CVR - Cancers of the lung, heart & vasculature

Question 1

What is an angiosarcoma?

Answer 1

Malignancy of vascular endothelial cells

Question 2

What is a cardiac tumour?

Answer 2

E.g. myxoma, tumour of connective tissue

Question 3

Why are cardiac cancers so rare?

Answer 3

• Low exposure of cells to carcinogens
• Turnover rate: cardiac myocytes divide very rarely
• Strong selective advantage against anything which could compromise function

Question 4

Besides smoking, what can cause lung cancer?

Answer 4

• Passive smoking
• Other aetiological factors:
  
  • Asbestos - Exposure
  • Radon
  • Indoor cooking fumes
  • Chronic lung diseases (COPD, fibrosis)
  • Immunodeficiency
  • Familial/genetic - several loci detected

Question 5

What is the origin of squamous cell carcinomas?

Answer 5

Originating from bronchial epithelium; centrally located

Question 6

What is the origin of adenocarcinomas?

Answer 6

Originate from mucus-producing glandular tissue; more peripherally located

Question 7

What is large cell lung cancer?

Answer 7

Heterogenous group, undifferentiated

Question 8

What is the origin of small cell lung cancer?

Answer 8

Originate from pulmonary neuroendocrine cells

Highly malignant

Question 9

What are squamous cell carcinomas, adenocarcinomas and large cell lung cancer also referred to as?

Answer 9

Non-small cell lung cancer (NSCLC)

Question 10

What are the important oncogenes in lung cancer?

Answer 10

• Epidermal growth factor receptor (EGFR) tyrosine kinase
• Anaplastic lymphoma kinase (ALK) tyrosine kinase
• c-ROS oncogene 1 receptor tyrosine kinase
• BRAF

Question 11

What are the key symptoms of lung cancer?

Answer 11

• Coughing
• Weight loss
• Breathlessness
• Fatigue
• Chest pain
• Haemoptysis - coughing up blood
• Repeated respiratory infections
  (Or frequently asymptomatic)

Question 12

Features of advanced/metastatic disease?

Answer 12

• Neurological features:
  
  • Focal weakness, seizures, spinal cord compression
• Bone pain
• Paraneoplastic syndromes:
  
  • Clubbing, hypercalaemia, hyponatraemia, Cushing’s

Question 13

What is the diagnostic strategy for lung cancers?

Answer 13

• Establish most likely diagnosis
• Establish fitness for investigation and treatment
• Confirm diagnosis:
  
  • Specific type of cancer if considering systemic treatment
• Confirm staging

Question 14

When is a bronchoscopy used?

Answer 14

• For tumours of the central airway

- Where tissue staging is not important

Question 15

When is a endobronchial ultrasound used?

Answer 15

To access the mediastinum to acheive a positive or negative tissue diagnosis

Question 16

When is a CT-guided lung biopsy used?

Answer 16

To access peripheral lung tumours

Question 17

What are the considerations for deciding treatment for a patient with cancer?

Answer 17

• Patient fitness
• Cancer histology - type
• Cancer stage
• Patient preference
• Health service factors - availability etc.

Question 18

What are the different levels of patient fitness according to the WHO performance status?

Answer 18

0 - Asymptomatic
1 - Symptomatic but completely ambulatory
2 - Symptomatic, <50% in bed during day
3 - Symptomatic, >50% in bed during day
4 - Bedbound
5 - Death

Question 19

What are the different types of surgery that can be given to a patient with early stage lung cancer?

Answer 19

• Wedge resection: remove a small section of lung containing the tumour with a small amount of healthy tissue
• Segmental resection: Removes a larger portion of the lung but not an entire lobe
• Lobectomy: removal of an entire lung lobe
• Pneumonectomy: removal of an entire lung

Question 20

What is radical radiotherapy?

Answer 20

Alternative to surgery for early stage cancer
Stereotactic ablative body radiotherapy:
Multiple convergent beams of radiation can be used to target the tumour directly
Good for people who cant have surgery or people that do not want to have prolonged stays at hospital

Question 21

What is immunotherapy?

Answer 21

Drugs are given to the patient which block the PD-L1 OR PD-1, which allows for the T cell to target and destroy the tumour cell

Question 22

What is the treatment for early stage lung cancer?

Answer 22

Surgery or radiotherapy with curative intent

Question 23

What is the treatment for locally advanced lung cancer?

Answer 23

Surgery + adjuvant chemotherapy

Radiotherapy + chemotherapy +/- immunotherapy

Question 24

What is the treatment for metastatic disease?

Answer 24

With a targetable mutation: tyrosine kinase inhibitors
No mutation, PDL-1 positive: immunotherapy
No mutation, PDL-1 negative: chemotherapy