Lung Cancer Flashcards
(39 cards)
What % of lung cancer cases does smoking cause?
85%
What types of lung cancer does smoking most commonly predispose to?
Squamous CC
Small CC
How many times is your risk of lung cancer increased if you smoke 10-20 cigarettes and 60 cigarettes a day?
10-20 = 30x risk 60 = 60x risk
List risk factors for lung cancer?
- Smoking
- Asbestos exposure
- Air pollution
- Fibrosing conditions of the lung
- HPV
- Hereditary: Polymorphisms in cytochrome p450
List symptoms of lung cancer?
- Cough
- SOB
- Haemoptysis
- Chest pain
- General malaise
- Weight loss/anorexia
List symptoms more common of a centrally located lung tumor?
- Haemoptysis
- Bronchial obstruction: SOB, retention pneumonia
- Cough
List symptoms more common of a peripherally located tumour?
- Pain if pleura or chest wall is involved
- May have few symptoms.
List some symptoms the can occur due to local tumor spread?
- Pleura: hemorrhagic effusion
- Adjacent lung tissue: May involve larger blood vessels causing hemoptysis
- Mediastinum: SVC obstruction, recurrent laryngeal nerve compression, phrenic nerve compression (hemidiaphragm paralysis)
- Pericardium: Pericardal effusion
- Pancoast tumor: Brachial plexus involvement and cervical sympathetic chain compression causing corners syndrome.
Why is haematogenous spread common in lung cancer?
If pulmonary vein gets invaded.
Where do haematogenously spread lung cancers normally metastasise to?
Liver, brain, bone and adrenals.
Where does lymphatic spread lung cancers normally metastasise to?
Cervical lymph nodes.
Describe some non-metastatic effects of lung cancer?
ACTH secretion
- adrenal hyperplasia
- raised blood cortisol
- bushings syndrome
ADH secretion
- water retention
- SIADH
Parathyroid hormone secretion
- Hypercalcaemia
- Osteoclast activity
Other
- Encephalopathy
- Neuropathy
- Myopathy
Why is a diagnosis of small cell lung cancer normally worse than others?
It is usually advanced at diagnosis and may have metastasized whereas non-small cell is normally more localized.
List types of lung cancer from the most common?
Adenocarcinoma
SCC
Small cell
Large cell
Why may there have been a recent rise in adenocarcinoma and small cell cancer and a fall in squamous CC?
- Change in smoking habits or cigarette composition
- Change in smoking demographics - more females getting lung cancer
- Filter tips, lower tar, lower nicotine - not same ‘hit’ as before so may inhale deeper - peripheral airways exposed to more carcinogens.
What type of cancer is normally a central tumor?
squamous or small cell - arise round hilus
What type of cancer is normally a peripheral tumor?
Adenocarcinoma
Describe the appearance of a small cell carcinoma on histology?
- Oval-spindle shaped cells,
- Inconspicuous nuclei
- Scant cytoplasm
- Nuclear moulding
- Apoptotic and mitotic bodies
What is crush artefact?
Seen in small cell carcinoma samples due to cells having little cytoplasm. When samples are removed by bronchoscopy forceps the sample gets ‘crushed’.
Does Small cell carcinoma respond well to chemo?
Yes, but usually relapses.
Why do squamous cell carcinomas get a central cavitation?
These tumors are often slow growing and outgrow their blood supply.
Describe histology of a squamous cell carcinoma?
- Malignant epithelial tumor
- May have keratinization
- May see intracellular bridges (desmosomes)
What people are adenocarcinomas most common in?
Females and non-smokers.
Describe histology of adenocarcinomas?
- wide range of patterns: glandular/solid/papillary/lepidic (grow along alveolar walls).
- can produce mucin.
