5. Lung Tumours

Question 1

Classify malignant lung tumours

Answer 1

Primary
-epithelial
-non-epithelial
Metastatic

Question 2

What tumours commonly metastasise to the lung

Answer 2

Colon
Breast
Renal cell carcinoma
Prostate 
Melanoma

Question 3

What are the types of benign lung tumour?

Answer 3

Hamartoma most common
Papilloma (upper airway)
Adenoma (lower)
Chondroma
Haemangioma

Question 4

How do benign tumours appear on PET?

Answer 4

Cold

Question 5

Classify primary epithelial tumours

Answer 5

Non-small cell

Neuroendocrine

Question 6

Classify non small cell tumours

Answer 6

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Non Small cell lung cancer not otherwise specified

Question 7

Classify neuroendocrine tumours

Answer 7

Small cell carcinoma
Large cell neuroendocrine carcinoma
Carcinoid tumour

Question 8

What tumour can arise from fibrosis?

Answer 8

Adenocarcinoma

Question 9

How do adenocarcinomas appear on CT?

Answer 9

Ground glass opacity

Question 10

What marker is positive in adenocarcinomas?

Answer 10

TTF-1

Question 11

Where are squamous cell carcinomas and carcinoid tumours usually found in the lung?

Answer 11

Centrally in major bronchi

Question 12

What process can cause squamous cell carcinomas?

Answer 12

Metaplasia

Question 13

What marker is present in squamous cell carcinomas?

Answer 13

p63

Question 14

Describe the appearance of a small cell carcinoma under the microscope

Answer 14

Small to medium sized cells
Nuclei stick together
Little cytoplasm
Evidence of necrosis and mitosis

Question 15

What markers are present in neuroendocrine tumours?

Answer 15

Synaptophysin

Chromogranin

Question 16

How can a carcinoid tumour present?

Answer 16

Recurrent pneumonia

Carcinoid syndrome

Question 17

How do carcinoid tumours appear under the microscope?

Answer 17

lots of ‘Salt and pepper’ cytoplasm

Nested or in trabeculae

Question 18

What are the 5 main causes of malignant lung neoplasms?

Answer 18

Smoking
Radon gas
Asbestos
Air pollution
Genetic

Question 19

What is an ECOG status?

Answer 19

Used to assess patient’s co-morbidities and whether they will survive treatment

Question 20

What are the local effects of lung tumours?

Answer 20

Cough, haemoptysis, pneumothorax, pleural effusion, recurrent pneumonia

Question 21

Which lung tumours are associated with paraneoplastic syndrome?

Answer 21

Small cell
Squamous cell
Adenocarcinoma

Question 22

How do paraneoplastic syndromes occur?

Answer 22

Cross-reacting antibodies interfere with normal metabolic pathways

Question 23

Which paraneoplastic syndromes are associated with small cell carcinomas?

Answer 23

Cushings syndrome

Hyponatraemia

Question 24

Which paraneoplastic symptom is associated with squamous cell carcinoma?

Answer 24

Hypercalcaemia

Question 25

Which paraneoplastic symptom is associated with adenocarcinoma?

Answer 25

Hypertrophic osteoarthropathy

Question 26

What are the symptoms of Pancoast’s tumour?

Answer 26

Horner’s syndrome: ptosis, meiosis and anhidrosis

Weakness in small muscles of the hand

Question 27

What mutations have been seen in adenocarcinomas?

Answer 27

EGFR
ALK
ROS-1
RET
B-RAF

Question 28

What mutations have been seen in non-small cell lung cancers?

Answer 28

KRAS
p53
EGFR
EML4
ALK