Lung Cancer

Question 1

How many deaths a year are there from lung cancer?

Answer 1

35000

Question 2

What is the 5 year survival rate of those diagnosed with lung cancer?

Answer 2

8%

Question 3

What is the most common cause of lung cancer?

Answer 3

Smoking

Question 4

Is the risk of lung cancer proportional to the amount smoked?

Answer 4

Yes

Question 5

Genetically at a cellular level how does smoking lead to lung cancer?

Answer 5

Carcinogens in smoke cause multiple mutation in epithelial cell DNA which accumulate
Multiple hits eventually leads to cell cycle regulation loss
The mutated cells being dividing uncontrollably

Question 6

What are the key symptoms of lung cancer?

Answer 6

Cough 
Haemoptysis 
Chest pain 
Breathlessness 
Weight loss (key sign) 
Hoarseness of voice 
Wheeze 
Swollen face

Question 7

What are the metastatic symptoms of lung cancer?

Answer 7

Bone pain
Headaches-neurological fits
Jaundice

Question 8

What is the most aggressive form of lung cancer?

Answer 8

Small cell carcinoma

Question 9

What are the characteristics of small cell carcinoma of the lungs?

Answer 9

Large tumours
Quick growing
Often metastasised before diagnosis

Question 10

What are the 3 types of non small cell lung cancer?

Answer 10

Large cell carcinoma
Adenocarcinoma
Squamous cell carcinoma

Question 11

What are common sites of metastasis of lung cancer?

Answer 11

Liver 
Bone 
Brain 
Adrenal glands 
Skin

Question 12

What 3 zones is the lung divided into?

Answer 12

Upper
Middle
Lower

Question 13

What is a pulmonary mass?

Answer 13

Opacity in lung over 3cm with no mediastinal adenopathy or atelectasis

Question 14

What is a pulmonary nodule?

Answer 14

Opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

Question 15

What does a tissue sample of mass in lung allow?

Answer 15

Histology to help stage the sample and diagnose the type of lung cancer

Question 16

What does the identification of the stage of the cancer allow?

Answer 16

A prognosis and treatment to be outlined

Question 17

What does TNM stand for?

Answer 17

Tumour size and position
Nodes
Metastases (has the tumour spread anywhere else in the body)

Question 18

How is T in TNM classified??

Answer 18

T1-4

Question 19

How is N in TNM classified?

Answer 19

N1-3

Question 20

How is M in TNM classified?

Answer 20

M0-1

Question 21

What are some of the other causes of lung cancer?

Answer 21

Asbestos

Occupational

Question 22

What % of smokers get lung cancer?

Answer 22

10%

Question 23

What is small cell carcinoma usually called by?

Answer 23

Smoking

Question 24

Why is lung cancer called ‘clinically silent’?

Answer 24

Because there are no symptoms for ages

Question 25

Why does lung cancer have such a bad prognosis?

Answer 25

Because by the time the symptoms normally appear the cancer is in too late a stage and the patient will normally die

Question 26

What is a PET-CT?

Answer 26

Radiolabelled glucose is injected into the body. Rapidly dividing cells (tumour cells) will use the most glucose This allows us to see distant metastasis

Question 27

What are the signs of lung cancer?

Answer 27

``` Finger clubbing Stridor Signs of consolidation Pleura effusion Cervical lymphadenopathy ```

Question 28

What is the most preventable form of lung cancer?

Answer 28

Lung cancer

Question 29

What initial investigations are done for suspected lung cancer?

Answer 29

``` CXR FBC Renal, liver functions and calcium Clotting screen Spirometry ```

Question 30

What does N0 mean?

Answer 30

No regional node involvement

Question 31

What does M0 mean?

Answer 31

Distant metastasis absent

Question 32

What does M1 mean?

Answer 32

Distant metastasis present

Question 33

What treatment options are available for lung cancer patients?

Answer 33

Surgery Radiotherapy Chemotherapy Palliative care

Question 34

What does palliative management involve?

Answer 34

Symptom control Quality of life Community support Decisions and planning, resuscitation status, end of life care Multidisciplinary team including lung cancer nurse and hospice

Question 35

Is lung cancer easy to treat?

Answer 35

No it is very difficult

Question 36

Where does the cancer have to start in order to be a primary lung cancer?

Answer 36

In the lung

Question 37

Give examples of inherited oncogene mutations which increase the likelihood of lung cancer

Answer 37

KRAs EGRF BRAF HER2

Question 38

What % of lung cancers are large cell?

Answer 38

10%

Question 39

What % of lung cancers are adenocarcinoma?

Answer 39

27%

Question 40

What % of lung cancers are squamous cell carcinoma?

Answer 40

35%

Question 41

What CXR signs may indicate lung cancer?

Answer 41

``` Hilar vascular structure defined? Is the costophrenic angle sharp? Is the trachea central? No widening mediastinium Lesions? Pleural effusion? Are the lungs inflated? Or is there pneumothorax present ```