Cancer

Question 1

Describe the epidemiology of lung cancer. (5)

Answer 1

Highest cancer related deaths worldwide.
About 10% survival 5 year survival.
Average age of diagnosis is 70
Much more common in lower socioeconomic classes.

Question 2

Describe the causes of lung cancer. (5)

Answer 2

SMOKING - even in non-smokers
Asbestos
Radon
Other ‘occupational carcinogens’
Genetic

Question 3

Describe the screening prospects of lung cancer. (3)

Answer 3

Not currently screened for.
No disease-specific reduction in mortality
Being trialled with low dose CT.

Question 4

Describe the staging used In lung cancer. (3)

Answer 4

TNM used
T - size and local invasion (heart, oesophagus)
N - location of nodes affected
M - distant (bone, adrenals) local (pleura, other lung).

Question 5

Describe the imaging techniques used to stage lung cancer. (7)

Answer 5

CXR
CT chest or abdo
PET scan
MRI
USS
bone scan
ECHO

Question 6

Describe the treatment options available for different stages. (2)

Answer 6

Stage 1+2 - radical treatment options

Stage 3+4 - non-operable or palliative.

Question 7

Describe symptoms of the primary tumour. (7)

Answer 7

Asymptomatic

Cough, dyspnoea, wheeze, haemoptysis, recurrent chest infections, weight loss, malaise.

Question 8

Describe the symptoms of regional mets of lung cancer. (3)

Answer 8

Bloating - SVC obstruction
Horseness - left recurrent laryngeal
Dysphagia - oesophageal compression

Question 9

Describe the symptoms of distant mets of lung cancer. (3)

Answer 9

Bone pain or fractures
CNS symptoms (headache, confusion)
Metabolic - Hyponatraemia, hypercalcaemia.

Question 10

Describe signs of lung cancer. (6)

Answer 10

Engorged chest veins from SVC obstruction, clubbing, Horner’s Syndrome, consolidation, pleural effusion
Nothing.

Question 11

Describe paraneoplastic syndromes. (6)

Answer 11

Endocrine - SIADH, Cushing’s syndrome
Neurological - encephalopathy, Pancoast syndrome
Haematological - anaemia, thrombocytosis.

Question 12

Describe the reasons for doing a PET scan. (3)

Answer 12

Differentiates between ordinary and very metabolically active tissues, whole body scan, can pick up distant mets.

Question 13

Describe the reasons for doing a biopsy. (2)

Answer 13

ONLY if it will change the course of treatment. No point harming pt if it won’t change anything.

Question 14

Describe the 5 different types of lung cancer and their occurrences. (16)

Answer 14

Non-small cell lung cancers:
Squamous cell carcinoma (smokers, releases atopic PTH) ~40%
Adenocarcinoma (non-smokers) ~35%
Large cell carcinoma ~5%

Small cell carcinoma (ACTH + ADH releasing neuroendocrine tumour) ~15%

Rare types of tumours eg carcinoid, mesothelioma ~5%

Question 15

What is performance status and what does it indicate. (3)

Answer 15

Score 0-5 on levels of activity with 0 being no symptoms, normal level of activity, 4 being bedridden and 5 being dead.
Indicates how well a patient is likely to be able to recover from treatment options.

Question 16

Describe the treatment options available for lung cancers. (10)

Answer 16

Surgery - best chance of cure, mostly small cell, needs to be early stage.
Radiotherapy - can be with surgery for cure or palliative.
Combination chemotherapy - can be with surgery or alone.
Combination therapy - chemo and radio to aim for cure.
‘Biologically targeted’ therapies - like treatments for BRCA.

Question 17

Describe palliative care things relating to lung cancer. (4)

Answer 17

Active symptom control - analgesia, airway stents, nutritional support.
Support groups and treatments of tobacco addiction and any other co-morbidities can also help.