Pathology of lung cancer Flashcards

(38 cards)

1
Q

which type of cancer is the most common cause of death worldwide (out of all other cancers)

A

lung cancer

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2
Q

main cause of lung cancer

A

tobacco smoke HOWEVER not everyone that smokes get lung cancer and just because they do it doesn’t mean that smoking is the cause

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3
Q

true or false: there is a gradual decline in lung cancer incidences

A

TRUE due to decrease in men having lung cancer. Pretty much the same for women though

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4
Q

Cure rate for lung cancer

A

under 10%

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5
Q

Causes of lung cancer (6)

A
tobacco 
asbestos
environmental radon
other occupational exposure
air pollution and urban environment
pulmonary fibrosis 
passive smoking
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6
Q

what is environmental radon

A

radon is naturally occuring

comes about from radioactive decay of other radioactive isotopes in naturally occurring rock like granite

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7
Q

what happens if you stop smoking?

A

your risk decreases but VERY slowly… >15 years and even still may not be enough

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8
Q

N-nitrosamines give rise to which type of cancer

A

adenocarcinomas

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9
Q

occupational exposure to polycyclic aromatic hydrocarbons (PAH) give rise to which type of cancer?

A

squamous SCC

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10
Q

N-nitrosamines modern day cigarettes

A

more common in modern cigarettes

and these modern cigarettes have caused a shift in the types of cancers present now compared to in the past

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11
Q

in order to develop lung cancer from smoking you most likely need to have had at least one of which 3 things?

A

epithelial effects

multi-hit ie a number of genetic alterations - in a sequence

inherited genetic polymorphisms that increase chance of lung cancer

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12
Q

what are the two main pathways of carcinogenesis in the lungs

A

in the lung periphery - bronchioloalveolar epithelial stem cells transform - adenocarcinoma

in the central lung airways - bronchial epithelial stem cells transform - squamous cell carcinoma

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13
Q

what are the 4 main cell type in lung cancers

A

most common are:-
Squamous Cell
Adenocarcinoma

less common:-
Small Cell Carcinoma
Large Cell Carcinoma

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14
Q

primary lung cancer and detection of symptoms

A

presents LATE in its natural history
as can grow ‘clinically silent’ for many years

symptomatic lung cancer is fatal- by the time it shows symptoms, cannot be cured

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15
Q

how can tumours be undetected in CT or scan?

A

sometimes they can grow behind the heart

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16
Q

why might you get haemoptysis or internal bleeding in tumours that grow into central bronchi

A

may be bleeding as it ulcerates into the airway

17
Q

local effects of lung cancer (7)

A
Bronchial Obstruction : 
Collapse						      	      	       
Endogenous Lipoid Pneumonia
Infection / Abscess						
Bronchiectasis 
Direct invasion - chest wall
pleural - inflammatory or malignant (if in periphery)
18
Q

what is bronchiectasis?

A

a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

19
Q

what local neural effects can lung cancer have if it spreads further into the mediastinum (4)

A
  • Phrenic – diaphragmatic paralysis
  • L Recurrent laryngeal (Hoarse, Bovine cough)
  • Brachial plexus- neurological conditions in hands
  • Cervical Sympathetic (in neck) - Horner’s syndrome - damage to the sympathetic nerves of the face
20
Q

signs of Horner’s syndrome

A

unresponsive pupil
drooping of upper eyelids
absence of facial sweating

21
Q

lymph node metastases

A

spreads into mediastinum and can then spread elsewhere

22
Q

most common place in the body that lung cancer lymph node metastases spreads to

23
Q

other distant metastases of lung cancer

A
Liver 
adrenals
bone 
brain 
skin
24
Q

what signs do you look for in the hands for lung cancer

A

finger clubbing

25
what is TNM staging
the staging mechanism in place to stage tumour growth
26
how many stages are there in TNM
stages 1-4 | treatment depends on which stage
27
when is PET scan used
patients who are in stage`1 or 2 (localised cancer of the lung- only spread to 1 side of the lymph glands) are offered surgery to remove tumour but before they go for surgery they have a PET scan done
28
what happens in PET scan
Inject glucose tag with radioactive element in PET scan | tumour- very metabolically active, glucose dye shows up
29
management/ treatment options
``` Performance status Patient wishes Histological type and stage Multidisciplinary team meeting Aims of treatment e.g. radical or palliative ```
30
radical radiotherapy means?
treatment with the intention to cure | radiotherapy, surgery
31
main types of lung cancer names
carcinoma of the bronchus (most common) cigarette smoke biggest cause also asbestos, radiation etc bronchial adenoma - rare, mainly carcinoid tumours (slow growing) malignant mesothelioma - rare, cancer in the lining of the lung (pleura). Associated with asbestos exposure
32
if you have never smoked and get lung cancer then it is extremely likely that it will be what type of lung cancer?
adenocarcinoma
33
What are the 2 main types of lung cancer?
non-small cell carcinoma small cell carcinoma
34
non-small cell carcinoma covers which cell types?
adenocarcinomas squamous cell carcinoma large cell carcinoma
35
what is oncogene addiction?
growth of cancer at molecular level is driven by an abnormality in one particular gene. Not to say there aren’t others. Growth is driven by intercellular signaling of one gene If you can identify this gene and you can target the protein that is making that then you can have a better treatment these abnormalities are independent of tobacco carcinogens
36
Oncogene targets for adenocarcinoma therapy
EGFR mutation ALK rearrangement ROS1 rearrangement BRAF mutation
37
oncogene addiction is virtually never present in which type of lung cancer
squamous cell carcinomas Very few suitable targets – very few addictive oncogenes
38
Bronchioloalveolar cell carcinoma can also be called what?
adenocarcinoma in situ