Intrathoracic Malignancy

Question 1

State some risk factors for Lung Malignancy

Answer 1

• Smoking tobacco
• Radon gas
• Asbestos
• Air pollution
• CXR and CT scans

Question 2

What are the five main types of Lung Malignancy and how are they categorised?

Answer 2

1. Small cell carcinomas
2. Non-small call carcinomas
   2a. Adenocarcinomas
   2b. Squamous cell carcinomas
   2c. Carcinoid tumours
   2d. Large cell carcinomas

Question 3

Which are more common; Small cell carcinomas or Non-small cell carcinomas?

Answer 3

Non-small cell carcinomas

Question 4

In Small cell carcinomas, what genes are inactivated?

Answer 4

RB1 and TP53

Question 5

In Non-small cell adenocarcinomas, what genes are inactivated?

Answer 5

EGFR, KRAS, BRAF, ALK etc.

Question 6

Small cell carcinomas are derived from what cell type?

Answer 6

Immature neuro-endocrine cells

Question 7

What are some secondary sites of primary tumour metastasis

Answer 7

• Mediastinum & Hilar lymph nodes
• Lung pleura
• Heart
• Breasts
• Liver
• Adrenal glands
• Brains
• Bones

Question 8

Cancers which cause a patient to develop a hoarse voice are due to damage to what structure?

Answer 8

Recurrent Laryngeal Nerve

Question 9

Cancers which cause a patient to have difficulty breathing are due to damage of what structure?

Answer 9

Phrenic Nerve

Question 10

Cancers which cause a patient to exhibit facial swelling is due to the cancer pressing on what structure?

Answer 10

Superior Vena Cava

Question 11

Most Pancoast tumours are what lung cancer type?

Answer 11

Non-small cell type (Adenocarcinomas and Squamous cell carcinomas)

Question 12

Where are Pancoast tumours located?

Answer 12

Apex of lung

Question 13

Which non-small cell lung cancer is derived from mature neuroendocrine cells?

Answer 13

Carcinoid tumours

Question 14

Para-neoplastic syndrome is common in what lung cancer types?

Answer 14

• Small cell cancer

- Squamous cell cancer (non-small)

Question 15

Outline the effects of Cortisol Para-neoplastic syndrome

Answer 15

Increased production of Cortisol, leading to Cushing’s syndrome. Causes increased blood glucose and blood pressure

Question 16

Outline the effects of ADH Para-neoplastic syndrome

Answer 16

Increased production of ADH, leading to increased water retention, increased blood pressure and increased oedema

Question 17

Outline the Lambert-Eaton Myesthenic Para-neoplastic syndrome

Answer 17

Production of auto-antibodies against Voltage gated Calcium channels

Question 18

Outline the PTH Para-neopastic Syndrome

Answer 18

Increased release of PTH, causing bone resorption and release of calcium into the blood (Hypercalcaemia)

Question 19

What is the treatment plan for Small cell carcinomas?

Answer 19

Chemotherapy

Question 20

What is the treatment plan for Non-small cell carcinomas?

Answer 20

Surgery first, followed by Radiotherapy or Chemotherapy

Question 21

In Adenocarcinomas non-small cell carcinomas, histologically what do they look like?

Answer 21

Glandular differentiation, producing mucin

Question 22

What is the normal histology of the Normal respiratory epithelium?

Answer 22

Psuedostratified cilitated columnar

Question 23

The production of keratin material is associated with which type of lung cancer?

Answer 23

Non-small cell, squamous cell carcinomas

Question 24

> 90% of Malignant Mesothelioma is associated with what exposure?

Answer 24

Asbestos

Question 25

Incidence of Malignant Mesothelioma is expected to peak when?

Answer 25

2020