CPRS 83: Lung Cancer

Question 1

___________ will lead to oxidative stress, then mutations, then cancer

Answer 1

Reactive Oxygen Species

Question 2

Name a Single Nucleotide Polymorphic (SNP) gene that will cause cancer

Answer 2

P450

Question 3

There are 4 types of Primary Lung Carcinoma:
Non-small cell Lung Cancers:
\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_
and
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 3

Non-small cell Lung Cancers:
Adenocarcinoma, Squamous cell carcinoma, Large cell carcinoma
and
Small cell lung carcinoma

Question 4

Which is the commonest type of cancer amongst smokers and non-smokers

Answer 4

Adenocarcinoma

Question 5

What is the feature of adenocarcinoma

Answer 5

Tumour forming glands and tubules

Question 6

Which cell types are involved in adenocarcinoma

Answer 6

Cells lining terminal bronchioles and alveoli

Question 7

What is the difference between Dysplasia and Adenocarcinoma

Answer 7

No invasion to underlying tissues VS

Yes invasion to underlying tissues

Question 8

Under adenocarcinoma, what’s ‘Lepidic predominant’?

Answer 8

Cells grow along the original alveolar wall with little invasion to the stroma

Question 9

Under adenocarcinoma, what’s ‘Solid Adenocarcinoma’?

Answer 9

A solid mass without glands

Question 10

Under adenocarcinoma, what’s ‘Acinar Predominant’?

Answer 10

Tumour cells arranged in gland-like structures

Question 11

Under adenocarcinoma, what’s ‘Papillary predominant’?

Answer 11

Branching and finger-like stromal cores

Tumour cells lining the cores

Question 12

Under adenocarcinoma, what’s ‘Mucinous Adenocarcinoma’?

Answer 12

Tumour cells spreading along alveolar wall

Large amounts of mucin

Question 13

What is the distinctive symptom for Mucinous Adenocarcinoma

Answer 13

Severe cough with sputum

Question 14

What are the process for formation of squamous cell carcinoma

Answer 14

Normal 
Metaplasia
Dysplasia
Carcinoma in situ
Squamous cell carcinoma

Question 15

What are some distinctive features for squamous cell carcinoma

Answer 15

Keratin formation

Intercellular bridges

Question 16

What are distinctive features for large cell carcinoma

Answer 16

Large, poorly differentiated tumour cells

Question 17

What cells are small cell lung carcinoma derived from

Answer 17

Neuro-endocrine cells

Question 18

What are the distinctive features of small cell lung carcinoma

Answer 18

Sheets of small tumour cells

Hyperchromatic nuclei and indistinct nucleoli

Question 19

What are the 4 ways for cancer to spread

Answer 19

Local spread (Irregular edges and infiltrate adjacent lung)
Direct spread to adjacent organs (e.g. Oesophagus, Pleura, Pericardium)
Lymphatic spread
Hematogenous spread

Question 20

What are the differences between Small Cell Lung Carcinoma (SCLC) and Non Small Cell Lung Carcinoma (NSCLC)

Answer 20

Aggressive VS Less Aggressive
Early blood spread VS Local spread at first
Poor Outcome VS Better Outcome
Good Response to Chemotherapy and Radiotherapy VS Surgery is the only treatment of choice

Question 21

For the NSCLC, what’s the TNM staging system?

Answer 21

T: Tumour- Tumour size and extent of local tumour spread
N: Lymph nodes- Site of lymph node involved
M: Metastasis-Distant organs

Question 22

Ipsilateral means on the _______ side

Contralateral means on the _________ side

Answer 22

Ipsilateral means on the same side

Contralateral means on the opposite side

Question 23

What are the nodal stages?
N1:
N2:
N3:
N3:

Answer 23

N1: Ipsilateral Hilar
N2: Ipsilateral Mediastinal
N3: Ipsilateral Neck
N3: Contralateral Hilar/ Contralateral Mediastinal
*For whatever contralateral, already indicates N3

Question 24

What is the difference between limited stage and extensive stage of small cell lung cancer

Answer 24

Limited stage: Tumour confined to an area, can be covered by 1 radiotherapy
Extensive stage: Cannot be covered by 1 radiotherapy

Question 25

What is the first thing to do after finding a malignant tumour in lung or pleura

Answer 25

Ensure the tumour is not due to metastasis

Question 26

How to diagnose the tumours

Answer 26

Bronchoscope

Question 27

What is meant by paraneopalstic syndromes

Answer 27

Signs or symptoms not directly due to physical presence of tumour, rather due to circulating tumour derived factors acting on distant sites

Question 28

What are the causes of paraneoplastic syndromes

Answer 28

1. immune responses generated against tumour cells that wrongly attack nromal cells
2. Cytokines and hormones affecting organ systems distant from the tumour

Question 29

When there is a mutation in oncogene, what cancer treatment method should be undergone?

Answer 29

Targeted therapy

Question 30

When there is no mutation, what cancer treatment method should be undergone?

Answer 30

Chemotherapy or Radiotherapy

Question 31

What is the most common mutation in non-small cell lung cancer?

Answer 31

epidermal growth factor receptor (EGFR)

Question 32

What does EGFR mutation lead to?

Answer 32

Continual activation: Cell proliferation

Dimerization occurrence even without EGF binding to EGFR

Question 33

What is the way to activate and inhibit EGFR respectively?

Answer 33

Activate: EGFR binding to ATP more than TKI
Inhibit: EGFR binding to TKI more than ATP, which will lead to reduced proliferation and reduced cancer

Question 34

What is the nature of EGFR mutation

Answer 34

Allow ATP binding more than TKI binding, so EGFR is not inhibited

Question 35

All mutations in EGFR involves exons __________

Answer 35

18-21

Question 36

ALK gene will partner with which two genes and leads to translocation, then cell proliferation and survival?

Answer 36

EML4

KIF5B

Question 37

In immune checkpoint blockade:

Tumour tolerance will be induced when ________ binds to __________, which inactivates _______.

Answer 37

Tumour tolerance will be induced when PD-L1 binds to PD-1, which inactivates T-cells.

Question 38

To prevent T-cell inactivation, one can inhibit _______ or ________.

Answer 38

To prevent T-cell inactivation, one can inhibit PD-L1 or PD-1.