1 - Lung Cancer

Question 1

What may be the reason for a hoarse voice presentation?

Answer 1

Recurrent laryngeal nerve compression

Question 2

What are 4 radiological tools for diagnosis?

Answer 2

X-ray CT
PET

MRI
Ultrasound

Question 3

What are the 3 main types of lung cancer?

Answer 3

Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma

Question 4

What cell types does adenocarcinoma arise from?

Answer 4

Glandular cells

Question 5

What cell type does squamous cell carcinoma arise from?

Answer 5

Epithelial dysplasia

Question 6

What cell types does small cell cancer arise from?

Answer 6

Neuroendocrine cells

Question 7

Which lung cancer is most associated with smoking as a risk factor?

Answer 7

Squamous cell carcinoma

Question 8

What appearance does an adenocarcinoma have on X-ray?

Why?

Answer 8

Ground glass

Slow growing

Question 9

Where are adenocarcinomas most likely to appear within the lung?

Answer 9

Peripherally

Question 10

What do squamous cell carcinomas tend to arise most commonly?

Answer 10

Centrally

Question 11

What 3 features are commonly seen in small cell carcinomas?

Answer 11

Aggressive (early metastasis)

Small primary nodule

Extensive lymph node involvement

Question 12

What % of cancers are small-cell?

Answer 12

12%

according to cancer research UK

Question 13

What % of cancers are non-small cell?

Answer 13

87%

according to cancer research UK

Question 14

What is most common form of NSCLC? Rank them.

Answer 14

Adenocarcinoma
Squamous cell
Large cell

Question 15

PET scanning uses a combination of which two techniques?

Answer 15

X-ray

Radioactive isotopes

Question 16

Give 1 example of a radioactive substance that is used in PET scanning.

Answer 16

Fluorodeoxyglucose

18 FDG

Question 17

What procedure will surgeons request prior to tumour excision? For what reason?

Answer 17

Percutaneous lung biopsy (CT guided)

To stage the cancer to determine how much surrounding tissue will need to be excised to reduce risk of recurrence.

Question 18

What is the average X-ray exposure across the UK?

Answer 18

2.2 milliSieverts (Sm)

Question 19

What is the biggest contributor of X-rays?

Answer 19

Radon gas from rocks

Question 20

What dose of X-ray does a simple CXR count for?

Answer 20

0.04 mSv (1 week)

Question 21

What dose of X-ray does a normal CT count for?

Answer 21

8 mSv (4 years)

Question 22

What dose of X-ray does a low-res CT count for?

Answer 22

1 mSv (men) - 6 months

1.4 mSv (women)

Question 23

What is the incidence of lung cancer annually?

Answer 23

40,000

Question 24

What % of SCLC presentations are already found to be disseminated?

Answer 24

70%

Question 25

With certain occupational history, what other lung cancer should be excluded?

Answer 25

Malignant mesothelioma

Question 26

What signs may indicate malignant mesothelioma?

Answer 26

General pleural thickening Pleural effusion Similar to lung cancer symptoms.

Question 27

How do you treat malignant mesothelioma?

Answer 27

Chemotherapy - Permetrexed.

Question 28

What are the general symptoms of lung cancer? And the % occurrence of each symptom?

Answer 28

Cough - 80% Haemoptysis - 70% Dyspnoea - 60% Chest pain - 40%

Question 29

What 3 general signs indicate lung cancer?

Answer 29

1) Cachexia 2) Anaemia 3) Clubbing

Question 30

What 3 chest signs might be present in lung cancer presentation?

Answer 30

1) Pleural effusion 2) Lung collapse 3) Focal consolidation

Question 31

What 4 signs may indicate metastatic status?

Answer 31

- Bone tenderness - Fits - Peripheral neuropathy - Proximal myopathy

Question 32

Name 4 local complications of lung tumours?

Answer 32

Recurrent laryngeal compression Phrenic nerve palsy SVC obstruction Horner's syndrome

Question 33

Name 4 metastatic locations of lung cancer?

Answer 33

Brain Bone (i.e. Increased calcium, tenderness, anaemia) Liver Adrenals (addison's)

Question 34

What is the triad of Horner's syndrome?

Answer 34

Ptosis - lid drooping Miosis - pupil constriction Anhydrosis - lack of facial sweat

Question 35

Why does Horner's syndrome present with that triad? What's the cause?

Answer 35

Pancoast tumour Compressing sympathetic fibres responsible for controlling eye lids, pupil constriction and sweat glands of the face.

Question 36

What are the 4 ways in which lung tumours can spread?

Answer 36

Local invasion (extends into lung tissue) Transcelomic spread (tumours migrates along pleural space) Lymphatic spread (tumour extends along pulmonary lymphatic vessels into hilar nodes) Blood-borne spread (tumour enters draining veins and cells enter systemic circulation)

Question 37

How are small NSCLCs ideally treated?

Answer 37

Lobectomy

Question 38

How are stage I, II and III NSCLCs treated?

Answer 38

Radical radiotherapy

Question 39

How are more advanced NSCLCs treated?

Answer 39

Chemotherapy + Radiotherapy

Question 40

Treatment regiments may in platinum. What does this mean?

Answer 40

Requires monoclonal antibodies that target epidermal growth factor receptor

Question 41

Give an example of a platinum regimen?

Answer 41

Cetuximab

Question 42

In limited SCLC, what treatment option is offered?

Answer 42

Surgery

Question 43

If well enough, besides surgery, what may be offered as an adjuvant in SCLC?

Answer 43

Chemo | Radio

Question 44

What treatment is offered in patients with the following symptoms: SVC obstruction, bronchial obstruction, haemoptysis, cerebral metastasis?

Answer 44

Radiotherapy

Question 45

Give examples of other drugs that could be used in lung cancer treatment?

Answer 45

Analgesia Steroids Anti-emetics Bronchodilators

Question 46

What is the prognosis of NSCLC without spread? (% and years)

Answer 46

50% last 2 years

Question 47

What is the prognosis of NSCLC with spread? (% and years)

Answer 47

10% last 2 years

Question 48

What is the median survival for SCLC if untreated?

Answer 48

3 months

Question 49

What is the median survival for SCLC if treated?

Answer 49

1-1.5 years