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103-theme 4 > pathological diagnosis of lung cancer > Flashcards

pathological diagnosis of lung cancer Flashcards

1
Q

how do we form a differential diagnosis of a lung mass? 7

A
  • Neoplastic or non-neoplastic?
  • Benign or malignant?
  • Primary or secondary?
  • Sit of origin?
  • Carcinoma, sarcoma, lymphoma, mesothelioma
  • Histological type
  • Prognostic and predictive features
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2
Q

how do we form a pathological diagnosis of lung cancer? 6

A
  • Histopathology uses the clinical method clinical history, examination, special investigation
  • Distribution of tumour, gross appearances, number, shape and size
  • Often information from imaging
  • Growth pattern at margin of tumour
  • Histological type, prognostic and predictive features
  • All requires a multidisciplinary approach
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3
Q

what are the main histological types of lung cancer? 2

A
  • Small cell (AKA oat cell) carcinoma (10-15%)
  • Non-small cell carcinoma (85-90%) squamous cell carcinoma, adenocarcinoma, undifferentiated/ large cell carcinoma, mixed and others
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4
Q

what does a small cell carcinoma look like? 4

A
  • Widespread bulky disease
  • Small, dark, delicate cells with little cytoplasm
  • ‘salt and pepper’ chromatin in the nuclei
  • Azzopardi effect
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5
Q

describe a squamous cell carcinoma? 2

A
  • Central origin often

- Cigarette smoke provokes squamous metaplasia, then dysplasia of bronchial epithelium

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6
Q

what does an adenocarcinoma begin with? 2

A
  • malignant cells lining alveolar spaces

- Typically, peripheral, contains fibrous tissue and shows variable differentiation which correlates with prognosis

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7
Q

how do we differentiation squamous cell carcinoma and adenocarcinoma? 2

A
  • Looking for specific proteins can help

- TTF1 expression is typical of adenocarcinoma

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8
Q

describe the patterns of spread of lung cancer? 3

A
  • Local and direct spread adjacent lung, intrapulmonary metastasis, pleura and pleural cavity
  • Lymphatic lymphatics within lung, lymph nodes hilar, mediastinal
  • Systemic spread liver, bone, brain, adrenal
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9
Q

how do we make a diagnosis of lung cancer? 6

A
  • Multidisciplinary effort
  • Clinical features, imaging
  • Histological type small cell carcinoma non-small cell carcinoma squamous cell carcinoma and adenocarcinoma
  • Confirm by looking for proteins
  • Prognostic and predicative molecular pathology
  • Increasingly diagnosis is made on tiny specimens obtained by minimally invasive procedures
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10
Q

describe palliative care in the management of lung cancer? 6

A
  • An approach which improves the quality of life of patients and their families
  • Need based, not diagnosis based
  • Role in lung cancer management terminal phase, after active oncological treatment or as only possible treatment, during treatment, peri-diagnosis
  • It is holistic care and treatment based on symptoms and suffering, and can be provided alongside life prolonging treatment
  • Incurable disease does not mean that nothing can be done
  • Your font needs to be dying to benefit
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11
Q

why are survival rates for lung cancer poor? 2

A
  • Patients present late with advanced stage 40% via ED

- Early symptoms similar to common smokers’ symptoms

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12
Q

what can cause lung cancer? 3

A
  • 70% are caused by smoking
  • Deaths in men have reduced by more than a quarter
  • Lung cancer deaths are increasing in women
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13
Q

describe the respiratory symptoms of lung cancer? 6

A
  • Cough
  • Haemoptysis
  • Dyspnoea
  • Wheeze
  • Chest pain
  • Hoarseness
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14
Q

what are the metastatic and systemic presenting symptoms of lung cancer? 5

A
  • Weight loss
  • Anorexia, nausea
  • Malaise
  • Fatigue
  • From secondary sites, CNS, bone, skin
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15
Q

what are the frequently seen paraneoplastic syndromes in lung cancer? 3

A
  • Hyponatraemia (due to SIADH) small cell carcinoma
  • Hypercalcaemia (due to PTH like activity) squamous cell carcinoma
  • Less commonly gynaecomastia, prutitis, cerebellar degermation, peripheral neuropathy
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16
Q

how does lung cancer present? 3

A
  • The presenting symptoms are highly variable and may involve sites distant from the chest, or be very non-specific
  • The approach is to have a high index of suspicion in any ex-smoker
  • Do CXR/CT early
17
Q

what are the common signs of lung cancer on examination? 6

A
  • Clubbing
  • Cachexia
  • Supraclavicular, cervical, lymphadenopathy
  • Stridor due to large airway disease or vocal cord palsy (hoarse voice)
  • Focal chest signs of lung collapse, fixed wheeze
  • Pleural effusion
18
Q

describe non small cell lung cancer?4

A
  • Squamous- central invade locally; frequently cavitation; hypercalcaemia common
  • Adenocarcinoma- peripheral lung; more common in non-smokers
  • Large cell
  • Undifferentiated
19
Q

what are the investigations to determine tumour cell type and stage? 6

A
  • CT
  • Bronchoscopy
  • Endobronchial ultrasound needle aspiration
  • Another biopsy procedure
  • PET scanning nuclear medicine scan, utilising the high uptake of a glucose analogue
  • Cell type and stage both determine further treatment, along with general health/coexisting illness
20
Q

describe TNS staging in cancer? 2

A
  • Staging is one of the important factors in determining treatment and prognosis in lung cancer
  • It takes into account tumour size, involvement of local structures, lymph and blood metastases
21
Q

how do we manage newly diagnosed lung cancer? 3

A
  • Small cell or non-small cell lung cancer
  • If NSCLC, is it resectable?
  • If NSCLC and not suitable for surgery other radical treatment appropriate
22
Q

what is the role of surgery in NSCLC? 2

other radical treatments in NSCLC? 3

A
  • Consider surgery for all patients with stage 1 and 2 disease
  • Usually involves lobectomy
  • Radical radiotherapy
  • +/- chemotherapy
  • Usually reserved for those with stage 1 or 2 disease who are unfit (or unwilling) for surgery
23
Q

describe palliative radiotherapy and chemotherapy in NSCLC? 5

A
  • Radiotherapy in palliative doses offers good symptom relief for haemoptysis, intractable cough or dyspnoea from bronchial or tracheal obstruction, chest and skeletal pain
  • Not expected to cure
  • Chemotherapy regimens can improve quality of life
  • Also offer a modest improvement in survival (measured in week)
  • May be used in conjunction with radiotherapy
24
Q

how do we treat small cell lung cancer? 4

outcomes?2

A
  • Chemotherapy is primary treatment, and more effective than in NSCLC
  • Excellent for symptom control, can induce remission
  • Prolongs survival by months on average
  • Some patients with limited disease become long term survivors
  • Only 15% 5-year survival
  • Slow improvement

103-theme 4 (19 decks)

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