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Respiratory > Pathology of Pulmonary Neoplasia > Flashcards

Pathology of Pulmonary Neoplasia Flashcards

1
Q

Describe lung cancer as a major health issue globally

A

Very high prevalence and is the number 1 cause of cancer mortality
Lung cancer deaths are expected to increase

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2
Q

What are the some of the causes of lung cancer?

A

Tobacco
Asbestos
Environmental radon
Air pollution and urban environment
Other occupational exposure, other radiation and pulmonary fibrosis

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3
Q

Explain lung cancer and smoking

A

More than 85% attributable to tobacco
10% of smokers get lung cancer
Females may be more susceptible
No safe smoking threshold

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4
Q

What does tobacco smoke contribute to in lung cancer?

A

Epithelial effects
Multi hit theory of carcinogenesis
Host activation of pro-carcinogens - inherited polymorphisms predispose and metabolism of pro-carcinogens

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5
Q

What is the multi-hit theory of carinogenesis?

A

Number of genomic events have to take place in a specific cell population in the same sequence
Billions of cells so makes it more likely

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6
Q

Describe bronchial epithelial transformation - pathway of lung carcinogenesis?

A

Bronchial squamous dysplasia
Squamous carcinoma-in-situ
Invasive squamous cell carcinoma

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7
Q

Describe terminal respiratory unit epithelial transformation - pathway of lung carcinogenesis

A

Atypical adenomatous hyperplasia AAH
Adenocarcinoma-in-situ AIS
Invasive adenocarcinoma
This can also transform into squamous cell carcinoma and become an invasive squamous cell carcinoma

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8
Q

What are some smoking induced oncogenes?

A

KRAS and EGFR

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9
Q

What are some oncogenes that are not related to tobacco carcinogenesis?

A

BRF, HER2
ALK
ROS 1

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10
Q

What are the 4 approved targets for oncogenic drivers in adenocarcinomas?

A

EGFR mutation
ALK rearrangement
ROS1 rearrangement
KRAS G12C mutation

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11
Q

Describe adenocarcinomas and oncogenic drivers

A

Only a minority are genetically simple with an oncogenic driver
Most are genetically complex

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12
Q

Describe squamous cell carcinomas and targets

A

Very few suitable targets - very few addictive oncogenes
The commonest alterations are inactivating mutations in tumour suppressor genes

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13
Q

What are thee tumours of the lung?

A

Benign, Carcinoid tumour, tumours of bronchial glands, lymphoma, sarcoma and metastases (common)

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14
Q

What is a carcinoid tumour?

A

Type of slow growing cancer in the lung and is a low grade malignancy

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15
Q

What are some tumours of the bronchial glands?

A

Very rare
Adenoid cystic carcinoma, mucoepidermoid carcinoma and benign adenomas

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16
Q

What are the 4 types of carcinoma of the lung?

A

Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

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17
Q

Does tobacco cause more adenocarcinomas or squamous cell carcinoma

A

Squamous cell carcinoma

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18
Q

What is bronchioloalveolar cell carcinoma now called?

A

Was a subtype of adenocarcinoma
Now it is called adenocarcinoma in situ

19
Q

What does in situ mean?

A

The term carcinoma in situ is a term used to define and describe a cancer that is only present in the cells where it started and has not spread to any nearby tissues
Is the earliest stage of cancer and is termed non-invasive

20
Q

What are the non-small cell carcinomas (NSCLC)?

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Others
NSCLC is not a single type of lung carcinoma - sometimes the term is used when we cannot distinguish between

21
Q

Explain some features of primary lung cancer?

A

Probably grows clinically silent for many years
Present late in natural history
May only have a few symptoms if disease is very advanced
May be found incidentally

22
Q

What are some lung cancer local effects which cause bronchial obstruction?

A

Collapse
Endogenous lipoid pneumonia
Infection/ Abscess - muco-ciliary escalator not working so accumulation of secretion
bronchiectasis

23
Q

Explain endogenous lipoid pneumonia

A

Localised accumulation of lipid-laden macrophages within alveoli distal to an obstructed airway
These lipids are difficult to digest and the macrophages, which attempt to phagocytose them, accumulate within the alveolar spaces

24
Q

What are some pleural local effects of lung cancer?

A

Inflammatory - effusion
Malignant

25
Q

What is the sign of phrenic nerve involvement with lung cancer invasion?

A

Diaphragmatic paralysis

26
Q

What are the signs of L recurrent laryngeal nerve involvement with lung cancer?

A

Hoarse and bovine cough due to paralysed voice box

27
Q

What are the signs of brachial plexus involvement in lung cancer?

A

Pancoast T1 damage

28
Q

What are the signs of cervical sympathetic nerve involvement in lung cancer?

A

Can get Horner’s syndrome - one side of neck and head paralysis

29
Q

What happens if SVC is invaded by lung cancer?

A

Caused by malignant tumours in the mediastinum
Face and arm swelling and shortness if breath

30
Q

Describe lung cancer local effects on lymph nodes?

A

Can get lymph node metastases
Cause mass effect and can get lymphangitis carcinomastosa

31
Q

Where can distant metastases be from lung cancer?

A

Liver, adrenals, bones, brain and skin

32
Q

What are some skeletal non-metastatic paraneoplastic effects of lung cancer?

A

Clubbing and HPOA (hypertrophic osteoarthropathy)

33
Q

What are some endocrine non-metastatic paraneoplastic effects of lung cancer?

A

Hormone secretion:
ACTH - small cell carcinomas
siADH
PTH - squamous cell carcinomas
Carcinoid syndrome
Gynecomastia

34
Q

What investigations are used for lung cancer?

A

Chest X-ray
Bronchoscopy
Trans-thoracic fine needle aspiration
Trans-thoracic core biopsy
Pleural effusion cytology and biopsy

35
Q

What are some advanced imaging techniques used for lung cancer?

A

CT scanning
MRI, PET scanning
Other scanning

36
Q

What are types of bronchoscopy?

A

Bronchial biopsy
Bronchial brushings and washings
Endobronchial US-guided aspiration (EBUS)

37
Q

Explain a bronchoscopy

A

Is a procedure to see inside of airways and remove a small sample of cells
A thin tube with a camera at the end, called a bronchoscope, is passed through your mouth or nose, down your throat and into your airways

38
Q

Explain an EBUS?

A

Combines a bronchoscopy with an ultrasound scan.
An EBUS allows to see the inside of your airways. However, the ultrasound probe on the end of the camera also allows the doctor to locate the lymph nodes in the centre of the chest so they can take a biopsy from them

39
Q

What are prognostic factors in Lung cancer?

A

Stage of disease
Classification - type
Markers/ oncogenes/ gene expression profiles
Might be used to select patients for adjuvant therapy

40
Q

What is the prognosis in lung cancer?

A

Generally nor good
There is overall correlation with stage
In Scotland, around 12-15% of patients with lung cancer get surgical treatment

41
Q

Explain predictive factors in lung cancer?

A

After diagnosis is made predictive biomarkers will increasingly be used to select patients for therapy

42
Q

What are predictive biomarkers for adenocarcinomas and squamous cell carcinomas?

A

Adenocarcinomas - EGRF, KRAS mutations, ALK and R0S1 translocations etc.
Squamous cell - little or no effective molecular targeted therapies

43
Q

What biomarker can be used in NSCLC?

A

The PD1/ PD-L1 axis immune checkpoint
This is a therapeutic target

44
Q

Explain therapeutic against cancer hallmarks

A

PD1, PD-L1 and CTLA4 are immune checkpoints adopted by tumours to avoid immune destruction
Drugs against these checkpoints are gaining increased use in lung and other cancer therapies

Respiratory (24 decks)

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