what is the stepwise pathogenesis of bronchial carcinoma?
carcinoma in situ
what are the symptoms of bronchial carcinoma? and cause of them
cough - mucosal irritation
chest pain - invasion of chest wall
dyspnoea - atelectasis, obstruction
weight loss - cancer cachexia
present late so high mortality
what are the clinical complications of bronchial carcinoma?
hoarseness of voice: left laryngeal nerve palsy
haemoptyis: vascular invasion
pneumonia, bronchiectasis, abscess: obstruction
dysphagia: oesophageal invasion
SVC syndrome: SVC obstruction
pleural effusion: pleural invasion
pericarditis: pericardial invasion
diaphragm paralysis: phrenic nerve invasion
horner's syndrome: sympathetic ganglia invasion
pancoast's humour: apical tumour causing hornets, shoulder, arm pain from brachial plexus involvement, hoarseness from laryngeal nerve palsy
what causes the paraneoplastic syndromes of bronchial carcinoma?
often ectopic hormone production
NOT due to local or met spread
name some endocrine paraneoplastic syndromes
hyperCa: PTH or PTHrP or PGE secertion esp scc
Cushing's syndrome: ACTH secreting tumour esp scc
SIADH: esp. in small cell carcinoma, get hyponatraemia leading to cerebral confusion and oedema
what are the non-endocrine paraneoplastic syndromes?
Eaton-Lambert syndrome: autoAb against pre-synaptic VGCC on NMJ leading to muscle weakness
Hypertrophic pulmonary osteoarthropathy (HPOA): wrist and ankle pain due to periosteal new bone formation in small long bones also causing arthritis of adjacent joints; clubbing
Acanthosis nigricans: due to secretion of epidermal growth factor
Dermatomyositis: autoAb production
Trousseau's syndrome: migratory thrombophelbitis due to mucins that activate clotting
what are the 3 types of non small cell lung cancer?
squamous cell carcinoma
large cell carcinoma
which type of bronchial carcinoma has the strongest association with smoking?
small cell carcinoma (99% are smokers)
squamous cell carcinoma (98% are smokers)
what is the most common paraneoplastic syndrome in squamous cell carcinoma and where in the lung are they located?
what are the histological signs of squamous cell carcinoma?
which bronchial carcinoma is least assoc. with smoking?
what is the gender difference between squamous and adenocarcinoma of lung?
squamous cell: m>f
adenocarcinoma: f>m, but increase is in males
what is the location of adenocarcinomas in lung? and which are associated with scarring?
peripheral as well as central
peripheral cancers associated with scarring
what is the difference in pathogenesis of squamous cell and adenocarcinoma of lung?
squamous: metaplasia then dysplasia
adeno: dysplasia without metaplasia
what is the histological feature of poorly differentiated adenocarcinoma of lung?
cells are vacuolated
cells produce lots of mucin WITHIN the individual cell, not as a gland
what is bronchioalveolar carcinoma? where is it located? what does it arise from and where does it extend to?
rare subtype of adenocarcinoma
arises from distal bronchi/bronchioles
extends to alveolar spaces
what is the other name for large cell carcinoma? and why?
lack of differentiation: no keratin/mucin/glands seen
when you cannot recognise if it is squamous or adeno
what is the prognosis of large cell carcinoma compared to other NSCLC?
poorly differentiated so worse prognosis than squamous and adeno
paraneoplastic phenomena are rare
where are large cell carcinomas located?
centrally, with cavitation due to necrosis
what do cells of large cell carcinoma look like?
high mitotic activity
which type of cells due squamous and adeno carcinoma arise from?
stem cell population
which type of cells do small cell carcinomas arise from?
which gender does small cell carcinoma affect more?
what are the paraneoplastic syndromes of small cell carcinoma?
Cushing's: ectopic ACTH
where are small cell carcinomas located?
what grade are small cell carcinomas? what is their stage at presentation?
already metastasised early even when the primary is small
what are the cytological features of small cell carcinoma
speckled chromatin (salt and pepper)
what is identifiable on electron microscopy and immunohistochemistry?
EM: neurosecretory granules
immunohistochemistry: secretory SUBSTANCES
confirm neuroendocrine tumour
what are the 2 treatment options for small cell cancer?
chemotherapy: as already disseminated, cant resect
radiotherapy: is SVC obstruction
what is the treatment of NSCLC?
25% are resectable
if not: radiotherapy
if mets: chemotherapy, but poor response
what is the difference between staging small cell and NSCLC?
NSCLC: TNM staging
small cell: not TNM as most already mets, so use limited v extensive
limited: disease confined to ipsilateral thorax, including supraclavicular fossa and pleural effusion. survival 1-2yrs
extensive: all other pts. survical 6-12months
what age group do neuroendocrine tumours affect and are they more B or M?
young, under 40
no known relationship with smoking
what is carcinoid syndrome due to?
5HT production and enters SYSTEMIC circulation
what are the symptoms of carcinoid syndrome?
GI: abdo pain, N&V
lungs: bronchospasm: cough and wheeze
carcinoid heart disease: endocardial scarring affecting tricuspid and pulmonary valves - 5HT has damaging effects on right heart. rare on left as 5HT is broken down by MAO as it passes through the pulmonary system
how are neuroendocrine tumours identified?
immunohistochemistry: stains for 5HT
where are the 3 most common lung mets originally from? and what histological type?
what are the 2 main ways of spread to lung and what do the mets look like?