Tumours of the lung and pleura

Question 1

What cancer is the most commonest cause of cancer that causes death?

Who is most likely to get cancer? Men or women?

Lung cancer is the _____ most common cancer in the UK

______ is one of the least commonest type of lung cancer

the treatment and diagnosis for lung cancer is good or bad?

What are the risk factors for lung cancer?

Why does lung cancers occur?

What should you recommend for the patient in terms of lifestyle modification to reduce their risk of lung cancer?

Answer 1

Lung cancer

Men. Women it has been increasing the amount of those who are getting cancers but it is not clear why it is.

Lung cancer is the second most common cancer in the UK

mesothelioma is one of the least commonest type of lung cancer - poor prognosis

treatment for cancer is not great and they are diagnosed very late - main aim is to prolong

Risk factors for lung cancers are old age, male sex, low socioeconomic status and smoking

check picture for causes of lung cancer

Stop smoking

Question 2

What is the diagnostic process for lung cancer?

What are specific and general symtoms of cancer?>

Answer 2

Specific to lung cancer:  Persistent cough  Haemoptysis  Breathlessness  Increasing, on little exertion  Chest pain

General cancer symptoms: Unintentional weight loss  Fatigue  Lymphadenopathy

Question 3

Answer 3

Question 4

What are the differential diagnosis for cough, haemoptysis, breathlessness and chest pain.

Answer 4

Question 5

What doest this person have?

what does the CT show characteristic of?

What does the adrenal glands show?

Answer 5

Lung cancer

CT - shows spiculations - characteristic of lung cancer

Metastasise from the lung cancer - very common

Question 6

How is diagnosis made for:

• frail patient
• Central tumour

peripheral tumour

Involved mediastinal lymph nodes

Answer 6

Question 7

Lung neoplasm can be subclassified into 4 subtypes what are they?

One is NSSC which has 3 sub divisions which are?

Answer 7

Question 8

What is giving the brown pigmentation?

Answer 8

TTF1 ( thyroid transcription factor 1 )

Question 9

Adenocarcinoma

Is it the most commonest type of lung cancer?

What is it’s association with smoking?

what sort of mass is it?

Histologically what does it have to be an adenocarcinoma?

Immunhistochemically how do you diagnose an adenocarcinoma?

Answer 9

Question 10

What are these X rays indicative of?

Answer 10

Adenocarcinoma

The bottom on could be a pneumonia - but if there is weight loss think more adenocarcinoma.

Biopsy needed to confirm

Question 11

What do they have?

If they have fewer glands what can you tell about how well differentiated they are?

what immunohistochemistry be done to prove it?

Answer 11

Adenocarcinoma

They are less well differentiated if they have fewer glands

TTF1 is +

Question 12

What does this person have?

Does this have associations with lung cancer?

Is it the most commonest type of lung cancer?

What sort of mass does it show on X ray?

What would histology show?

What would immunohistochemistry show?

What tells you the cells are poorly differentiated?

Answer 12

• Squamous cell carcinoma
• Associated with smoking

Not the commonest

Generally central cavitating mass

• histology: keratinisation: intracellular or extracellular, intercellular bridges

Immunohistochemistry shows: p63+. p40+, TTF1 -

Question 13

What do they have?

What symptoms can have?

What is the histological findings?

What is the immunohistochemistry it is positive for?

Answer 13

Question 14

What does this person have?

What is the prevelance

How is this different from small cell carcinoma?

Answer 14

• Carcinoid tumour
• It is more well defined than small cell carcinoma

Question 15

metastases is the commonest tumoiurs in the lung

Lung is the common site of metastasis

what iare the commonest sources?

Answer 15

 Commonest sources:  Breast  Colon  Stomach  Pancreas  Kidney

Question 16

How is the tumours staged?

Answer 16

Question 17

How are cancers treated?

Small cell lung carcinoma treatment

Carcinoid treatment

Non small cell carcinoma treament

Answer 17

Small cell carcinoma ->  Virtually all cases stage IV at diagnosis  Chemoradiotherapy  Initial rapid improvement, then progression  6-12 month survival  Very rare cases are localised  Surgery + adjuvant chemotherapy, if well enough (most are not)  Very few cases cured

Carcinoid tumour->  Vast majority localised to lung  Cured by surgery  Biological behaviour difficult to predict  Some behave aggressively (atypical carcinoids)  Surgery + chemotherapy

Non-small cell carcinoma ->  In principle, about 50% curable  But generally unwell patients, so only around 20% have curative treatment  Curative disease  Surgery (+/- adjuvant chemotherapy if adverse factors)  Stereotactic ablative radiotherapy (SABR)  Metastatic disease  Chemotherapy  Molecular targeted therapy  Immunotherapy (PDL1 inhibitor -> PDL1 normally stops the cytotoxic T cells from acting on the cells)

Question 18

All non small cell carcinomas are tested for what?

Answer 18

Question 19

Tumous of the pleural are most commonly _________ ___________

What does the image show the person has?

It is more common in men than women They present with shortness of breath, chest pain, tumour infilitrating into fissures and growing into pericardium.

Histologically shows sarcomatoid type (bad prognosis) and epithiloid subtype

Always do immunohistochemistry for this condiition

Answer 19

Mesothelioma

 Tumours of the pleura are most commonly metastatic adenocarcinoma  Mesothelioma is rare, derives from mesothelial lining of pleura  < 2,000 UK cases annually  Male > female  Usually present with shortness of breath, chest pain  > 90% caused by asbestos (20-30 year lag)  Extremely poor prognosis  Almost always palliative chemotherapy ± radiotherapy  Compensation if asbestos exposure can be proven

Question 20

Lung cancers are divided intwo two types

Key points for NSCLC, small cell carcinoma, mesothelioma

Answer 20