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Pulmonary NeoplasiaPulmonary NeoplasiaPulmonary NeoplasiaPulmonary Neoplasia
Prof. Frank Carey
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Lung NeoplasmsLung Neoplasms
Primary benign (rare) malignant (very common)
Metastatic (Very common)
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Male 21 – metastatic Male 21 – metastatic osteosarcomaosteosarcoma
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Suspicious lesion on CXR…..Suspicious lesion on CXR…..
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Lung abscessLung abscess
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Primary Lung CancerPrimary Lung Cancer
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The Size of the Problem 1The 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
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Tobacco smoke….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)
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Other risk factors…..Other risk factors…..
Asbestos nickel chromates radiation atmospheric pollution (genetics)
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Clinical Presentation 1Clinical 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 White tumour obstructing bronchus. Distal area of yellow discolouration represents pneumonia.discolouration represents pneumonia.
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Clinical Presentation 2Clinical Presentation 2
Metastases nodes bones liver brain
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Metastatic small cell lung cancer in liver at autopsy.Metastatic small cell lung cancer in liver at autopsy.
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Clinical Presentation 3Clinical Presentation 3
Systemic effects weight loss “ectopic” hormone production
PTH (SQUAMOUS CANCER) ACTH (SMALL CELL CANCER)
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Classification of Lung Classification of Lung TumoursTumours
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)Squamous carcinoma (keratinising)
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Adenocarcinoma (gland forming)Adenocarcinoma (gland forming)
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Adenocarcinoma with mucin (blue stained)Adenocarcinoma with mucin (blue stained)
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Small cell carcinomaSmall cell carcinoma
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Large cell carcinomaLarge cell carcinoma
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A bronchial biopsyA bronchial biopsy
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Cancer….which type?Cancer….which type?
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Malignant cells in cytological specimenMalignant cells in cytological specimen
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WHY CLASSIFY?WHY CLASSIFY?
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ClassificationClassification
Prognosis Treatment Pathogenesis/biology Epidemiology
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Prognosis and HistologyPrognosis 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 HistologyTreatment 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 The most simple classification of lung cancer:of lung cancer:
Small cell lung cancer (SCLC)
V.
Non-small cell lung cancer (NSCLC)
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Molecular Genetic Abnormalities Molecular Genetic Abnormalities (potential therapeutic targets)(potential therapeutic targets)
p53, 1q, 3p,9p,11p, Rb
p53, Rb, 3pTumour suppressor genes
myc, K-ras, her2(neu)
mycOncogenes
NSCLCSCLC
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PathogenesisPathogenesis
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) Bronchial (large airway) TumoursTumours
Squamous metaplasia Dysplasia Carcinoma in situ Invasive malignancy
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Normal bronchial mucosaNormal bronchial mucosa
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Basal cell hyperplasiaBasal cell hyperplasia
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Squamous metaplasiaSquamous metaplasia
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Dysplasia/carcinoma in situDysplasia/carcinoma in situ
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Peripheral AdenocarcinomasPeripheral 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 hyperplasiaAtypical adenomatous hyperplasia
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Prognostic Indicators in Lung Prognostic Indicators in Lung CancerCancer
Tumour stage Tumour histological subtype
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TNM stagingTNM staging
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Other Lung NeoplasmsOther Lung 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 tumourLarge obstructing carcinoid tumour
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Carcinoid histologyCarcinoid histology
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Pleural NeoplasiaPleural 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