Tumours of the lung
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Tumours of the lung

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    Tumours of the lung Tumours of the lung Presentation Transcript

    •  Tobacco smoking Most imp carcinogens e.g, polycyclic aromic hydrocarbons Enviromental exposure radiation, asbestos, air pollution Genetics K-RAS, EGFR, c-MYC and HER2 Loss of p53, RB, p16
    •  Primary benign (rare) malignant (very common) Metastatic (Very common)
    •  Squamous cell ca Small cell ca Combined small cell ca Adenocarcinoma Acinar, papillary, broncoalveolar,solid, mixed Large cell ca large cell neuroendocrine ca. Adenosquamous ca Ca with pleomorphic sarcomatoid element Carcinoid tumor Typical, atypical Ca of salivary gland type Unclassified ca
    •  Frequency: 35% Smoking: X 25 (increased risk) Males > females Survival (5 years): 15 - 20% Arises in bronchial squamous metaplasia Centrally located May cavitate
    •  Frequency: 30% Smoking: X 3 (increased risk) Males < females Survival (5 years): 15 - 20% Peripheral
    •  Frequency: 2% Smoking: yes Males = females Survival (5 years): 25 a 40 %. Presentation: Single or multiple tumor nodules Miliary tumor “Pneumonic form”
    •  Frequency: 25 % Smoking: 95% of patients Males >> females Survival (5 years): 1 - 5 %. Central or hilar tumor Associated with paraneoplastic syndromes
    •  Frequency: 10 % Gross Peripheral lesion Microscopic Wastebasket group of tumors that do not fitthe criteria of a squamous cellcarcinoma, adenocarcinoma, or small cellcarcinoma Prognosis Similar to adenocarcinoma
    •  Mesothelioma: Malignant tumor of mesothelial cells Highly malignant neoplasm with short survival Most patients (70%) have an asbestos exposure history Asbestos exposure also increases the risk of pulmonary cancer Smoking is not related to mesothelioma
    •  Neuro-endocrine tumours. Not related to cigarette smoking. Polypoid intrabronchial masses, but may infiltrate bronchial wall and surrounding lung tissue. Slow-growing, low-grade malignant, as opposed to the aggressive behaviour of small cell carcinomas. Similar in appearance and behaviour to carcinoid tumours arising in other organs. Neuropeptides demonstrable in tumour cells, but the majority are endocrinologically silent.
    •  Secondary(metastatic) tumours More common than primary lung tumours. Carcinomas or sarcomas.
    •  Benign lung tumours Rare. Commonest: Hamartoma (chondroma)
    • A hamartoma is a benign focal malformation. Resembles a neoplasm in the tissue of its origin. This is not a malignant tumor, and it grows at the same rate as the surrounding tissues. It is composed of tissue elements normally found at that site, but which are growing in a disorganized mass.
    •  Macroscopic appearances -The papillomas have a cauliflower-likeappearance. Histopathology - The great majority are exophytic, but an inverted variant has been reported. -A loose fibrovascular core is covered by stratified squamous epithelium with orderly maturation. -- -Wrinkled nuclei and koilocytes may beapparent -There may be the occasional large atypical cell.
    • A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells.[1] These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor
    •  Endocrinopathies Neuromyopathies Osteochondral Disorders Vascular Phenomena Fever Nephrotic Syndrome
    •  Cushing’s Syndrome Adrenal carcinoma (cortisol) more common with benign adrenal processes. Small cell undifferentiated lung cancer (ACTH) released through cleavage of pro- opiomelano- cortin gene product. Inappropriate ADH syndrome (Hyponatremia) Small cell undifferentiated lung cancer (vassopressin-like hormone. Hypothalamic tumors (vasopressin)
    •  Hypercalcemia (Cancer is the most common cause of hypercalcemia by either humoral or metastatic mechanisms) Squamous cell lung cancer (PTH-like peptide) Renal cell carcinoma (prostaglandins) Parathyroid carcinoma (PTH) Multiple myeloma and T-cell lymphoma (IL-1 and perhaps TGF-a) Breast carcinoma, usually by bone metastasis
    •  Hypoglycemia - caused by tumor over- production of insulin or insulin like activities Fibrosarcoma, Cerebellar hemangioma, Hepatocarcinoma Carcinoid syndrome - Caused by serotonin, bradykinin or ?histamine produced by the tumor Bronchial carcinoids, Pancreatic carcinoma, Carcinoid tumors of the bowel
    •  Polycythemia - caused by tumor production of erythropoietins • Renal cell carcinoma, Cerebellar hemangioma, Hepatocarcinoma • WDHA syndrome (watery diarrhea, hypokalemia, and achlorhydria) - caused by tumor production of vasoactive intestinal polypeptide (VIP). Islet cell tumors, Intestinal carcinoid tumors
    •  Myasthenia - A block in neuromuscular transmission possibly caused by host antibodies against the tumor cells that cross react with neuronal cells or perhaps caused by toxins. • Bronchogenic carcinoma, Breast cancer Carcinomatous Myopathy - probably immune- mediated
    •  HypertrophicOsteoarthropy - clubbing, periosteal new bone, and arthritis • Isolated clubbing occurs in chronic obstructive pulmonary disease and in cyanotic congenital heart disease, but the full-blown syndrome is limited to lung cancer.
    •  Altered Coagulability - caused by the release of tumor products Migratory Venous Thromboses (Trousseau’s sign) Pancreatic, gastric, colon, and bronchogenic carcinomas; particularly adenocarcinoma of the lung. Marantic endocarditis - Small thrombotic vegetations on mitral or aortic valves that occur with advanced carcinomas.
    •  Associated with bacterial infections -Common where blockage of drainage occurs -Decreased immunity may play a role Not associated with infection -Episodic as with Hodgkin’s lymphoma; poor prognostic sign in sarcomas, indicates dissemination -Likely caused by response to necrotic tumor cells and/or immune response to necrotic tumor proteins.
    •  Excessive loss of protein in the urine probably caused by damage to renal glomeruli by tumor antigen-antibody complexes.