SMOKING RELATED LUNG DISEASES Flashcards
(21 cards)
TYPES OF COPD (2)
Empysema (Morpjologic)
AND
Chronic Bronchitis (clinical) - will NOT see in a POT a diagnosis because of cough for years
Often will co-exist
EMPHYSEMA
“Abnormal permanent enlargement of the a_irspaces distal to the terminal bronchioles_ with destruction of alveolar walls without fibrosis
(does not trigger healing and repair)
Two Types
Panacinar emphysema - near the end of alveolus
Centriacinar emphysma - lower down in resporatory bronchiole
What causes EMPHYSEMA?
= PROTEASE-ANTIPROTEASE THEORY
Neutrophils and macrophages accumulate in the alveoli of smokers
neutrophils release PROTEASES and macrophages release ELASTASE
Free radicals in smoke DECREASE LUNG ANTIOXIDANT (a-1-antitrypsin) and decreases protection of cells
SUMMARY
INCREASE in ELASTASE –> Elastic Damage –> Empysema
DECREASE in ANTIELASTASE –> Elastic Damage –> Empysema
What does it look like?
Often carbon (black) in the lungs “atherocastis”
Broken down alveoli
NOT PINK
JOINED ALVEOLI - DESTRUCTION WITH HOLES
SEE IMAGES SLIDE 7
What are the CLINICAL FEATURES of EMPHYSEMA?
Gradual cough or wheeze
Weight Loss
Barrel Chest
Prolonged expiration
“pink puffers” - long time to breathe
CHRONIC BRONCHITIS
Definition
What Casues
“persistent cough with sputum production for at least 3 months in at least 2 consecutive years”
Hypersecretion of mucous in the large airways
Hypertrophy of submucosal glands
Increase in goblet cells of smaller airways
ALL EQUAL - MUCUS SECRETION
Later features of Chronic Bronchitis?
Mucis plugging of small airways
Inflammation
Fibrosis (Causing reduced lumen size)
Infection plays a secondary role –> pooling of mucus = BACTERIA!!!
Clinical Features of CHRONIC BRONCHITIS?
Persistent cough with copius sputum
Dysponea on exhertion (can’t breate out)
Cor Pulmonare
“Blue Bloaters” - blue lips and skin
LUNG CANCER
What type are we looking at?
Risk Factors
Most common cause of death from neoplasia
Looking at BRONCHOGENUC CARCINOMAS
RISK FACTORS? SMOKING (also air pollution and industrial hazards)
WHAT ARE THE FOUR TYPES OF LUNG CANCER??
Squamous Cell Carcinoma
Adenocarcinoma
Small Cell Carcinoma
Large Cell Carcinoma
Clinical Features of LUNG CANCER
cough, weight loss, chest pain, shortness of breath, metastic disease
BUT remember the lungs have no pain receptors. If you are getting back pain = secondary or jaundice = secondary
LOCAL EFFECTS of LUNG CANCER
bronchial obstruction –> pneumonia/abscess/collapse
pleural invasion –> pleural effusion
chest wall invasion –> rib destruction
pericardial involvement –> pericarditis; temponade
Bronchogenic Carsimomas
Who is affected (commonly)
Specific Risk Factors
most common in MEN but increasing in WOMEN
Peak age of incidence = 40 -70 YEARS OF AGE
Risk Factors?
- Tobacco Smoking (risk increases with number of cigarettes)
- Industrial hazards (radiation, asbestos)
- Air pollution (by radon)
Bronchocarcimonas - what are they (SC, AD, SMALL or LARGE CELL) %
Squamous Cell - 25% - 40% MOST COMMON
Adenocarcinoma 25% - 40%
Small Cell Carcinoma 20% - 25%
Large Cell Carcinoma 10-15%
MORPHOLOGY of BC CARCINOMAS
May arise in and about the HILUS of the lung (near main bronchi) More centrally located e.g. squamous cell carcinomas
Some arise in the PERIPHERY (alveolar septal cells or terminal bronchioles) e.g. adenocarcinomas
Cancers are WHITE due to the FIBROTIC nature. They are HARD and OBSTRUCTIVE
Look for LYMPH nodes full of tumour material.
What type of cancer is it? LOOK AT PISTURES
SCC = top of the lungs but need to take a biopsy
Adenocarcinoma looks a bit like TB - SO LOOK AT HISTORY
Symptoms of Lung Cancer?
No early symptoms
many have…
- general cough(infection distal to blocked airway)
- haemoptysis (ulceration of tumour in bronchus)
- dyspnoea (local extention of tumour)
- chest pain (involvement of pleura and chest wall)
- wheeze (airway narrowing)
TYPE 1:
Squamous Cell Carcinomas
Location
and
Morphology
Location:
Usually CENTRAL and close to the CARINA
Often found in an area that has previously undergone metaplasia
FIRM, GREY-WHITE AND MAY BE ULCERATED
Morphology:
Highly variable microscopic appearance
slow growing - 60% resectable at diagnosis
Median survival time = less than 1 year
KERTAIN WHIRLS OR PERALS, purple cells (mitosis) and Pink with white around edges) see image Slide 16
Type 2:
Adenocarcinoma
Epidemiology
- not as closely related to SMOKING and equal sex incidence. Most common in women
LOOK AT IMAGES
The GLANDS are not normal. Lots of purple plus glands (not as big as the keratin whirls) Pg 17
Type 3:
Small Cell Carcinomas
Epidemiology
and
Ectopic Hormone Production
Epidemiology
Highly malignant lung cancer
Strong relationship to smoking
Male to female 2:1
MOST COMMONLY ASSOCIATED WITH ECTOPIC HORMONE PRODUCTION
Dervived from neuroendocrine cerlls of the lining bronchial epithelium
Results of Ectopic Hormone Production
- antidiuretic hormone
- adrenocorticotrophic hormone (ACTH) = cushing syndrome
LOOKS LIKE - Lymphocytes “oat cell” no structure
Type 4
Large Cell Carcinomas
Microscopic Features
Probably represent a poorly differentiated unrecognisable combination of a squamous cell carcinoma and an adencarcinoma
May be found centrally or perphherallyn–> everywhere in lungs
Really poor diagnosis!
LOOK LIKE HUGE CELLS
PATHWAY OF TUMOUR GROWTH
May follow a variety of paths.
- Fungate into bronchial lumen
- penetrate wall of bronchus
- extend to pleural surface
- spread to tracneal, bronchial and mediastinal nodes
- metastisise to adrenals, liver, brain, bone
