Respiratory pathology

Question 1

1. What are common symptoms of lung cancer?

Answer 1

Heamotopsys-coughing blood, chough, chest/shoulder pain, dysnpnae, hoarnsess and finger clubber

Question 2

2. How can samples be acquired for cytological analysis?

Answer 2

PET scans can see the tumors after being given radioactive glucose
Fine needle aspiration
Brochial brushing, lavage and pleural fluid

Question 3

3. What are some features of benign tumours?

Answer 3

Tumour is very metabolically active therefore takes radioactive glucose for pet scan fast
Grow slower, no metastase, no invasion

Question 4

4. What are the three types of non-small cell carcinoma? What percentage of lung cancers are non-small cell?

Answer 4

Small cell lung cancer
Non-small cell lung caner-about 80%
Adenocarcinoma
Large cell carcinoma

Question 5

5. How are the incidences of squamous cell carcinoma and adenocarcinoma changing?

Answer 5

Squamous cell carcinoma is decreasing, adenocarnioma is increasing

Question 6

6. Where do squamous cell carcinomas and adenocarcinomas tend to arise?

Answer 6

Squamous near mediastinum-shallow, adenocarcinoma near periphery

Question 7

7. State three major risk factors for lung cancer.

Answer 7

Smoking, radiation, asbestos

Question 8

8. What are the four stages in the pathway to carcinoma?

Answer 8

Metaplasia, dysplasia, carcinoma in situ, invasive carcinoma

Question 9

9. Why has a precursor lesion for small cell lung carcinoma not been found?

Answer 9

Because small cell cancer goes too quicly and metabolises early

Question 10

10. How do the cells lining the airways change in squamous cell carcinoma?

Answer 10

Ciliated cell undergo metaplasia due to chronic stimulation by cigarette smoke-become squamous

Question 11

11. Which type of lung cancer is common in non-smokers?

Answer 11

adenocarcinoma

Question 12

12. Which types of lung caner are strongly associated with smoking?

Answer 12

Small cell carcinoma and squamous cell carcinoma

Question 13

13. Describe the cytological features of squamous cell carcinoma.

Answer 13

Large nuclei and keratin in cytoplasm

Question 14

14. What is the precursor lesion for adenocarcinoma?

Answer 14

Atypical adenomatous hyperplasia

Question 15

15. At what point does adenocarcinoma in situ become invasive adenocarcinoma?

Answer 15

When the cells aquire a mutation allowing to break stomae and invade. Tjis causes inflammation and leads to fibrious tissue

Question 16

16. Describe the cytological features of adenocarcinoma.

Answer 16

Differentiate to glandular-big atypical nuclei with mucin globules

Question 17

17. Where does adenocarcinoma usually develop and are they usually multi-focal?

Answer 17

They develop near the periphery and are usually multifocal

Question 18

18. What are the two molecular pathways for adenocarcinoma and which one is associated with smoking?

Answer 18

K-ras pathways-smoking

EFGR-responder/resistance mutation

Question 19

19. Why is it important to differentiate between the different pathways? (kras and EGFR-lung cancer)

Answer 19

React very differently to drugs and targeted therapies-kras responds much worse, while EGFR can regress completely

Question 20

20. What is large cell carcinoma?

Answer 20

Poorly differentiated-poor prognosis. Electron microscopy suggests evidence of ssquamous/neuroendocrine

Question 21

21. What are the cytological features of small cell carcinoma?

Answer 21

Look like lymphocytes-large nucleus and little cytoplasm

Question 22

22. Where does small cell carcinoma tend to arise?

Answer 22

Centrally, near the bronchi

Question 23

23. What does the ERCC1 marker determine?

Answer 23

If there marker is there, means advances non-small cell cancer UNLIKELY to respond to cisplatin

Question 24

24. What type of receptor is EGFR and what is used to block this receptor?

Answer 24

Tyrosine kinase like-can use TKL inhbitors

Question 25

25. What are paraneoplastic syndromes?

Answer 25

Systemic effect of tumour due to abnormal expression of factors (eg hormones) not normally in tissue

Question 26

26. State some endocrine paraneoplastic syndromes.

Answer 26

``` SIADH (make ADH) Cushing syndrome (make ACTH ```

Question 27

27. What is strongly associated with mesothelioma?

Answer 27

asbestos