Lung cancer

Lung cancer

1. malignant

   • small cell carcinoma
     • etiology: mutations in 3p - c-kit-myc-p53 poorly differntiated neuroendocrine cells
       • epidemiology: common in smokers
         • pathogenesis: central mass with quick spreading across the lung
           • morphology
             • microscopically
               • large purple nuclei - no cytoplasm - molding of cells -atypical mitotic figures -center area of necrosis
             • grossly
             • stained with:
               • chromogranin synaptophysin CD56
   • squamous cell carcinoma
     • epidemiology: most common tumor in smokers
       • pathogenesis: A PERCURSOR LESION---damage of airways by smoking :
         • basal cell hyperplasia---squamous cell metaplasia --- dysplasia --- Carcinoma in situ --- invasive SCC
           • MORPHOLOGY
             • microscopically
               • keratin pearls and desmosomes (intercellular bridges)
             • grossly
             • staining: p40 - p63
   • Adenocarcinoma
     • epidemiology: common in nonsmokers-female smokers
       • pathogenesis: Either acinar (glandular formation) OR A percursor lesion--- atypical adenomatous hyperplasia--bronchoalveolar (adenocarcinoma in situ AIS) --- invasive adenocarcinoma (lepidic)
         • morphology
           • staining
             • TTF1 - napsin A
           • histology
             • acinar
               • AIS
                 • Lepidic
           • grossly
             • peripheral
       • ETIOLOGY: mutations-EGFR-ALK-KRAS
   • large cell carcinoma
     • etiology: undifferentiated Squamous CC or AC
       • morphology:
         • micro
           • large anaplastic cells
             • grossly
   • carcinoid tumors
     • low grade well differntiated neroendocrine cells
       • pathogenesis: can cause carcinoid syndrome: flushing diarrhea cynosis
         • morphology
           • grossly
             • polyp like mass in the bronchial lumen
           • micro
             • uniform cells with salt and piper chromatin
           • staining
             • Serotonin-calcitonin-NSE
   • metastatic
     • secondary tumors from breast-kidney-colon-stomach-liver
       • morphology
         • X-ray: cannon ball apperance
         • grossly: small multiple masses around the lung
       • can metastasize to: breast and liver

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4. common clinical picture

   • unintentional weight loss
     • other causes
   • coughing
     • hemoptysis
       • low grade fever
   • paraneoplastic syndrome
     • small Cell carcinoma
       • lambert-eaton syndrome-cushing (ACTH)-hyponatremia (ADH)
     • squamous cell carcinoma
       • hyperthyroidism (PTHrP)
     • all
       • growth hromone (acromegaly) and bone growth agents (pulmonary osteoarthropathy)

5. treatment

   • small cell carcinoma
     • combinations of chemotherapy
       • CAV
         • cyclophosamide - adriamycin-vinblastine
       • most commonly used
         • etoposide and cisplatin
       • ACE
         • doxorubucin-CP-Etoposide
       • Gemcarbo
         • gemcitabine-carboplatin
   • non small cell carcinoma
     • surgery and radiotherapy
     • in case of mutations EGFR - ALK ..
       • personalized cancer therapy
         • tyrosine kinase inhibtior (gefitinib) against EGFR in AC

6. complications

   • pancoast tumor
     • horner syndrome
       • anhydrosis of the face
       • ptosis of the eye
       • miosis of the pupils
     • brachial pleux compression
       • muscle wasting
     • rib destruction
   • SVC syndrome
   • other tissue
     • horseness (compress RL nerve)
     • diaphragm paralysis
     • pleural effusion

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