RAD427 Pulmonary Pathology PDF

**[RAD427: Pulmonary Pathology]** **Lung Cancer:** **Non-small cell (NSCLC):** The most common type of lung cancer -- higher association with smoking Subdivided into: - Adenocarcinoma -- more common peripherally - Squamous cell carcinoma -- more commonly found in the airways - Large cel...

**[RAD427: Pulmonary Pathology]** **Lung Cancer:** **Non-small cell (NSCLC):** The most common type of lung cancer -- higher association with smoking Subdivided into: - Adenocarcinoma -- more common peripherally - Squamous cell carcinoma -- more commonly found in the airways - Large cell - Mixed - Carcinoid (rare) -- a type of tumour that secretes certain chemicals into your bloodstream, causing a variety of signs and symptoms **Small cell (SCLC):** - Less common type of lung cancer - Not amenable to surgery - More often associated with paraneoplastic effects -- this is when cancer causes unusual symptoms in other parts of the body due to substances released in the bloodstream **Lung Cancer Symptoms:** **Specific to LC:** - Cough - Shortness of breath - Haemoptysis - Non-resolving pneumonia - Chest pain -- direct invasion - Mass effect -- hoarse voice - Pancoast symptoms (rare) **Generalised** **cancer symptoms:** - Fatigue - Unexplained weight loss - Pain/symptoms from metastases - Paraneoplastic phenomena - Hypocalcaemia **Lung Cancer Signs:** - Palpable lymph nodes - Signs of SVC obstruction -- swelling of the face, neck, arms and upper body - Monophonic wheeze - Signs of nerve damage from mass effect - An effusion (unilateral), therefore dull to percussion General cancer signs: - Cachexia - emaciated - Finger clubbing **Lung Cancer Investigation:** People are referred using a **suspected cancer pathway referral** (appt within 2 weeks) if they have: - Chest X-ray findings that suggest LC or - Are aged over 40 and over with unexplained haemoptysis Urgent chest X-rays (2 weeks) are offered to assess for LC in people who are over 40 and have two or more of the following unexplained symptoms/if they have ever smoked and have 1 or more: Cough, fatigue, shortness of breath, chest pain, weight loss, appetite loss, persistent or recurrent chest infection. Finger clubbing, thrombocytosis, supraclavicular or persistent cervical lymphadenopathy or chest signs consistent with lung cancer. **Lung Cancer Evaluation:** - Grading is a histological categorisation and needs a biopsy -- this may require imaging to guide. - Tumours closer to the airway, the endobronchial method may be used, e.g. endobronchial ultrasound. - Staging is an anatomical categorisation and requires imaging, it considers size and location, presence and position of metastases -- most tumours use the TNM classification. **Staging and Grading (TNM):** Stages include 1-4 as well as substages. Tumours T1-4 (+substages) -- based on size and structures invaded Nodes N0-3 -- based on lymph node spread Metastases M0-1 + substages Staging is specific to each type of malignancy, ie TNM is different for lungs and breast. Grading is based on histological evaluation. Further tests may provide further information on the likely rate of spread or suitability. **Treatment:** **Surgery:** suitable if it is a localised tumour with limited areas of spread. **Radiotherapy:** Used if the tumour or region is more localised but the tumour or patient is not suitable for surgery. Crossing the radiation beam over the tumour site allows a high dose to the tumour and a lower dose to the surrounding tissue. **Chemotherapy:** Affects rapidly dividing cells. It can control or sometimes cure certain cancers but is toxic -- it reduces a patient's immune system. **Immunotherapy:** More specific to tumour subtype and may require specific testing. E.g PD-L1 allows cancer cells to hide from T cell immune attack -- immunotherapy blocks this receptor. **Screening:** Everyone between 55-75 who either smokes or used to smoke will get an invite for an assessment -- if you are at high risk of LC, you will be offered a low-dose CT scan of your lungs. **[Respiratory Infections]** **URTI: Upper Respiratory Tract Infection** - Larynx, Pharynx, Tonsils and nasal cavity - Less likely to be severe **LRTI: Lower Respiratory Tract Infection** - Below larynx, involving airways and alveoli - More likely to be severe **Pneumonia: is a LRTI -** infection of the lung parenchyma Lower respiratory tract infection with radiographic evidence of consolidation. Alveoli walls become inflamed, and the air space is filled with pus and fluid containing bacteria and blood cells. - Lobar pneumonia - Conforms to lobar anatomy - Bronchopneumonia - Multifocal - Interstitial pneumonia - Interstitial inflammation -- round alveoli & airways Community-acquired (CAP) Hospital-acquired (HAP) By organism Risk of sepsis Antibiotic treatment for bacterial pneumonia **Epiglottitis:** Inflammation of the upper airway tissues -- life-threatening, usually bacterial causes pyrexia: painful swallowing and drooling **Bronchitis:** Inflammation of the bronchial mucosa, mainly viral and self-limiting. Causes a cough and sputum and may have URTI symptoms as well. **Bronchiolitis:** Small airway (\