Pulmonary Neoplasia - PowerPoint PPT Presentation

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Pulmonary Neoplasia

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The Size of the Problem 1 ... Metastatic small cell lung cancer in liver at autopsy. Clinical Presentation 3. Systemic effects ... – PowerPoint PPT presentation

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Title: Pulmonary Neoplasia


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
(No Transcript)
28
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

29
The most simple classification of lung cancer
  • Small cell lung cancer (SCLC)
  • V.
  • Non-small cell lung cancer (NSCLC)

30
Molecular Genetic Abnormalities (potential
therapeutic targets)

31
Pathogenesis
  • Pulmonary epithelium
  • Bronchial (ciliated, mucous, neuroendocrine,
    reserve)
  • Bronchioles/alveoli (Clara cells, types 1 and 2
    alveolar lining cells)

32
Bronchial (large airway) Tumours
  • Squamous metaplasia
  • Dysplasia
  • Carcinoma in situ
  • Invasive malignancy

33
Normal bronchial mucosa
34
Basal cell hyperplasia
35
Squamous metaplasia
36
Dysplasia/carcinoma in situ
37
Peripheral Adenocarcinomas
  • Atypical adenomatous hyperplasia
  • Spread of neoplastic cells along alveolar walls
    (bronchioloalveolar carcinoma)
  • True invasive adenocarcinoma
  • THIS PATTERN IS BECOMING COMMONER

38
Atypical adenomatous hyperplasia
39
Prognostic Indicators in Lung Cancer
  • Tumour stage
  • Tumour histological subtype

40
TNM staging
41
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

42
Large obstructing carcinoid tumour
43
Carcinoid histology
44
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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