Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology - Year 2 AC > Week 5 - Respiratory - Neoplastic Disease > Flashcards

Week 5 - Respiratory - Neoplastic Disease Flashcards

1
Q

What is the most common type of lung tumour?

A

90-95% = carcinomas (arising from lining epithelium)

5% = bronchial carcinoids (neuroendocrine)
2-5% = mesenchymal and other miscellaneous neoplasms inc. sarcomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How common are lung carcinomas and who does it affect?

A

-2nd most common cancer in uk

  • male> female - but incidence increasing in females and decreasing in males
  • age 40-70 years
  • 5 year survival (8% men, 9% women)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for lung carcinomas?

A
  • smoking
  • industrial hazards (high dose ionising radiation, uranium, asbestos, radon, silica, diesel exhaust/air pollution)
  • family history
  • immunodeficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical symptoms of lung carcinomas?

A
  • cough (75%)
  • weight loss (40%)
  • chest pain (40%)
  • dyspnoea (20%)

-may present with symptoms of metastases (local extension of tumour within pleural cavity to pericardium, spread to tracheal, bronchial and mediastinal nodes found in most cases, nodal involvement average (50%), most common distant spread = adrenals (>50%), liver (30-50%), brain (20%), bone (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the local effects of tumour spread?

A
  • pneumonia, abscess, lobar collapse (obstruction of airway)
  • pleural effusion (spread in to pleura)
  • hoarseness (recurrent laryngeal nerve invasion)
  • dysphagia (oesophageal invasion)
  • diaphragm paralysis (phrenic nerve invasion)
  • rib destruction (chest wall invasion)
  • SVC syndrome (SVC compression by tumour)
  • Horner syndrome (sympathetic ganglia invasion)
  • pericarditis, tamponade (pericardial involvement)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are lung carcinomas staged?

A

TNM staging

  • T = primary tumour size/degree of invasion?
  • N = lymph nodes positive or not?
  • M = distant metastases or not?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are lung carcinomas treated?

A

Surgery, chemo (targeted therapy for EGFR mutation), radiotherapy

-or combination of all 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the prognosis for lung carcinomas usually?

A
  • 15% overall 5 year survival (48% cases detected when still localised)
  • adenocarcinoma, squamous cell carcinoma - slightly better prognosis, tend to remain localised for longer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are lung carcinomas classified?

A

Small cell carcinoma (20-25%)

Non-small cell carcinoma

  • squamous cell carcinoma (25-40%)
  • adenocarcinoma (25-40%)
  • large cell carcinoma (10-15%)

Combined carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do small cell carcinomas have a strong relationship too?

A

Smoking - 1% occur in non-smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where do small cell carcinomas occur?

A
  • occur in major bronchi at periphery

- rapidly invade bronchial wall and parenchyma (early lymphatic and blood-bourne spread)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What treatment do small cell carcinomas respond to the most?

A
  • mostly incurable by surgery

- most responsive to chemo - but worst prognosis as relapses early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the histopathology of small cell carcinomas?

A

Small, tightly packed, darkly stained ovoid tumour cells (resemble oats - also termed oat cell carcinoma)

  • cells with little cytoplasm, finely granular nuclear chromatin, absent or inconspicuous nucleoli, can be pure or combined (with any other non-small cell type)
  • nuclear molding, crush artefact, necrosis, high miotic index
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Who do squamous cell carcinomas effect?

A
  • most commonly affects men

- closely correlated with smoking history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do squamous cell carcinomas affect/arise?

A
  • arises close to hilum, usually in area of squamous metaplasia (due to cigarette smoke)
  • usually arise centrally from the bronchi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the histopathology of squamous cell carcinoma?

A
  • well differentiated - resembles stratified squamous epithelium
  • characterised by keratin formation and or intracellular bridges
17
Q

What characterises squamous cell carcinoma?

A

Keratinisation and/or intracellular bridges

2/3 central (segmental bronchi), 90% of cases are smokers

18
Q

Who is adenocarcinoma most common?

A

-most common type in women and non-smokers

But >75% found in smokers

19
Q

Where does adenocarcinoma tend to be located?

A
  • tends to be peripherally located
  • 2/3 peripheral
  • grows more slowly than squamous cell carcinoma but metastasise early and widely
  • peripheral adenocarcinomas - sometimes associated with scarring e.g. healed TB
20
Q

What is the histopathology of adenocarcinoma?

A
  • well differentiated (have obvious glandular elements)
  • 80% contain mucin

-usually not associated with bronchus - don’t spread as fast as SSC but metastasise more quickly

21
Q

Which adenocarcinomas are sometimes associated with areas of scarring?

A

Peripheral adenocarcinomas

22
Q

What is a large cell carcinoma?

A
  • undifferentiated malignant epithelial tumour

- undifferentiated SCC and adenocarcinoma with no discernible features by light microscopy

23
Q

What is the histopathology of a large cell carcinoma?

A

Large, anaplastic, epithelial cells growing in islands and sheets

-neuroendocrine variant -highly malignant, nests and islands of tumour cells with granular cytoplasm, central necrosis, peripheral palisading

24
Q

Describe lung metastases

A
  • most common site of metastatic neoplasms
  • arrive by blood, lymphatics or direct continuity
  • usually multiple discrete nodules (cannonball lesions) scattered throughout all lobes
  • peripheral lesions
  • common primary sites - bowel, prostate, breast, kidney
25
Q

What is a paraneoplastic syndrome?

A

A syndrome (a set of signs and symptoms) that is the consequence of cancer in the body but that, unlike mass effect, is not due to the local presence of cancer cells.

26
Q

Describe paraneoplastic syndromes

A
  • ectopic hormone secretion by tumour
  • incidence 1-10% of all lung cancer patients

Hormones involved include:

  • ADH - hyponatraemia
  • adrenocorticotrophic hormone (ACTH) - Cushing’s syndrome
  • parathormone, parathyroid hormone - related peptide, prostaglandin E, cytokines- hypercalcaemia
  • calcitonin -hypocalcaemia
  • gonadotrophins - gynaecomastia
  • serotonin and bradykinin - carcinoid syndrome
27
Q

What are pleural tumours?

A

The pleura’s function is to protect and cushion the lungs.

The most common tumors that occur in the pleura are malignant (cancerous) forms of mesothelioma caused by exposure to asbestos. But sometimes fibrous tumors unrelated to asbestos exposure can develop in the pleura.

28
Q

Describe pleural tumours

A
  • secondary metastatic involvement more common than primary tumour (most frequently lung or breast, serous/serosanguinous effusion often present containing neoplastic cells)
  • primary tumour (malignant mesothelioma)
29
Q

Who are more likely to get malignant mesotheliomas?

A
  • increased incidence in people with asbestos exposure
  • latent period of 25-45 years
  • no increased risk in asbestos workers who smoke
30
Q

Describe malignant mesotheliomas

A
  • diffuse lesion that spreads widely in the pleural space
  • associated with extensive pleural effusion and direct invasion of thoracic structures
  • plaques (thickened areas of pleura) resulting from asbestos exposure can be found on the pleural surfaces
31
Q

What is the histology of malignant mesotheliomas?

A
  • asbestos bodies are found in increase numbers in the lungs of patients with mesothelioma
  • affected lung is ensheathed by a layer of soft, gelatinous, greyish pink tumour tissue
32
Q

What is the clinical presentation and prognosis of malignant mesotheliomas?

A
  • presents with chest pain, dyspnoea, pleural effusions
  • 50% die within 12 months of diagnosis
  • invades lung directly
  • often spread to hilar LN, and eventually to liver and other organs
33
Q

How are malignant mesotheliomas treated?

A
  • extra-pleural pneumonectomy, chemo, radiotherapy

- doesn’t often improve prognosis

34
Q

Where do mesotheliomas also arise?

A

Peritoneum
Pericardium
Genital tract

35
Q

Benign and malignant tumours can both arise in the lung - true or false?

A

True

Pathology - Year 2 AC (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions