5.lung-neoplasms

8/7/2019 5.lung-neoplasms

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Pulmonary Neoplasia


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Lung Neoplasms

Primary

benign (rare)

malignant (very common)

Metastatic (Very common)


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Male 21 metastatic

osteosarcoma


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Lung abscess (surgical

resection)


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PrimaryLung Cancer


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TheS

ize of the Problem 1

30,000 new cases of lung cancer per year inEngland (6,000 in Scotland)

Commonest cause of cancer death (33%)in men

Commonest cause of cancer death inwomen in Scotland (20%)

90% mortality 1 year after diagnosis The most rapidly increasing cancer in

developing countries


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Tobacco smoke.

polycyclic hydrocarbons

aromatic amines

phenols

nickel

cyanates20% of smokers die of lung cancer

(also suffer laryngeal, cervical, bladder,

mouth, oesop

hageal, colon cancer)


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Other risk factors..

Asbestos

nickel

chromates

radiation

atmosph

eric pollution (genetics)


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Clinical Presentation 1

Local effects

obstruction of airway (pneumonia)

invasion of chest wall (pain)

ulceration (haemoptysis)


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White tumour obstructing bronchus. Distal area of yellow

discolouration represents pneumonia.


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Metastases

nodes

bones

liver

brain


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Metastatic small cell lung cancer in liver at autopsy.


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Systemic effects

weight loss

ectopic hormone production

PTH (SQUAMOUS CANCER)

ACTH (SMALL CELL CANCER)


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Classification ofLung Tumours

Very heterogeneous

4 common smoking-associated types

adenocarcinoma (35%)

squamous carcinoma (30%)

small cell carcinoma (25%)

large cell carcinoma (10%)

Neuroendocrine tumours

Bronchial gland tumours


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Squamous carcinoma (keratinising)


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Adenocarcinoma (gland forming)


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Adenocarcinoma with

mucin (blue stained)


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Small cell carcinoma


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Large cell carcinoma


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A bronchial biopsy


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Cancer.which

type?


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Malignant cells in cytological specimen


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WHY CLASSIFY?


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Classification

Prognosis

Treatment

Pathogenesis/biology

Epidemiology


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Prognosis and Histology

Survival time:

Small cell worst (almost all dead in one

year)

Large cell worse than squamous or

adenocarcinoma


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Treatment and Histology

Small cell known to be chemosensitive

but with rapidly emerging resistance

Surgery the treatment of choice in

other types. Non-small cell regimens

have also been developed in

chemotherapy/radiotherapy


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The most simple classification

of lung cancer:

Small cell lung cancer (SCLC)

V.

Non-small cell lung cancer

(NSCLC)


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Molecular Genetic Abnormalities (potential

therapeutic targets)

p53, 1q,3p,9p,11p,

Rb

p53, Rb, 3pT

umoursuppressor

genes

myc, K-ras,

her2(neu)

mycOncogenes

NSCLCSCLC


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Pathogenesis

Pulmonary epithelium

Bronchial (ciliated, mucous,

neuroendocrine, reserve)

Bronchioles/alveoli (Clara cells, types 1

and 2 alveolar lining cells)


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Bronchial (large airway) Tumours

Squamous metaplasia

Dysplasia

Carcinoma in situ

Invasive malignancy


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Normal bronchial mucosa


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Basal cell hyperplasia


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Squamous metaplasia


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Dysplasia/carcinoma in situ


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Peripheral Adenocarcinomas

Atypical adenomatous hyperplasia

Spread of neoplastic cells along

alveolar walls (bronchioloalveolar

carcinoma)

True invasive adenocarcinoma

THIS PATTERN IS BECOMING

COMMONER


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Atypical adenomatous hyperplasia


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Prognostic Indicators in Lung

Cancer

Tumour stage

Tumourhistological subtype


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TNM staging


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OtherLung Neoplasms

Carcinoid: Neuroendocrine neoplasms

of low grade malignancy

Bronchial gland neoplasms (tumours

more often seen in salivary glands)

Adenoid cystic carcinoma

Mucoepidermoid carcinoma


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Large obstructing carcinoid tumour


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Carcinoid histology


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Pleural Neoplasia

Benign tumours rare

Primary malignant neoplasm

mesothelioma (see lecture on pleural

disease)

Also a very common site of invasion by

lung carcinomas and metastaticcancers

5.lung-neoplasms

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