Bronchial Carcinoma

Question 1

define bronchial carcinoma

Answer 1

malignant neoplasm of the lung

Question 2

risk factors for bronchial carcinoma

Answer 2

• smoking
• asbestos
• radiation
• pre-existing lung disease
• pulmonary fibrosis

Question 3

types

Answer 3

• small cell carcinoma
• non-small cell
• adenocarcinoma
• large cell carcinoma

Question 4

where does small cell carcinoma arise?

Answer 4

from neuroendocrine cells and often secrete polypeptide hormones (GH, SIADH)

Question 5

does small cell carcinoma metastasise

Answer 5

yes, very early

Question 6

where is small cell carcinoma usually located?

Answer 6

centrally

Question 7

where does non-small cell arise?

Answer 7

squamous epithelium and is associated with production of keratin (cavities with central necrosis)

Question 8

timing of metastasises

Answer 8

local spread common

metastasises late

Question 9

where are adenocarcinomas located?

Answer 9

peripheral lesion

Question 10

what is the most common type in non-smokers

Answer 10

adenocarcinoma

Question 11

where does adenocarcinoma originate from

Answer 11

mucus secreting glandular cells

Question 12

which type of bronchial carcinoma can present with gynaecomastia

Answer 12

adenocarcinoma

Question 13

metastasises in adenocarcinoma

Answer 13

pleura, lymph nodes, brain and bones

Question 14

describe large cell carcinoma

Answer 14

poorly differentiated and metastasises early

Question 15

clinical features

Answer 15

• cough
• breathlessness
• haemoptysis
• chest pain
• wheeze
• hoarse voice (recurrent laryngeal nerve palsy)
• hand muscle wastage (pancoast tumour, brachial plexus invasion) and Horner’s syndrome
• recurrent infection (due to partial obstruction of airway)

Question 16

describe Horner’s syndrome

Answer 16

name for a group of symptoms including flushing on one side of the face and that side doesn’t sweat. The eye on the same side has a constricted pupil with a drooping eyelid

Question 17

metastatic spread

Answer 17

• mediastinum, cervical and axillary lymph nodes
• liver
• bone
• adrenal glands
• brain

Question 18

list of investigations into bronchial carcinoma

Answer 18

• CXR
• CT
• PET
• biopsies

Question 19

CXR for bronchial carcinoma

Answer 19

• mass lesion
• pleural effusion
• mediastinal widening
• collapse
• reticular shadowing
• normal

Question 20

CT for bronchial carcinoma

Answer 20

indicates extent of disease, should include liver and adrenal glands

Question 21

PET for bronchial carcinoma

Answer 21

characters extent of mediastinal nodal involvement and distal metastases

Question 22

how is a biopsy taken in peripheral lesions?

Answer 22

percutaneous FNA

Question 23

biopsy for mediastinal lymph node staging

Answer 23

endoscopic bronchial US biopsy

Question 24

methods for biopsies

Answer 24

Bronchoscopy
CT guided biopsy
Lymph node aspirate
Aspiration of pleural fluid
Endobronchial Ultrasound
Thoracoscopy

Question 25

prognosis in lung cancer

Answer 25

BAD

Question 26

When is surgery performed for bronchial carcinoma

Answer 26

early stage non-small cell lung cancer

Question 27

when is radiotherapy used?

Answer 27

non-small cell lung carcinoma with curative intent

Question 28

small cell treatement

Answer 28

• chemotherapy and radiotherapy for symptoms

- palliative care