Lung Cancer Flashcards Preview

Hugh's MD2 Core Conditions and Presentations > Lung Cancer > Flashcards

Flashcards in Lung Cancer Deck (20):
1

Describe the micro pathological features of large cell carcinoma

Undifferentiated non-small cell carcinoma that lacks the cytological features of adenocarcinoma, SCC, or small cell carcinoma

2

How do presenting symptoms differ in relation the location of the tumour?

Centrally located - Haemoptysis, cough, SOB, wheeze

 

Peripheral - Pleuritic chest pain

 

Tumours at the apex - Pancoast syndrome

3

What are carcinoid tumours?

Neuroendocrine tumours typically found around the main bronchus. Commonly an incidential finding but still have metastatic potential

4

Describe the macro and micro pathology features of adenocarcinomas

Macro - Peripheral, often with pleural involvement

- Grey white with necrosis and haemorrhage and mucoid appearance

 

Micro - Generally well to moderately well differentiated with glandular and papillary structures 

- Mucin producing cells with cytoplasmic mucin granules

5

What are some targeted biological therapies for lung Ca?

EGFR receptor antagonist

ALK

6

How can lung cancer present?

Local complications

- Cough, change in voice

- Pruritic chest pain

- SOB (effusion, pneumothorax, PE, SVC obstruction)

- Haemoptysis

Metastatic Disease

- Bone pain

- CNS signs

Systemic symptoms

- Fatigue, LOW

- Hypercalcaemia

7

What treatment options are available in lung Ca? Which has the best chance of cure in lung cancer?

Surgery (best)

Chemotherapy

Radiotherapy

Target biological

Palliation

8

What are some risk factors for the development of lung Ca?

Smoking

Radiation exposure

Second hand smoke

Abestos

Radon

Pulmonary fibrosis

 

9

Describe the macro and micro pathology features of small cell carcinomas?

Macro - Often local obstruction of bronchi and SVC

 

Micro - neuroendocrine type architecture with nests, ribbons, rosettes and trabeculae

- Cells have high N/C ratio with large ovoid nuclei, granular chromatin, inconspicuous nucleoli, scanty cytoplasm

10

What are the common sights of lung Ca metastasis?

Adrenal (>50%)

Liver

Brain

Bone

11

What are the types of adenocarcinomas are there?

Mucinous

Non-mucinous

Mixed

12

What patient population have ALK mutation? How do their tumours appear?

Males 40-60 with no or light hx of smoking

Tumours have a solid pattern with signet ring cells and prominent host inflammatory response

13

Metastases in the lung typically come from where?

Breast

Lower GIT

Renal cell carcinoma

Melanoma

14

Describe the macro and micro pathology features of carcinoid tumours?

Macro - Soft tan colour and well demarcated

May have areas of congestion and haemorrhage

 

Micro

- Neuroendocrine type architecture with nests, ribbons, rosettes and trabeculae

- Cells have high N/C ratio with large ovoid nuclei, granular chromatin, inconspicuous nucleoli, scanty cytoplasm

15

What is a adenocarcinoma in situ (aka bronchiolo-alveolar carcinoma)?

 

Adenocarcinoma growing out of existing structures with no evidence of invasion of stroma, blood vessels, or pleura

16

Describe the macro and micro pathology features of Squamous Cell Carcinomas

Macro - centrally located, often with cavitation

- Grey-white to yellow, often flaky due to keratinisation

 

Micro - intercellular bridges and keratinisation

 

 

17

What is pancoast syndrome?

Tumours at the apex of the lung in the superior sulcer causing blocking the thoracic inlet and damage to the brachial plexus and cervical sympathetic nerves which can result in:

 

- Pain in the shoulder radiating to the ulnar aspect of the hand

- Atrophy of hand muscles

- Horner syndrome

- Compression of blood vessels with oedema

18

What patient population typically have EGFR mutations? How do the tumour appear?

Non or light smoking young asian females with low stage disease

Tumour often are well differentiated with lepidic growth and no necrosis

19

Outline staging for lung cancer

I - Primary with no nodal metastasis

II - Primary with ipsilateral nodal metastasis to peribronchiolar or hilar LNs

III - Local invasion plus mediastinal LN spread or local invasion to adjacent organs

IV - Distant organ metastasis

20

How do adenocarcinomas in situ present on imaging?

Single or multi-nodular consolidation that can involve a whole lobe - can be pneumonic in appearance