cancer

Question 1

risk factors

Answer 1

smoking 
asbestos 
nickel
chromates
radiation 
atmospheric pollution 
genetics

Question 2

clinical presentation local effects

Answer 2

obstruction of airways - pneumonia
invasion of chest wall - pain
ulceration - haemoptysis

Question 3

clinical presentation metastases

Answer 3

nodes
bones
liver
brain

Question 4

clinical presentation systemic effects

Answer 4

weight loss
ectopic hormone production
PTH - squamous cancer
ACTH - small cell cancer

Question 5

respiratory acinus

Answer 5

functional unit of the lung

extends through respiratory bronchiole, alveolar ducts and alveoli

Question 6

classification

Answer 6

adenocarcinoma - 35%
squamous carcinoma - 30%
small cell carcinoma - 25%
large cell carcinoma - 10%
neuroendocrine 
bronchal gland

Question 7

why classify

Answer 7

prognosis
treatment
pathogenesis/biopsy
epidemiology

Question 8

survival time

Answer 8

small cell worst

large cell worse than squamous or adenocarcinoma

Question 9

immunohistochemistry adenocarcinoma

Answer 9

expresses TTF - thyroid transcription factor

Question 10

immunohistochemistry squamous carcinoma

Answer 10

expresses nuclear antigen p63 and high molecular weight cytokeratins

Question 11

EFGR

Answer 11

oncogene

Question 12

erlotinib

Answer 12

tyrosine kinase inhibitors

EGFR tumours respond

Question 13

crizotinib

Answer 13

EML4-ALK fusion oncogene also identifies a target for specific drug treatment

Question 14

pathogenesis

Answer 14

pulmonary epithelium
bronchial - ciliated, mucous, neuroendocrine, reserve
bronchioles/alveoli - club cells, types 1 and 2 alveolar cells

Question 15

bronchial large airway tumours

Answer 15

squamous metaplasia
dysplasia
carcinoma in situ
invasive malignancy

Question 16

peripheral adenocarcinomas

Answer 16

atypical adenomatous hyperplasia
spread of neoplastic cells along alveolar walls
true invasive adenocarcinoma

Question 17

carcinoid

Answer 17

neuroendocrine neoplasms of low grade malignancy

Question 18

bronchial gland neoplasms

Answer 18

often seen in salivary glands
adenoid cystic carcinoma
mucoepidermoid carcinoma

Question 19

treatment options

Answer 19

giving the diagnosis
surgery
radiotherapy
chemotherapy
supportive care

Question 20

small cell

Answer 20

rapidly progressive disease
early metastases
rarely suitable for surgery
good initial response to chemotherapy

Question 21

non small cell

Answer 21

includes squamous and adeno carcinoma
curative options are surgery or radical radiotherapy
palliative chemotherapy and new targeted treatment
majority of lung cancers

Question 22

surgery for lung cancer

Answer 22

pneumonectomy or lobectomy
curative objective
peri-operative mortality
post-operative morbidity

Question 23

cytotoxic chemotherapy

Answer 23

rarely curative but longer survival
better response in small cell cancer 
major side effects 
IV every 3-4 weeks 
outpatient visits
targets rapidly dividing cells

Question 24

chemotherapy side effects

Answer 24

nausea and vomiting 
tiredness
bone marrow suppression 
hair loss
pulmonary fibrosis

Question 25

radiotherapy

Answer 25

ionising radiation radical - curative intent palliative well tolerated

Question 26

radiotherapy negatives

Answer 26

maximum cumulative dose collateral damage only goes where you point the beam

Question 27

SABR

Answer 27

``` sterotactic ablative radiotherapy many more beams less collateral damage total dose to tumour is higher and so more effective 4D scanning required ```

Question 28

endobronchial therapy

Answer 28

stent insertion for stridor photodynamic therapy other laser therapy

Question 29

palliative care

Answer 29

``` pain breathless cough anxiety poor mobility ```

Question 30

mesothelioma

Answer 30

uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity 30-40 years to develop asbestos

Question 31

mesothelioma symptoms

Answer 31

``` SOB chest pain weight loss fever sweating cough ```

Question 32

chrysotile

Answer 32

white asbestos | most common

Question 33

amosite

Answer 33

brown asbestos

Question 34

crocidolite

Answer 34

most dangerous

Question 35

mesothelima investigations

Answer 35

imaging - pleural nodularity, circumferential pleural thickening, local invasion, lung entrapment pleural fluid aspiration - low cytological yield, avoid repeated aspiration biopsy - thorascopy or CT/US guided

Question 36

mesothelioma treatment

Answer 36

``` pleurodese effusions radiotherapy surgery chemotherapy palliative care report deaths to fiscal ```

Question 37

malignant pleural effusion treatment

Answer 37

``` palliate repeated pleural taps drain and/or pleurodesis long term pleural catheters surgical options - abrasion, pleurectomy ```

Question 38

TALC

Answer 38

``` slurry in suspension poudrage insufflated involves a hospital stay ```

Question 39

Talc complications

Answer 39

``` minor pleuritic pain and fever pneumonia resp failure talc pneumonitis/ARDS secondary empyema local tumour implantation at port site in mesothelioma ```

Question 40

predicting survival in malignant pleural effusion

Answer 40

``` LENT score LDH ECOG PS neutrophil to lymphocyte ratio tumour type ```

Question 41

malignant pleural effusion treatment

Answer 41

depends on cause LVF - diuretics Infection - drain, antibiotics, surgery malignancy - drain, pleurodesis, pleural catheter