Pathology of Lung Cancers Flashcards
Describe the common symptoms of lung tumours
- Chronic cough
- Haemoptysis
- Wheezing
- Chest pain
- Chest infections
- Difficulty swallowing
- Hoarse raspy voice (nerve damage)
- Dyspnoea
- Unexplained weight loss
- Appetite loss
- Bone pain
- Nail clubbing
- Haematuria
- Confused, headache, personality change
What are the 6 red flag symptoms for lung cancer?
- Cough 2-3 weeks
- Haemoptysis
- Recurrent chest infection
- Shoulder pain, change in voice unexplained weight loss in smokers
Define the types of lung carcinoma
Small cell (15%)
Non-small cell (85%);
- Squamous: central, close to main airways, smoking
- Adenocarcinoma: most common lung cancer, in lung periphery bronchoalveolar epithelial stem cells, never smoked
- Large cell undifferentiated
- Other (NOS)
Describe the epidemiology of primary lung cancer
- One of most common cancers
- Kills more than breast and prostate combined
- Cure rates under 10%
Describe the aetiology of primary lung cancer
- Tobacco (>85%)
- Asbestos
- Radiation
- Occupational
- Air pollution
- Pulmonary fibrosis
- Passive smoking
Describe the common signs of lung tumours
- Chest signs
- Finger clubbing
- Hepatomegaly
- Lymphadenopathy
- SVC obstruction: face swelling, prominent veins
- Tracheal deviation
- Horner’s syndrome
- Pancoast tumour
- Skin/soft tissue nodules (metastases)
- Recurrent laryngeal nerve palsy
- Chest wall masses
Describe a CXR of lung cancer
- Pleural effusion
- Chest wall invasion
- Phrenic nerve palsy
- Collapsed lobe/lung
Describe a blood test of lung cancer
- Anaemia
- Normal LFT
- Abnormal bone profile
Describe a CT scan of lung cancer
- Size of tumour
- Mediastinal nodes
- Metastatic disease
- Proximity to mediastinal structures
- Pleural/pericardial effusion
- Diaphragmatic involvement
Describe the pathogenesis of adenocarcinomas
- Non-smokers
- Thus, cancer caused by intracellular signalling of specific oncogenes
- KRAS, EGFR, BRAF, ROS1
Describe the local effects of a lung carcinoma
- Bronchial obstruction: collapse, lipid pneumonia, bronchiectasis
- Pleural: inflammatory, malignant
- Direct invasion
- Lymph node metastsases
Nerves;
- Phrenic: diaphragmatic paralysis
- L recurrent laryngeal: hoarse voice, bovine cough
- Brachial plexus: pancoast T1 damage
- Cervical sympathetic: Horner’s syndrome
Describe the distant effects of a lung carcinoma
Direct metastases;
- Liver
- Adrenal
- Brain
- Bone
- Skin
Describe the initial investigation of lung carcinoma
- CXR
- Full bloods
- Liver, renal, calcium
- Clotting screen
- Spirometry (maybe COPD?)
Describe the secondary investigation of lung carcinoma
- CT
- MRI
- PET
- Bronchoscopy: biopsy, washings and brushing, EBUS
Describe the tissue diagnosis of lung carcinoma
- Bronchoscopy and EBUS
- Image-guided biopsy
- Mediastinoscopy for mediastinal lymph nodea
- Mediastinotomy for anterior mediastinal lymph nodes
- Explorative thoracotomy
