Week 4 - Pathology of Lung Cancer

Question 1

What is the aetiology of lung cancer? (5)

Answer 1

Tobacco, asbestos, environmental radon, other occupational factors, air pollution,

Question 2

How many known chemical compounds and carcinogens is found in a cigarette?

Answer 2

4000+ chemical compounds, 60+ recognised carcinogens

Question 3

How are genetics involved in the likelihood of developing lung caner? (2)

Answer 3

individual metabolism of pre-carcinogens
nicotine addiction

Question 4

What are the 2 main pathways to carcinogenesis?

Answer 4

lung periphery - bronchioloalveolar stem cells transform into cancer cells and then invade - adenocarcinoma
central lung - bronchial epithelial stem cells transform to cancer cells and form squamous cell carcinoma

Question 5

What are the types of tumours? (5)

Answer 5

benign, lymphoma, sarcoma, carcinoid (low grade malignancy), bronchial gland tumour (rare)

Question 6

What are the 4 types of carcinoma of the lung?

Answer 6

NSCLC - squamous, adenocarcinoma, large cell carcinoma
SCLC - small cell carcinoma

Question 7

What is the most prevalent carcinoma?

Answer 7

squamous cell carcinoma - 40-60%

Question 8

Which tumour is surgery commonly not carried out on and why?

Answer 8

SCLC - its fast growing and metastasises quickly

Question 9

What are some features of primary lung cancer?

Answer 9

grows clinically silent for many years, presenting late in its natural history. usually found by accident in an alternative investigation

Question 10

What is the issue with symptomatic lung cancer?

Answer 10

It’s fatal

Question 11

What are the local effects of bronchial obstruction?

Answer 11

collapse of bronchi, bronchiectasis, endogenous lipid pneumonia

Question 12

What is endogenous lipid pneumonia?

Answer 12

bronchial obstruction may lead to breakdown of destroyed alveolar walls, which release cholesterol as debris. lipid gathers in lung and cause inflammation and pneumonia

Question 13

What are the local effects of tumour to the pleura?

Answer 13

inflammation from infection, malignancy in pleural wall,

Question 14

What issues can direct invasion of lung cancer cause?

Answer 14

• Invade chest wall directly
• Phrenic nerve - diaphragmatic paralysis
• Laryngeal nerve - hoarse voice and bovine cough - cant close epiglottis
• Pancoast tumour - brachial plexus damage
• nerve damage - Horners syndrome

Question 15

What is horners syndrome?

Answer 15

cervical sympathetic chain damage - paralysis on one side of face - droopy eyelid and cant sweat

Question 16

What is the danger of lymph node metastasis?

Answer 16

lymphangitis carcinomatosa - inflammation of lymph vessels caused by malignancy

Question 17

What are the 4 wide local effects of tumours?

Answer 17

Bronchial obstruction,
pleural issues,
lymph node invasion,
direct invasion nerve issues

Question 18

What are the skeletal distant effects?

Answer 18

• clubbing
• HPOA (hypertrophic pulmonary osteoarthropathy)

Question 19

What are the endocrine distant effects? (4)

Answer 19

1. SCLC - abnormal ACTH - too much cortisol - and SIADH - too much adh - keep water
2. Squamous cell - PTH imbalance - hypercalcaemia
3. Carcinoid syndrome - cancer spreads to liver, serotonin released
4. Gynaecomastasia - man boobs

Question 20

What are the neurological distant effects? (4)

Answer 20

Polyneuropathy, encephalopathy (agent affecting functioning of brain) , cerebellar degeneration, myasthenia

Question 21

What are the dermatological distant effects?

Answer 21

dermatomyositis, acanthosis nigricans

Question 22

What are the haematolytic distant effects?

Answer 22

granulocytosis, eusinophilia, DIC (disseminated intravascular coagulation - blood clots)

Question 23

What is a renal distant effects?

Answer 23

nephrotic syndrome - passing too much protein in urine

Question 24

What main investigations are carried out for lung cancer? (5)

Answer 24

CXR, bronchoscopy, trans-thoracic fine needle aspiration, core biopsy (larger sample), pleural effusion cytology and biopsy

Question 25

Which type of tumour has the greatest ability to be switched on by oncogenes?

Answer 25

adenocarcinoma

Question 26

Which types of tumours are everything to d with tobacco?

Answer 26

squamous cell and SCLC

Question 27

What is carcinoid syndrome?

Answer 27

symptoms which occur when carcinoid cancer spreads to the liver