pathology of lung cancers

Question 1

what is one of the most common cancers and the most common cause of death by cancer?

Answer 1

lung

Question 2

what is the main cause of lung cancer?

Answer 2

tobacco

Question 3

whats the aetioology of lung cancer?

Answer 3

TOBACCO
Asbestos 
Environmental radon 
Other occupational exposure 
Chromates, Hydrocarbons, Nickel
Air pollution and Urban environment
Other radiation
Pulmonary fibrosis

Question 4

what percentage of smokers get lung cancer?

Answer 4

10%

Question 5

can passive smoking cause lung cancer?

Answer 5

yes 25% non smokers

Question 6

what effects does tobacco smoke have?

Answer 6

Epithelial effects

Multi-hit theory of carcinogenesis

Host activation of pro-carcinogens
Inherited polymorphisms predispose
Metabolism of pro-carcinogens
Nicotine addiction

Question 7

what are the two main pathways of carcinogenesis?

Answer 7

In the lung periphery
Bronchioloalveolar epithelial stem cells transform
Adenocarcinoma

In the central lung airways
Bronchial epithelial stem cells transform
Squamous cell carcinoma

Question 8

what other cancers are associated of tumours of the lung?

Answer 8

carcinoid tumour
tumours of bronchial glands
lymphoma
sarcoma

Question 9

what are the 4 main types of carcinoma cell types?

Answer 9

Squamous Cell
Adenocarcinoma
Small Cell Carcinoma
Large Cell Carcinoma

Question 10

is lung cancer mostly caught early or late?

Answer 10

late, grows silently for years

presents late in natural history

Question 11

what are the local effects of lung cancer?

Answer 11

Bronchial Obstruction : 
Collapse						      	      	       
Endogenous Lipoid Pneumonia
Infection / Abscess						
Bronchiectasis 

Pleural
Direct Invasion
Lymph Node Metastases

Question 12

what are the 4 nerves that can be affected by lung cancer?

Answer 12

Phrenic – diaphragmatic paralysis

L Recurrent laryngeal – Hoarse, Bovine cough

Brachial plexus – Pancoast T1 damage

Cervical Sympathetic - Horner’s syndrome

Question 13

what are distant effects of lung cancer?

Answer 13

Distant Metastases : Liver, Adrenals, Bone, Brain, Skin

Secondary to
Local Effects :
Neural, Vascular

Non- Metastatic
Effects

Question 14

what are non-metastatic paraneoplastic effects of lung cancer?

Answer 14

skeletal- clubbing

endocrine-Carcinoid syndrome

neurological

cutaneous

haematologic

cardiovascular

renal

Question 15

what are the investigations for lung cancer?

Answer 15

Chest X-Ray

Sputum Cytology rarely used
Bronchoscopy
Bronchial biopsy
Bronchial brushings and Washings
Endobronchial US-guided aspiration (EBUS)
Trans-thoracic Fine Needle Aspiration
Trans-thoracic Core Biopsy
Pleural effusion cytology and Biopsy

Question 16

what are the advanced imaging techniques

Answer 16

CT scanning
MRI, PET scanning
Other imaging

Question 17

what are the prognostic factors in lung cancer?

Answer 17

STAGE of disease
CLASSIFICATION:  Type of disease
Markers / Oncogenes / Gene expression profiles
Growth  Rate
Cell  Proliferation
DNA  Aneuploidy
Immune  Cell  Infiltration

Question 18

what is the cure rate of lung cancer?

Answer 18

<10%

Question 19

which pathway of carcinogenesis involves adenocarcinoma

Answer 19

lung periphery

Question 20

which pathway of carcinogenesis involves squamous cell carcinoma

Answer 20

central lung airways

Question 21

what are the important oncogene addiction mutations?

Answer 21

KRAS, EGFR, BRAF, HER2

Question 22

what are the effects of bronchial obstruction?

Answer 22

Collapse
Endogenous Lipoid Pneumonia
Infection / Abscess
Bronchiectasis

Question 23

what is the effects of cancer on pleural?

Answer 23

inflammatory

malignant

Question 24

where does lung cancer directly invade?

Answer 24

chest wall

Question 25

what happens in lymph node metastases?

Answer 25

mass effect

Lymphangitis carcinomatosa

Question 26

which kind of cell carcinoma is treated differently?

Answer 26

small cell carcinoma

Question 27

whats the new kid of therapy in NSCLC

Answer 27

immunotherapy