Respiratory: - Lecture 2. Pulmonary Neoplasia

Question 1

What are the types of Primary Lung Neoplasms ?

Answer 1

Benign

Malignant

Question 2

What types of lung neoplasm are there?

Answer 2

Primary Neoplasms - the site at which they originated from

Metastic Neoplasma - Metastasis are secondaries of the primary tumour

Question 3

What is a Neoplasm?

Answer 3

An Abnormal cell growth

Question 4

What is contained in Tobacco smoke?

Answer 4

Polycyclic hydrocarbons
Aromatic amines
Phenols
Nickel
Cyanates

• All of these are carcinogens.

Question 5

What percentage of smokes will die of lung cancer?

Answer 5

20%

Question 6

Generally, what types of cancer is caused by tobacco smoke?

Answer 6

suffer laryngeal
cervical, bladder
mouth
oesophageal
colon cancer

-respiratory cancer

Question 7

What are the other risk factors that can cause lung cancer?

Answer 7

Asbestos
Nickel
Chromates
Radiation 
Atmospheric pollution
(Genetics)

Question 8

How can a tumour present ?

Answer 8

Local Effects

Systemic effects

Question 9

What are the Local effects of a tumour?

Answer 9

Obstruction of the airway - Causes Pneumonia
Invasion of Chest wall - causes Pain
Ulceration - Haemoptyosis

Question 10

What is Pneumonia?

Answer 10

Pneumonia is an inflammatory condition of the lung affecting primarily in the alveoli

Question 11

What are secondary sites of cancer called?

Answer 11

Metastases

Question 12

What are the common sites of metastases?

Answer 12

Nodes
Bones
Liver
Brain

Question 13

What is the commonest brain cancer a metastases from?

Answer 13

Lung Cancer

Question 14

What are the Systemic effects of a tumour

Answer 14

Weight Loss

Ectopic (abnormal) hormone production

Question 15

What can hypercalcaemia be a systemic effect of?

Answer 15

Squamous cell cancers

-parathyroid hormone

Question 16

What hormone is produced in excess to cause hypercalcaemia?

Answer 16

Parathyroid hormone

Question 17

What hormone stimulates the cortex of the adrenal gland to produce steroids?

Answer 17

Adrenocorticotropic hormone

Question 18

In squamous cancers what hormone can be produced in excess?

Answer 18

Parathyroid hormone

Question 19

In what cancer can there be an increase in Adrenocorticotropic hormone?

Answer 19

Small cell cancers

small cell lung cancer

Question 20

What are the common types of smoking-associated types of cancer?

Answer 20

Adenocarcinoma
Squamous Carcinoma
Small cell Carcinoma
Large Cell Carcinoma

Question 21

What endocrine related cancers can form in the lung?

Answer 21

Neuroendocrine tumours

Bronchial gland tumours

Question 22

What characterises Squamous Cell carcinoma?

Answer 22

Keratinising/production of keratin from the cells

Question 23

What characterises Adenocarcinoma?

Answer 23

Presents in glandular epithelium and spread along pre-existing structures of the lung or gland-like structure.

Occasionally produces mucin which is see in the epithelium (STAINS BLUE)

Question 24

What characterises Small cell carcinoma?

Answer 24

Darkly staining tumours
Very little cytoplasm
No attempt at glandular formation
Formed by small nuclei with homogeneous dark nuclei

Question 25

What characterises Large cell carcinoma?

Answer 25

Defined by large cells with absence of squamous differentiation or glandular differentiation

Question 26

How are lung cancers subtyped?

Answer 26

Standard histological staining Protein expression within them. Sometime: Analysis of the sputum. e.g. haemoptysis

Question 27

What antigen is expressed in a squamous cell carcinoma?

Answer 27

P63 protein

Question 28

What antigen is expressed in small cell carcinoma and adenocarcinoma?

Answer 28

TTF - 1 (Thyroid transcription factor)

Question 29

Why are cancers subtyped?

Answer 29

Difference in Treatment. Difference in Prognosis Difference in Epidemiology Difference in Pathogenesis

Question 30

What cancers have the worst prognosis? (from worst to best)

Answer 30

Small cell Large Cell Squamous cell Adenocarincoma

Question 31

How are patients treated for small cell carcinoma?

Answer 31

Treated by chemotherapy - Small cell carcinoma is chemosensitive, however grows back afterwards. - Should still be given even in palliative situations

Question 32

What are the Non-small cell carcinomas?

Answer 32

Adenocarcinoma Squamous cell Carcinoma Large Cell carcnoma

Question 33

What Oncogenes are mutated in Small Cell Lung Cancer?

Answer 33

MYC gene

Question 34

Where is the MYC oncogene located?

Answer 34

Chromosome 8

Question 35

What Oncogenes are mutated in Non-small cell lung cancer?

Answer 35

K-Ras EGFR myc

Question 36

What tumour supressor genes are switched off in SCLC?

Answer 36

p53 Rb 3p

Question 37

What tumour suppressor genes are switched off in NSCLC?

Answer 37

``` p53 1q 3p 9p 11p Rb ```

Question 38

What are most adneocarcinoma related to?

Answer 38

K Ras mutation | Wild-type EGFR gene

Question 39

What tyrosine kinase inhibitor can be used for some NSCLC?

Answer 39

Gefitinib

Question 40

How does Gefitinib work?

Answer 40

Tyrosine Kinase Inhibator | - interrupts signalling through the epidermal growth factor receptor (EGFR - oncogene) in target cells.

Question 41

What is the pulmonary epithelium divided into?

Answer 41

Bronchial epithelium | Bronchioles/alveoli epithelium

Question 42

What cells are in the Bronchial epithelium?

Answer 42

ciliated mucous neuroendocrine reserve

Question 43

What cells are in the Bronchiales and alveoli epithelium?

Answer 43

Clara cells | types 1 and 2 alveolar lining cells

Question 44

Describe the process of a tumour formation in the large airways, or for bronchial tumours?

Answer 44

Squamous metaplasia Dysplasia Carcinoma in situ Invasive malignancy

Question 45

What tumours generally are large airway tumours/bronchial tumours?

Answer 45

Squamous cell | Small cell

Question 46

Describe the pathogensis of basal cell hyperplasia and how it changes to a squamous metaplasia?

Answer 46

Cells begin to proliferate from the base due to tobacco smoking - hyerplasia. Eventually works it way to the epithelium. It changes the epithelium cells to more skin-like epithelium - This is Squamous metaplasia

Question 47

What is the definition of metaplasia?

Answer 47

Reversible replacement of one differentiated cell type with another mature differentiated cell type.

Question 48

What is Dysplasia?

Answer 48

change in cell or tissue phenotype

Question 49

Describe how a periperal adenocarcinomas forms?

Answer 49

Atypical adenomatous hyperplasia - tumour spread along the alveolar walls. (Bronchioalveolar carcinoma)

Question 50

What could a differential diagnosis of a Bronchioalveolar carcinoma be?

Answer 50

Pneumonia

Question 51

What does the prognosis of the lung cancer depend on?

Answer 51

Tumour stage Histological subtype

Question 52

What staging is used for lung cancer?

Answer 52

TNM staging

Question 53

What is a Carcinoid tumour?

Answer 53

Neuroendocrine neoplasma of low grade malignancy Occurs in young people

Question 54

What is a Bronchial gland neoplasm?

Answer 54

Tumours seen in salivary glands

Question 55

What is a primary pleural neoplasia called?

Answer 55

Mesothelioma They are generally maligant