by lung cancer?

A

Paraneoplastic syndrome can result in auto-antibodies to neuronal calcium channels

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27
Q

How are respiratory neoplasms classified?

A

Lower vs upper tract

Benign vs malignant

Primary vs secondary

Tissue of origin

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28
Q

What kind of tissues can be an origin for a tumour of the respiratory tract?

A

Epithelium (99% of tumours in the lung are epithelial)

Cartilage

Smooth muscle

Blood vessels

Fibrous tissue

Lymphoid tissue

29
Q

What type of tumours commonly are primary tumours?

A

Solitary tumours

They can be either benign or malignant

30
Q

What type of metastases spread to the lungs?

A

Commonly carcinomas, melanomas, and sarcomas.

Any tumour that spreads via haematogenous route can end up in the lungs

31
Q

What morphology do secondary malignant tumours commonly take in the lungs?

A

Multiple and bilateral

32
Q

What are the common epithelial lung tumours?

A

Squamous cell carcinoma

Adenocarcinoma

Neuroendocrine: Small cell carcinoma, large cell neuroendocrine carcinoma, and carcinoid tumours

Large cell (undifferentiated) carcinoma

33
Q

Why is it important to make the distinction between small cell and non small cellcarcinomas?

A

Small cell carcinoma can’t be operated on whereas all the others can

34
Q

Why is it important to distinguish between squamous cell carcinoma and adenocarcinoma in the non-small cell carcinoma group?

A

Treatments for adenocarcinoma can cause problems in people with squamous cell carcinoma thus shortening their lives

35
Q

What are characteristic features of adenocarcinomas?

A

They are peripherally located

More common in women than men

Most common epithelial carcinoma in non-smokers

Forms glands

36
Q

What are the different patterns of adenocarcinomas of the lung?

A

Lepidic

Acinar

Papillary

Micropapillary

Solid

Mucinous

Others

37
Q

Why are adenocarcinomas so important to detect early?

A

They grow slowly but metastasize early and widely.

38
Q

What mutations can trigger adenocarcinomas of the lung?

A

EGFR mutations (survival can be prolonged with EGFR inhibitors)

KRAS or ALK mutations (Have bad prognoses)

39
Q

What shape do squamous cell carcinomas often take?

A

Enlarged cells with atypical nuclei and prominent dense eosinophilic cytoplasm with intracellular bridges and dyskeratosis (whorls)

40
Q

Where are squamous cell carcinomas of the lung typically found?

A

Central location (bronchocentric)

41
Q

What kind of spread is common for squamous cell carcinomas of the lung?

A

Lymphatic spread more common than haematogenous spread

42
Q

What kind of damage do squamous cell carcinomas cause?

A

They are locally aggressive and often necrotic tumours

43
Q

What do large cell undifferentiated carcinomas look like?

A

No differentiating features by light microscopy

Marked atypia

Multinucleation, giant cells and frequent mitoses.

44
Q

What percentage of lung cancers are small cell carcinomas?

A

20%

45
Q

Where in the lung do small cell carcinomas typically occur?

A

Nearly always central

46
Q

How do small cell carcinomas spread?

A

Lymphatic spread and metastasize early

47
Q

Do small cell carcinomas cause ectopic hormone production?

A

Yes, they are neuroendocrine carcinomas

48
Q

How are small cell carcinomas treated?

A

Chemoradiotherapy

49
Q

Who most often gets small cell carcinomas?

A

99% of cases are in smokers

50
Q

What do the cells in small cell carcinomas look like?

A

Large nuclei but not much cytoplasm and fine chromatin

51
Q

What is a carcinoid?

A

Low grade neuroendocrine tumours. They are malignant but grow slowly.

52
Q

Who most often gets carcinoid tumours?

A

Young (<40yo) males and females equally get it

53
Q

Where are carcinoid tumours located?

A

Can be central or peripheral and can be typical and atypical (mitotic count and necrosis)

54
Q

What is the survival rate for carcinoid tumours?

A

80% 10 year survival rate for resected typical carcinoids and 50% 5 year survival for atypical carcinoid tumours

55
Q

What is grading of tumours?

A

The extent to which neoplastic parenchymal

cells resemble the corresponding normal parenchymal cells, both morphologically and functionally (worse = higher grade)

56
Q

What determines prognosis in adenocarcinomas besides grading?

A

In adenocarcinoma, prognosis is also determined by architectural pattern (lepidic, acinar, papillary, solid)

57
Q

How are tumours staged? Why is this useful?

A

How far has the tumour spread?

Enables comparison of cases for research and risk stratification

58
Q

What systems are used for staging of lung cancers?

A

AJCC system

TNM system

59
Q

How is lung cancer approached prior to treatment?

A

Prevention (Stop people smoking, help people stop smoking, help people addicted to smoking quit and prevent complications)

Early detection: Difficult

60
Q

How is lung cancer treated?

A

Surgery

Radiotherapy (Slow down growth of tumour but not curative)

Chemotherapy (slow down growth of tumour but is not curative)

Immunotherapy

61
Q

What targets are there for immunotherapy?

A

EGFR-specific antibodies

EGFR -TKIs

mTOR inhibitors

62
Q

What is the prognosis like for immunotherapy treatment?

A

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
Q

What are some issues with managing lung cancer?

A

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
Q

How does asbestos increase chances of lung disease?

A

Causes localised pleural plaques

Pleural effusions

Asbestos-interstitial fibrosis

Bronchiogenic carcinoma

Mesothelioma

Laryngeal and colonic carcinoma

65
Q

What is the main cancer that affects pleura?

A

Pleural tissue is lined by mesothelium. The cancer is called mesothelioma

66
Q

What other cancers affect the pleura?

A

Lymphomas, mesenchymal tumours and metastases

67
Q

What aetiological factors increase chance of mesothelioma?

A

Asbestos

Chronic inflammation, smoking, and other inhaled lung disease

68
Q

How long is the latency period of mesothelioma?

A

20 - 30 years

69
Q

Pathology of mesothelioma:

A 
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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