2B Week 8 - Lung Cancer

Question 1

What percentage of users does tobacco kill?

Answer 1

50%

Question 2

What percentage of the worlds population using tobacco live in low - middle income countries

Answer 2

80% - basically tobacco use is more prevalent in poorer countries

Question 3

At what age do most people start smoking?

Answer 3

15 is the average age when people start smoking cigarettes in Europe and US

Question 4

What is habitus

Answer 4

A body of consciousness - so our behaviour and habits are influences by our surroundings and social standing - e.g. Veganism, climate activism, clean living etc

Question 5

Has prevalence of smoking increased or decreased in the 21st century

Answer 5

Decreased

Question 6

What is the importance of social practices in something like smoking

Answer 6

Social practices - like smoking - within our habitus will play a role in making them socially acceptable

Question 7

How much more at risk are children of smoking parents more likely to smoke themselves compared with non-smoking parents

Answer 7

3x more likely to smoke

Question 8

What are the 4 mechanisms of health inequality (same as 1st year)

Answer 8

behavioural, materialist, psychosocial and life-course

Question 9

What is the behavioural model in smoking

Answer 9

It’s an individual choice - whether that is for a good behaviour or bad

Question 10

What is the materialist model in smoking

Answer 10

People have no choice - e.g. do you parents smoke therefore you have no choice but to inhale second hand smoke.
Constrained by housing, money, job etc

Question 11

What is the psychosocial model in smoking

Answer 11

Feeling affects behaviour - if you smoke you know the stigma and so may not seek help from a doctor etc

Question 12

What is the life-course model in smoking

Answer 12

How things accumulate over your life - smoking impacts later in life, lifestyle drift

Question 13

What is surveillance medicine

Answer 13

The idea that medicine has become more about monitoring healthy bodies than curing sick bodies

Question 14

Which lung cancer is strongly related to cigarette smoking
SCLC
NSCLC
Squamous cell
Adenocarcinoma
Large cell carcinoma

Answer 14

SCLC
And from NSCLC - squamous cell carcinoma

Question 15

Which type of lung cancer is most common in non-smokers

Answer 15

Adaenocarcinoma

Question 16

Which type of lung cancer is associated with late metastasis and poor prognosis

Answer 16

Large cell carcinoma

Question 17

Where would you see an adenocarcinoma

Answer 17

Peripheral - associated with EGFR, ALK and KRAS mutations

Question 18

Where would you see squamous cell carcinoma

Answer 18

Central - direct spread to hilar lymph nodes
Has cavitation lesions which can be seen on x-rays (clear space)

Question 19

What is more common NSCLC or SCLC

Answer 19

NSCLC

Question 20

What determines the stage of a persons lung cancer

Answer 20

Location of primary tumour
Tumour size
Lymph node involvement
Any metastasis

Question 21

What is the TNM classification

Answer 21

T - size and extent of tumour
N - extent and spread of nodes
M - any metastasis

Question 22

What is the name of the model used to stage probability of malignancy following CT
Brock model
Herder Model

Answer 22

Brock Model

Question 23

What is the name of the model used to stage probability of malignancy following PET-CT
Brock model
Herder model

Answer 23

Herder model

Question 24

What are possible treatment options for lung cancer

Answer 24

Surgery
Chemo
Radiotherapy
Palliation

Question 25

What are some possible complications of a lobectomy (try and give 3)

Answer 25

displacement of the heart towards surgery Pneumothorax Postoperative haemorrhages Pneumonia Atelectasis Chylothorax (damage to thoracic duct)

Question 26

How does radiation damage cells is radiotherapy

Answer 26

Damaging DNA and cell structure Prevent cell replication Inducing cell death

Question 27

What are some acute and long term side effects (give 3)

Answer 27

Acute: Oeasophagitis Pneumonia is Nausea/vomiting Bone marrow suppression Long term: Rib fractures Cardiac fibrosis/dysfunction Hypothyroidism Pneumonitis Pulmonary fibrosis

Question 28

Can you perform surgery for small cell cancinoma

Answer 28

NO - radiation and chemo

Question 29

What symptoms can patients present with with lung cancer (give 3)

Answer 29

Persistent cough, chest or shoulder pain, dyspnoea (SOB), haemoptysis, lethargy, weight loss, hoarseness, anorexia

Question 30

What signs can patients present with with lung cancer (give 3)

Answer 30

often none (idiopathic), clubbing, stridor, persistent wheeze, hoarseness, horners syndrome, superior vena cava obstruction, supra-clavicular lymphadenopathy, signs of lung collapse, consolidation and pleural effusion, Pulmonary embolism

Question 31

What investigations would you do for a patient with suspected lung cancer

Answer 31

CT staging and biopsy Bronchoscope Pulmonary function tests PET-CT Bone scan Cardiac ECHO, ECG Bone scan 6 minute walk/CP exercise

Question 32

What are the 4 characteristics of horners syndrome?

Answer 32

Loss of sympathetic function to the eye 1. Affects pupillary reaction (small pupil) 2. Eyelid droops 3. No sweat over half forehead (where the tumour is affected) 4. Enothalmos - opposite to bulging eye - sunken eye in the socket

Question 33

70 year old retired carpenter. 60py current smoker. Presents to GP with chronic non-productive cough. He has had 2 courses of antibiotics and steroids from his GP. What is the next best step in managing this patient?

Answer 33

Lung cancer

Question 34

What is SVCO?

Answer 34

sub vena vena cava obstructure - tends to be on the right lung and they get a red face with arms over their heads

Question 35

What is horners syndrome

Answer 35

Myosin, rossi, anhydrosis, suncken eyelids (oftalmous) - compression of the sympathetic chain

Question 36

Why do you get hypercalcaemia in cancer

Answer 36

In squamous cell lung cancer - tumour secretes PTH parathyroid hormone

Question 37

What type of cancers give hypo sodium Na

Answer 37

Small cell lung cancer - diruretic hormone - syndrome of inappropriate ADH release (SIADH)

Question 38

Share is lung cancer most common to metastasis?

Answer 38

Liver, adrenal glands, bones

Question 39

58 year old lady presents with weight loss and breathlessness. Her GP suspects she may have have cancer? What are the common secondary lung lesions in a woman?

Answer 39

breast and ovary In men renal, testicular and prostate

Question 40

60 year old 40 py ex smoker RUL peripherally based Lesion PET-CT Staging T1a N0M0. Patient is keen to have surgery. FEV12.6 (76%) Performance status 0 What is the next best approach in management 1. Refer to Thoracic Surgery 2. CT Guided biopsy 3. Oncology referral

Answer 40

Go to mdt - CT guided biopsy

Question 41

Which of the following statements is true with regards to solitary pulmonary nodules 1. Nodule in a smoker is always considered malignant 2. Nodules in the contralateral lung excludes from curative surgery 3. Rheumatoid nodules are very common in seronegative patients 4. Lesions more than 3cm are considered a mass than nodule