Chapter 9

Question 1

What are the types of lung cancer?

Answer 1

Small cell carcinoma

Non-Small Cell Carcinoma
- squamous
- adenocarcinoma
- ‘large cell’

Question 2

Location and spread of lung cancer?

Answer 2

Central or peripheral

Local
Lymphatic
Transcoelomic - pleural and pericardial effusions
Hematogenous

Question 3

5 features of squamous cell carcinoma

Answer 3

1. Common in males, central location
2. Association with smoking
3. Undergoes central cavitation
4. Preceded by squamous metaplasia or dysplasia
5. Keratinisation may be present

Question 4

3 features of adenocarcinoma.

Answer 4

1. Equal gender incidence
2. Not linked to smoking
3. Special type: minimally-invasive adenocarcinoma/previously known as bronchioalveolar carcinoma (BAC): spreads along alveolar septa, looks like consolidation rather than mass on X-Ray

Question 5

Features of small cell carcinoma

Answer 5

central, rapid growth rate

early metastases (by diagnosis alr metastasise)

high association with smoking

tumour cells show neuroendocrine differentiation & high nc ratio

poor prognosis

Question 6

what is the prognosis of lung cancer

Answer 6

very poor. most pt diagnosed are stage 4. 5 yr survival is <20% for NSCC and <5% for SCC
operable tumours ar eonly 20%, survival for these are only 30% in 5 yr

Question 7

reasons for poor prognosis of lung cancer

Answer 7

natural history of disease currently allows little opportunity for screening
- no early symptoms
- many lesions found on chest xray screening have already spread
- only way to pick up is by CT scan

metastatic spread is already present (>50%) at presentation (symptoms may even be caused by metastatic disease

Question 8

What paraneoplastic syndromes are associated with lung cancer?

Answer 8

SIADH, Ectopic ACTH, Hypercalcemia

Question 9

Treatments of NSCLC and SCLC.

Answer 9

NSCLC: cancer not spread out of lung, surgery - most are unoperable tho bc of high stage or other lung and heart disease

SCLC: radiotherapy and chemotherapy

Question 10

What are some novel therapies for lung cancer

Answer 10

Adenocarcinoma: some harbour mutations of EGFR - pt can receive tyrosine kinase inhibitors as part of treatment

Question 11

How do metastases to lung present?

Answer 11

Cannon-ball lesions

Question 12

4 abnormal accumulations in the pleura and their names

Answer 12

Pus = empyema
Blood = hemothorax
chyle = chylothorax (leakage from thoracic duct)
air = pneumothorax

Question 13

Transudate vs exudate

Answer 13

Transudate: Low protein fluid, usually due ot high hydrostatic pressure, low oncotic pressure

Exudate: High protein fluid, due to damage in vessel walls or inflammatory reaction to tumour or infection

Question 14

Common causes of transudate and exudate

Answer 14

Transudate: Cardiac Failure
Exudate: Infections, Neoplasm