lung tumours Flashcards
(22 cards)
classification of lung tumours - malignant:
Primary
* — (>95%)
* —
Metastatic ( — )
* Colon
* Breast
* Renal cell carcinoma
* Prostate
* Melanoma
classification of lung tumours - bengin:
* Arise from lung —
* Commonest is —
* Example: Hamartoma, which is a tumour composed of a mixture of —, — , —, — tissue and —- .
* Other examples of benign lung tumours:
* Papilloma
* Adenoma
* Chondroma
* Haemangioma
epithelial
non epithelial
common
parenychymal tissue
hamarotoma
cartlige, fat , blood vessels , fibrous tissue , epithelium
malignant lung tumours:
Primary epithelial malignancies:
* Non small cell carcinoma:
▪ —
▪ — cell carcinoma
▪ — cell carcinoma
▪ NSCLC, Nos
* Neuroendocrine carcinoma:
▪ — cell carcinoma
▪ — cell neuroendocrine carcinoma
▪ — tumour (typical and atypical)
adenocarcinoma
squamous cell
large cell
small cell
large cell
carcinoid tumour
incidence in ireland:
* Approximately 2200 cases diagnosed / year
* — > – ; although rising incidence in —
* Accounts for 13% of carcinoma deaths in men, 7% in
women
* 1700 deaths in 2010 from lung carcinoma vs 659 from
breast carcinoma
* —- causes more deaths per year than any other invasive carcinoma
aetiology:
* Cigarette Smoking
▪ 85% of lung carcinoma occurs in —
▪ Mode of action: contains 18 hydrocarbons; act as a chemical
carcinogen
▪ Approx. 1 in 9 smokers eventually develop lung carcinoma
* City Living
* Other types of smoking
▪ Tobacco use (cigar and pipe smoking)
▪ Weaker risk
* Industrial Exposure:
▪ —
▪ —
* Radon
* Other lung disease e.g. COPD, fibrotic lung disease
* Genetic factors
m > f
females
Lung carcinoma
smokers
asbestos and hameatite
bronchogenic carcinoma:
Lung carcinoma is also known as
BRONCHOGENIC CARCINOMA
(Bronchial carcinoma) Often arises from —
presentation of lung carcioma:
* Depends on — of the primary tumour and — of
Disease at presentation
* —
* —
* — metastases
* — manifestations
* —- - chest x-ray
major bronchi
site
stage
local
intrathoracic
distant
non metastatic
asymptomatic
local effects:
* — surrounding —
* Mucosa — , — or —
* Cough
* Haemoptysis
* Pleural / mediastinal involvement
▪ Pneumothorax
▪ Pleural effusion
* Recurrent pneumonia — to obstructing tumour
▪ Carcinoma narrows — of bronchus ->
▪ — -> — of secretions ->
▪ — ->
▪ — -> — formation
spread:
* Intrathoracic spread to — and —
* — mediastinal obstruction
mass
main bronchus
ulcerated , roughened , nodular
distal
lumen
obstruction
retention
infection
pneumonia
abscess
hilar and mediastinal lymph
nodes
superior
1- pan coasts tumour aka — lung tumour:
* — SYNDROME
* Ipsilateral ptosis
* Miosis
* Anhidrosis
* Due to invasion of — chain and the —-
* Also — and — pain and weakness and — of hand muscles
2- distant metastases:
* Lymph nodes:
▪ Axilla, cervical, other
* Bone:
▪ Pathological fracture, pain
* Liver
* Brain:
▪ Seizures, stroke, headache
* Adrenal gland
* Skin
* Other
apical
horners
sympathetic and stellate ganglion
shoulder and arm
atrophy
non metastatic manifestation:
* — late symptom
▪ Weight loss, anorexia
* — of fingers
* — syndromes
Cachexia
clubbing
paraneoplastic
- Paraneoplastic syndrome is a— or a — that is a consequence of — , but not due to the presence
of — - It is mediated through:
▪ — antibodies
▪ Production of physiologically —
▪ Interference with normal — pathways
▪ – - Primarily associated with — cell lung carcinoma
- Also seen with — cell carcinoma and —
disease or syndrome
carcinoma
local carcinoma cells
cross reacting
active factors
metabolic
idiopathic
small cell
squamous and adeocarcinma
paraneoplastic syndromes:
* — , —
* Cushing’s Syndrome – ACTH or ACTH-like substance
production ( — cell carcinoma)
* Hypercalcaemia – PTHRP, TGF-alpha, IL-1( — cell
carcinoma)
* Hyponatraemia – SIADH ( — cell carcinoma)
* Encephalopathies
* Hypertrophic osteoarthropathy (HPOA) ( — )
* Gynaecomastia
* Lambert-Eaton myasthenic syndrome - muscle weakness proximal arms and legs, difficulty climbing stairs and rising from a sitting position
neuropathy , myopathy
small cell
squamous cell
small cell
adenocarcimoa
1- investigations:
* Radiology:
▪ CXR
▪ CT thorax
▪ PET scan
* Bloods:
▪ FBC, Calcium, LFT’s, U&E
* Bronchoscopy:
▪ Washings / lavage / biopsy if —
* Tissue sampling
▪ — guided biopsy
▪ EBUS TBNA
▪ CT guided biopsy of a metastasis
2- tissue diagnosis:
* —- for diagnosis
* Essential for –
* Main discriminator for management is — cell
carcinoma vs — cell carcinoma
* Small cell carcinoma is staged as — and —
* Treatment is —, with — and
prophylactic cranial —
endobronchial
CT
gold standard
mangement
small vs non small
limited and extensive
non surgical w chemotheroay
irradiation
tissue:
* Sputum
* Bronchoscopic samples
▪ Washings
▪ Lavage
▪ Biopsy
* EBUS TBNA
▪ Mediastinal nodes
▪ Mass lesion
* CT guided aspiration of mass
* Pleural fluid aspirate
* Radiologically guided lesion of a
metastasis
▪ Liver, bone, lymph node etc.
primary epithelial lung malignancy — ( most common ) , — , —-
histologic types:
* —
* — cell carcinoma
* — cell carcinoma
* — cell carcinoma
* Other
adeocarcinoma
squamous cell
small cell
adenocarcinoma
squamous cell
small cell
large cell
adenocarcinoma:
* More commonly arise as —
* Can arise as — carcinoma (with — )
* — growing:
▪ — adenomatous — (AAH)- >adenocarinoma — (AIS) -> — adenocarcinoma
* CT correlate of AIS is ground — opacity (GGO)
* — forming tumour
* TTF-1 —
peripheral lesions
scar
fibrosis
slow
atypical
hyperplasia
in situ
invasive
glass opacity
gland
+ve
squamous cell carcinoma:
* More common — (— )
* Stepwise progression:
* Squamous — -> — -> carcinoma — -> — squamous cell carcinoma
* Well / moderately / poorly differentiated
* — production
* — and — common
*—- bridges
* Positive with — and — immunohistochemical
markers
centrally
major bronchus
metaplasia
dysphasia
in situ
invasive
keratin
necrosis and caviation
intracellular bridges
CK5/6 and p63
- Immunohistochemistry stains in — , — cell
carcinoma, — , positive for — , — - Squamous cell carcinoma cytokeratin —
- Adenocarcinoma — , Napsin —
- Neuroendocrine tumours, small cell carcinoma, carcinoid - chromogranin, synaptophysin, — (small cell carcinoma TTF1)
- Metastatic tumours – melanoma S100, Melan-A, hmb45, SOX-10
- Metastatic — tumour – cytokeratin 20, CdX2
- Metastatic— – GATA-3 oestrogen receptor
- Head and neck squamous cell carcinomas, cervix squamous cell carcinomas may be— positive ( – related)
carincoma , squamous , adenocarcinoma
AE1-3 , cytokeratin 7
cytokeratin 5/6
TTF1 , napsin A
CD56
colorectal
breast
P16
HPV
molecular advances in lungs:
* A key discovery in the past 2 decades have been that some
lung carcinomas harbour specific mutations that are essential
for malignant growth, which lead to—- of oncogenes or— of tumour suppressor genes
* Identification of specific molecular alterations and driver
mutations in lung carcinomas have resulted in development of
targeted therapies
* Adenocarcinoma predominant subtype with identifiable targets
▪ — mutations
▪ —
▪—-1
▪ –
▪ —
gain of function
loss
EGFR
ALK
ROS-1
RET
B-RAF
1- * — ligand 1 (PD-L1) is a — protein that plays a role in — the immune system
* The binding of PD-L1 to PD-1 transmits an – signal which reduces the proliferation of – cells
* Upregulation of PD-L1 may allow carcinomas to — the host immune system
* Thus many PD-L1 inhibitors are being developed as — therapies
* Current testing is through immunohistochemistry on tumour cells for PD-L1
2- liquid biopsy:
* Analysis of tumour — detected in the– , circulatory
tumour DNA (ct-DNA)
* ct-DNA is fragmented — in the blood stream
* Assessed by Next Generation Sequencing (NGS) digital —
* — , — , trials in progress
* Evolving roles: – , molecular — of tumours, — to treatment, tumour —
programmed death
trasmembrane
suppressing
inhibitory
cd8+ t cells
evade
immune-oncology
dna
blood
tumour dna
digital PCR
fast convient
screening , assessment m response , resistance
1- neuroendocrine carcinoma:
* 2015 WHO Classification
▪ Small cell carcinoma
- Combined SCLC
▪ Large cell neuroendocrine carcinoma
- Combined LCNEC
▪ Carcinoid tumours
- Typical
- Atypical
2- small cell carcinoma:
* Histological features:
* — to — sized cells
* Nuclear —
* Granular chromatin
* Scant cytoplasm
* Chromatin streaking (“ — artefact”)
* — and prominent —
* Neuroendocrine markers (—- and — positive)
* May get combined tumours: small cell carcinoma with
squamous cell carcinoma or adenocarcinoma
small to medium
moulding
crush
necrosis and prominent mitosis
synaptophysin and chromogranin
management:
* STAGE
* Small cell carcinoma:
▪ — vs – stage
▪ —
- Extremely chemosensitive; platinum and Etoposide
▪ —
▪ — survival
* Non-small cell carcinoma:
▪ —
- Tumour size, nodal involvement, distant metastases
▪ Surgery
▪ Chemotherapy
▪ Radiotherapy
▪ Molecular testing for targeted drug therapies
limited vs extensicvr
chemo
radiology
poor
TNM
1- staging of non small cell carcinoma:
* PET CT:
▪ – metastases
▪ — involvement
* EBUS TBNA:
▪ Assess— for
involvement by tumour
* Must define the extent of
disease to:
▪ Assess –
▪ Assign appropriate —
2- ECOG status:
* Patient with lung carcinoma often have numerous —
▪ As they are frequently heavy – and have severe — (COPD)
▪ Heart disease
* In addition to tumour stage, the ECOG status (ECOG 0-5) is evaluated, this describes how generally — the patient
is
* Pulmonary function tests are also essential prior to surgery or radiotherapy to assess —
distant
nodal
nodes
prognosis
treatment
co morbidities
smokers and severe emphysema
well
lung function
other primary malignancies:
* Mesothelioma:
▪ See lecture on asbestos
* Thymic lesions:
▪ Thymoma, thymic carcinoma
▪ – carcinoma
▪ — like carcinoma
* Salivary gland like tumours:
▪ — carcinoma
▪ – carcinoma
* Lymphoma:
▪ — lymphoma
▪ – lymphoma
NUT
lymphoepithelioma
adenoid cystic
mucoepidermoid
b cell
T cell
carcinoid tumour:
* — neoplasm
* Mean age of presentation is – years
* 5% of — neoplasms
* Usually arise in the – , — , showing — growth
* Presentation: — (very vascular tumours), cough,
recurrent — (due to— obstruction), — (incidental finding on CXR)
* Biopsy: Medium sized cells, “—” chromatin, typical of neuroendocrine tumours, growing in a nested pattern or trabeculae
neuroednodarine
40 years
pulmonary
central large bronchi
intraluminal growth
haemoptysis
recurrent pneumonia ( proximal )
asymptomatic
salt anf peper
carcinoid tumours of lungs - continued:
* Positive for neuroendocrine immunohistochemical markers,
( — , — , — )
* Grade depends on number of — , percentage of cells in— (Ki67 immunostain)
* Prognosis is excellent in — carcinoid
* Treatments is by —
* Atypical carcinoid tumours have a — mitotic rate and can
be associated with — metastases, but generally
have a very — prognosis
* Only — induce carcinoid syndrome
- carcinoid tumours are basically Round to ovoid or
spindle shaped cells
with relatively — cell s i z e
Abundant cytoplasm
and nuclei with fine
granular chromatin
CD56, synaptophysin and chromogranin
mitoses
cell cycle
typical
surgical excision
higher
lymph nodes
very good
rarely
uniform
