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: 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.
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. These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor
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.