Lung cancer Flashcards
(32 cards)
What % of death by lung cancer are caused by smoking?
Men - 90%
women - 80%
1/3 of all cancer deaths
What are the risk factors of lung cancer?
Smoking COPD Asbestos Radon Other occupational carcinogens Diet Genetic/familial factors Social class Around 5000 cases a year in never smokers
What are the symptoms of a primary lung tumour?
Cough Dyspnoea Wheezing Hemoptysis Chest pain Postobstructive pneumonia Weight loss Lethargy/malaise
What are the symptoms of lung cancer regional metastases?
Superior vena caval obstruction
Hoarseness (left recurrent laryngeal nerve palsy)
Dyspnoea (phrenic nerve palsy)
Dysphagia
What are the symptoms of lung cancer distant metastases?
Bone pain/fractures CNS symptoms (headache, double vision, confusion etc)
What investigations are carried out to diagnose and stage lung cancer?
Plain chest x-ray - does NOT have to appear abnormal
Serum biochemistry (Sodium, LFT, calsium
Imaging (cross sectional)- CT and PET-CT scans. Isotope bone scan etc
Bronchoscopy, CT guided needle biopsy, lymph node biopsy, mediastinoscopy, pleural biopsy/cytology
How many people with non-small cell lung cancer have inoperable disease at presentation?
2/3rds
In small cell lung cancer, how many people have metastatic disease at presentation?
75%
What is the incidence of the various types of lung cancer?
Small/oat cell - 20-25%
Squamous cell - 30-35%
Adenocarcinoma - 30-35%
Large cell undifferentiated - 15-20%
What do the letters of TNM classification mean?
T - Primary tumour (<3 cm, surrounded by lung and visceral pleura, no invasion proximal to lobar bronchus at bronchoscopy)
N - Regional lymph node
M - Distant metastasis
What is the role of imaging in lung cancer?
Diagnosis Staging Treatment plan Response to treatment Complications Intervention Recurrence Screening
What does ultrasonography show?
Metastases - liver, adrenal
Pleural effusion
Aspiration-PI fluid
Chest wal invasion
What is the abbreviation for metastases?
MO - No known distant metastasis
M1a - lung nodules, pleural effusion
M1b - distant metastases
Explain the abbreviations of nodal staging
N1 - peribronchial ipsilateral hilar
N2 - ipsilateral mediastinal and subcranial nodes
N3 - Contralateral mediastinal, contralateral mediastinal hilar, scalene, supraclavicular
What are the cellular histological factors of malignancy?
Nuclei of irregular shape (pleomorphic)
Nucleic dark staining (hyper chromatic)
Increased size of nuclei compared to cytoplasm
Frequent/abnormal mitoses (cell division)
Prominent/multiple nucleoli
What architectural histological features suggest malignancy?
Ulceration Necrosis Infiltrative margins Vascular invasion Poorly circumscribed Reaction in the surrounding tissue (stroma) Little resemblance to normal tissue
What is a lung carcinoma?
Invasive malignant epithelial tumour
How are NSCLC further subclassified?
Use additional pathology stains - immunocytochemistry and mucin
Describe squamous carcinoma
Often central tumours Angulate cells Eosinophilic cytoplasm Keratinisation Intercellular bridges - 'prickles' Keratin pearls
Immunos: CK5/6 and P63 +
Describe adenocarcinoma.
Often peripheral tumours Columnar/cuboidal cells Form glands (acini) Papillary structures May line alveoli Some produce mucin
Immunos: Most TTF-1+
Describe small cell carcinoma.
"Oat cell carcinoma" Very cellular tumour Small nuclei - c.f. size of lymphocyte Little cytoplasm Nuclear moulding Often necrosis and lots of mitoses
Immunos: CD56, Synaptphysin
What local complications can result from lung cancer?
Necrosis =/- cavitation
Ulceration - haemoptysis
Infection - abscess formation
Bronchial obstruction - lung collapse, consolidation
Where might lung cancer metastasise to locally (within the thorax)?
Direct spread or metastasis pleural/pericardial effusions
Mediastinal structures - SVCO, dysphagia
Recurrent laryngeal nerve - vocal cord palsy and hoarseness
Phrenic nerve - diaphragm palsy
Where does lung cancer commonly metastasise to?
Other lung Liver Adrenals Bone Brain
