clinical lung cancer

Question 1

risk factors for squamous cell carcinoma?

Answer 1

Smoking
Age > 40
Environmental
– Radon Gas
– Urban Living
Occupational
– Asbestos
– Uranium Mining
– Tin Mining
Pulmonary Scarring
– Cryptogenic Fibrosing Alveolitis
– Sarcoidosis

Question 2

when to refer?

Answer 2

Persistent haemoptysis in smokers of ex
smokers over 40 years of age
Signs of superior vena caval obstruction
(swelling of face/neck with fixed elevation
of JVP
Stridor

Question 3

examinations?

Answer 3

Hands - Clubbing, muscle wasting
Face - Eyes, mucous membranes
Neck - Lymph nodes, trachea
Breasts - Axillae
Chest signs - collapse, consolidation,
stridor, wheeze
Abdo - hepatomegaly

Neurological assessment -
mental status, muscle wasting, pain,
paraneoplastic manifestations
Skin lesions – primary, secondary
Musculoskeletal- bony tenderness,
mobility

Question 4

spirometry?

Answer 4

Question 5

lung performance score?

Answer 5

Question 6

lung cancer investigations?

Answer 6

Blood Tests
FBC, Coag, UEC, LFT, Bone profile
CXR
CT
– Chest
– Abdomen
– Brain
PET Scan
Ultrasound Scan

CXR
Staging CT scan
PET scan (staging)
Bone scan
U/Sound

invasive

Percutaneous needle biopsy
Bronchoscopy
EBUS
Mediastinoscopy

Question 8

purpose of bronchoscopy?

Answer 8

Diagnostic
– Endobronchial Biopsy
– Extraluminal Biopsy - TBNA
– Transbronchial Biopsy
– Bronchoalveolar Lavage
Therapeutic
– Foreign Body
– Removal of Tumour
– Stent Insertion

Question 9

CP-EBUS?

Answer 9

convex probe endobronchial ultrasound

Question 10

other biopsy

Answer 10

Pleural Aspiration/Biopsy
Lymph Node Aspiration/Biopsy
Skin Metastasis Aspiration/Biopsy
Surgical Biopsy
– VATS
– Medistinoscopy

Question 11

squamous cell cancer

Answer 11

Arises in metaplastic squamous epithelium
25 - 35% of all Ca lung
Male preponderance
Cigarette smoking
Bulky mass, central or peripheral,
cavitation and necrosis common

Question 12

all plasias

Answer 12

Anaplasia – dedifferentiation
Aplasia – when an entire organ or a part of an organ is missing
Hypoplasia – inadequate or below-normal number of cells
Hyperplasia – physiological proliferative increase in number of cells
Neoplasia – abnormal proliferation
Dysplasia – change of phenotype (size,shape and organization of tissue)
Metaplasia – cell type conversion
Prosoplasia – cell type develops new function
Desmoplasia – connective tissue growth

Question 13

adenocarcinoma

Answer 13

Usually in periphery
Commonest form of primary lung cancer
Female preponderance
Several morphological subtypes
Cuboid to columnar cells, often mucin
secreting forming acinar and papillary
structures

Question 14

small cell carcinoma

Answer 14

Small cells, scant cytoplasm
Clinically often centrally located
Neuroendocrine cell origin
Chemosensitive
Aggressive course

Question 15

tnm stage?

Answer 15

Tumour
– X,1,2,3,4
– Size of Tumour
– Where it Invades
Node
– 0,1,2,3
– Extent of Nodal Spread
Metastasis
– 0,1a, 1b
– Are there any?

Question 16

staging

Answer 16

Question 17

treatment

Answer 17

Surgical resection – stages 1 & 2
Mediastinoscopy – frozen section
wedge resection
lobectomy
pneumonectomy
Approx 8% patients are suitable

Question 18

radiothrerapy?

Answer 18

Radical radiotherapy – stage 1 & 2 not suitable
for surgery
Palliative radiotherapy – pain, SVCO,
hypercalcaemia
Radiosurgery – cyberknife, gammaknife

Question 19

radiosurgery

Answer 19

Radiotherapy for patients “medically
inoperable”
Precise, image guided high dose radiation
Fiducial markers (gold seeds)

Question 20

stage 3 an 4

Answer 20

Can extend life by 2 – 3 months
Platinum based doublet therapy
Side effects vs quality of life
Palliation of symptoms