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Pathology of Lung Cancer Flashcards

(46 cards)

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1
Q

What is the leading cause of lung cancer?

A

Tobacco

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2
Q

What are other other causes of lung cancer?

A 
Asbestos 
Environmental radon 
Occupational exposure: chromate, hydrocarbons, nickel
Air pollution 
Other radiation 
Pulmonary fibrosis
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3
Q

What are two important compounds in tobacco that are through to cause lung cancers?

A

Polycyclic aromatic hydrocarbons

N-Nitrosamines

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4
Q

What type of lung cancer are the N-nitrosamines thought to cause?

A

Adenocarcinomas in the periphery of the lungs

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5
Q

What type of lung cancer are polycyclic aromatic hydrocarbons thought to cause?

A

Squamous cell carcinoma in the central bronchi

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6
Q

What are the 3 effects of tobacco smoke that can lead to lung cancer?

A

Epithelial effects
Multi-hit theory of carcinogens
Host activation of pro-carcinogens

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7
Q

What is the multi-hit theory?

A

3-12 key significant changes must occur in cells that survive, and must occur in a specific sequence for tumour to develop

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8
Q

How can inherited polymorphisms predispose a person to developing lung cancer?

A

Metabolism of pro-carcinogens

Nicotine addiction

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9
Q

What type of cells are targets for carcinogens?

A

Stem cells

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10
Q

Describe the pathway of carcinogenesis in the lung periphery

A

Bronchioalveolar epithelial stem cell transforms - adenocarcinoma

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11
Q

Describe the pathway of carcinogenesis in the central lung airways

A

Bronchial epithelium stem cells transform - squamous cell carcinoma

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12
Q

Describe basic formation on the invasive bronchogenic carcinoma

A
  1. Squamous dysplasia in the epithelium of the bronchial tree
  2. Carcinoma in situ
  3. Has invasive potential allowing it to develop into an invasive carcinoma

Process strongly associated with smoking

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13
Q

Describe stages in development of peripheral lung adenocarcinoma

A
  1. Atypical adenomatous hyperplasia
  2. Adenocarcinoma in situ
  3. Invasive carcinoma

Can occur in non-smokers

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14
Q

What type of cancer can occur in non smokers?

A

Peripheral lung adenocarcinoma

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15
Q

What is the most common driver mutation in lung cancer?

A

KRAS

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16
Q

Name a driver mutation which is smoking induced?

A

KRAS

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17
Q

Name driver mutations which are not smoking induced?

A

EGFR
BRAF
HER2
ALK rearrangements

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18
Q

What is an addictive oncogene?

A

An oncogene that when inactivated will stop the growth of the cancer

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19
Q

What is important about addictive oncogenes in terms of treatment?

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A

May allow molecular target therapy to inactivate this gene and stop the cancer from spreading

20
Q

What are 4 addictive oncogene targets for adenocarcinomas?

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A

EGFR mutation
ALK rearrangement
ROS1 rearrangement
BRAF mutation

21
Q

Why aren’t addictive oncogene used in squamous cell carcinomas and what is used instead?

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A

Very few addictive oncogenes

Inactivate mutations in tumour suppressor genes

22
Q

Give some examples of some tumours in the lung which arent lung cancer

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A 
Carcinoid tumour
Tumour of bronchial glands
Lymphoma
Sarcoma
Metastases
23
Q

What is an example of a benign mass lesion of the lung?

24
Q

What are the four main cell types of carcinoma of the lung?

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A

Squamous cell
Adenocarcinoma
Small cell
Large cell

25
What is another name for bronchioalveolar cell carcinoma?
Adenocarcinoma in situ
26
What cell types are in the non-small cell carcinomas (NSCLC)?
Adenocarcinoma Squamous cell Large cell Other
27
Why is term NSCLC used?
Sometimes in diagnosis because we cannot distinguish between some types of NSCLC on small biopsy samples
28
Clinical presentation of primary lung cancers
Grows clinically silent for many years and presents late May be found incidentally, during investigation for something else Symptomatic lung cancer fatal
29
What are the local effects of lung cancer in terms of bronchial obstruction?
Collapse Endogenous lipoid pneumonia Infection/abscess Bronchiectasis
30
What is endogenous lipoid pneumonia?
Occurs from obstruction of the airway which results in the accumulation of cellular breakdown debris, including cholesterol from destroyed alveolar cell walls (LDL)
31
What are the local effects of lung cancer in terms of pleura?
Inflammation | Malignant
32
What are the local effects of lung cancer in terms of direct invasion?
Chest wall and into ribs Into mediastinum and its organs Nerves
33
Potential effects of nerve invasion
Phrenic - diaphragmatic paralysis L Recurrent laryngeal - hoarse, bovine cough Brachial plexus - pancoast T1 damage Cervical sympathetic - Horner's syndrome
34
What are the local effects of lung cancer in terms of lymph node metastases?
``` Mass effect Lymphangitis carcinomatosa (term given to tumour spread through the lymphatics of the lung) ```
35
What are the distant effects of the lung?
Distant metastases: liver, adrenals, bone, brain, skin Neural and vascular effects Non-metastatic effects
36
Name two non-metastatic effects
Finger clubbing | Hypertrophic pulmonary osteoarthropathy (HPOA)
37
Name investigations for lung cancer
CXR ``` Bronchoscopy - biopsy Trans-thoracic fine needle aspiration Trans-thoracic core biopsy Pleural effusion Sputum cytology (rare) ``` CT MRI, PET
38
What determines the prognosis of lung cancer?
Stage of disease Classification: type of disease Markers/oncogene/gene expression profiles - MIGHT be used to select patients for ADJUVANT therapy
39
Why is pleural effusion an investigation for lung cancer?
Cancer cells can spread to the pleura. This can cause fluid to build up and press on the lungs, causing breathlessness.
40
What is adjuvant therapy?
Refers to surgery followed by chemo or radiotherapy to help decrease the risk of the cancer recurring
41
What are predictive factors in lung cancer used for?
To select patients for therapy
42
What are the main predictive markers are used in adenocarcinomas?
EGFR (and KRAS, HER2, BRAF mutation) | ALK translocations
43
What are the main predictive markers are used in sqaumous cell carcinoma?
Little effective targeted therapy
44
How do tumour evade the immune response?
Inhibitory immune checkpoints Immune checkpoints control immune reactions and are controlled by tumours to avoid immune destruction
45
What are the proteins at the immune checkpoint?
PD1 PD-L1 CTLA4
46
How do drugs act against the immune check points in lung cancer therapy?
When PD-1 binds to PD-L1, it blocks immune response Some cancer cells have large amounts of PD-L1, which helps them evade immune attack Target either PD-1 or PD-L1 can block this binding and boost the immune response against cancer cells

Respiratory System (29 decks)

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