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Pulmonary Neoplasia

Pulmonary Neoplasia. Lung Neoplasms. Primary benign (rare) malignant (very common) Metastatic (Very common). Male 21 – metastatic osteosarcoma. Suspicious lesion on CXR…. Lung abscess (surgical resection). Primary Lung Cancer. The Size of the Problem 1.

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Pulmonary Neoplasia

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  1. Pulmonary Neoplasia

  2. Lung Neoplasms • Primary • benign (rare) • malignant (very common) • Metastatic (Very common)

  3. Male 21 – metastatic osteosarcoma

  4. Suspicious lesion on CXR…..

  5. Lung abscess (surgical resection)

  6. Primary Lung Cancer

  7. The Size of the Problem 1 • 30,000 new cases of lung cancer per year in England (6,000 in Scotland) • Commonest cause of cancer death (33%) in men • Commonest cause of cancer death in women in Scotland (20%) • 90% mortality 1 year after diagnosis • The most rapidly increasing cancer in developing countries

  8. Tobacco smoke…. • polycyclic hydrocarbons • aromatic amines • phenols • nickel • cyanates 20% of smokers die of lung cancer (also suffer laryngeal, cervical, bladder, mouth, oesophageal, colon cancer)

  9. Other risk factors….. • Asbestos • nickel • chromates • radiation • atmospheric pollution • (genetics)

  10. Clinical Presentation 1 • Local effects • obstruction of airway (pneumonia) • invasion of chest wall (pain) • ulceration (haemoptysis)

  11. White tumour obstructing bronchus. Distal area of yellow discolouration represents pneumonia.

  12. Clinical Presentation 2 • Metastases • nodes • bones • liver • brain

  13. Metastatic small cell lung cancer in liver at autopsy.

  14. Clinical Presentation 3 • Systemic effects • weight loss • “ectopic” hormone production • PTH (SQUAMOUS CANCER) • ACTH (SMALL CELL CANCER)

  15. Classification of Lung 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

  16. Squamous carcinoma (keratinising)

  17. Adenocarcinoma (gland forming)

  18. Adenocarcinoma with mucin (blue stained)

  19. Small cell carcinoma

  20. Large cell carcinoma

  21. A bronchial biopsy

  22. Cancer….which type?

  23. Malignant cells in cytological specimen

  24. WHY CLASSIFY?

  25. Classification • Prognosis • Treatment • Pathogenesis/biology • Epidemiology

  26. Prognosis and Histology • Survival time: • Small cell worst (almost all dead in one year) • Large cell worse than squamous or adenocarcinoma

  27. 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

  28. The most simple classification of lung cancer: Small cell lung cancer (SCLC) V. Non-small cell lung cancer (NSCLC)

  29. SCLC NSCLC Oncogenes myc myc, K-ras, her2(neu) Tumour suppressor genes p53, Rb, 3p p53, 1q, 3p,9p,11p, Rb Molecular Genetic Abnormalities (potential therapeutic targets)

  30. Pathogenesis • Pulmonary epithelium • Bronchial (ciliated, mucous, neuroendocrine, reserve) • Bronchioles/alveoli (Clara cells, types 1 and 2 alveolar lining cells)

  31. Bronchial (large airway) Tumours • Squamous metaplasia • Dysplasia • Carcinoma in situ • Invasive malignancy

  32. Normal bronchial mucosa

  33. Basal cell hyperplasia

  34. Squamous metaplasia

  35. Dysplasia/carcinoma in situ

  36. Peripheral Adenocarcinomas • Atypical adenomatous hyperplasia • Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma) • True invasive adenocarcinoma • THIS PATTERN IS BECOMING COMMONER

  37. Atypical adenomatous hyperplasia

  38. Prognostic Indicators in Lung Cancer • Tumour stage • Tumour histological subtype

  39. TNM staging

  40. Other Lung Neoplasms • Carcinoid: Neuroendocrine neoplasms of low grade malignancy • Bronchial gland neoplasms (tumours more often seen in salivary glands) • Adenoid cystic carcinoma • Mucoepidermoid carcinoma

  41. Large obstructing carcinoid tumour

  42. Carcinoid histology

  43. 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 metastatic cancers

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