Lung cancer

Question 1

What are the classifications of tumors in the lungs?

Answer 1

Benign tumors and malignant tumors.

Question 2

What are the examples of benign tumors in the lungs?

Answer 2

Hamartoma, aterio-venous malformations (AVMs), and granuloma

Question 3

What are the examples of malignant tumors in the lungs?

Answer 3

Primary lung cancer, carcinoid tumor, and secondary tumors from metastases.

Question 4

What is bronchogenic cancer?

Answer 4

It is the most common primary lung cancer that arises from the cells of the bronchial mucosa.

Question 5

What is non-small cell lung cancer?

Answer 5

It is a type of bronchogenic cancer that arises from the epithelial and glandular cells of the lungs.

Question 6

What is small cell lung cancer?

Answer 6

It is a type of bronchogenic cancer that arises from neuroendocrine cells of the lungs.

Question 7

What is adenocarcinoma in situ?

Answer 7

It is a type of lung cancer that accounts for 5% of all lung cancers and arises from the alveolar cells of the lungs.

Question 8

What is mesothelioma?

Answer 8

It is a tumor of the pleura that is associated with asbestos exposure.

Question 9

What is the epidemiology of lung cancer?

Answer 9

Lung cancer is the most common fatal malignancy that is more prevalent in the north of England, in lower socioeconomic groups, and is diagnosed usually between the ages of 40 to 70, with a higher incidence in females.

Question 10

What is the main risk factor for developing lung cancer?

Answer 10

Cigarette smoking

Question 11

What is the latency period for asbestos exposure and the development of bronchogenic lung cancer?

Answer 11

30-40 years

Question 12

What is the synergistic effect of cigarette smoking and asbestos exposure on the risk of lung cancer?

Answer 12

They increase the risk of lung cancer 100X

Question 13

What is asbestos associated with, besides bronchogenic lung cancer?

Answer 13

Mesothelioma

Question 14

What is the most common type of primary lung cancer?

Answer 14

Bronchogenic

Question 15

What is the difference between non-small cell lung cancer and small cell lung cancer?

Answer 15

Non-small cell lung cancer arises from the epithelial and glandular cells of the bronchial mucosa, while small cell lung cancer arises from neuroendocrine cells

Question 16

What is adenocarcinoma in situ?

Answer 16

Adenocarcinoma in situ, previously called bronchoalveolar cell carcinoma, accounts for 5% of lung cancers and arises from alveolar cells.

Question 17

What are the areas of local invasion in lung cancer?

Answer 17

The areas of local invasion in lung cancer include parenchyma (ipsilateral or contralateral sides), pleura, pericardium, ribs, muscle, nerves (recurrent laryngeal nerve, phrenic nerve, sympathetic chain, brachial plexus), and lymph nodes in thorax (hilar, mediastinal, subcarinal).

Question 18

Where can lung cancer spread to through the lymphatics?

Answer 18

Lung cancer can spread to lymph nodes outside the thorax, mainly supraclavicular and cervical lymph nodes.

Question 19

What are the sites where lung cancer can spread to through haematogenous spread?

Answer 19

Lung cancer can spread to the liver, adrenals, bones, brain, and skin through haematogenous spread.

Question 20

What are the symptoms of lung cancer?

Answer 20

The symptoms of lung cancer include persistent cough, breathlessness, chest pain, haemoptysis, monophonic wheeze, shoulder pain, hoarse voice, superior vena cava (SVC) obstruction, enlarged lymph nodes, and skin nodules.

Question 21

What are the systemic symptoms of lung cancer?

Answer 21

The systemic symptoms of lung cancer include weight loss (cachexia), lethargy, bone pain, neurological symptoms (such as headache, limb weakness, and peripheral neuropathy), spinal cord compression, and paraneoplastic symptoms caused by secretion of hormones or cytokines by SCLC.

Question 22

What are the signs of lung cancer?

Answer 22

The signs of lung cancer include cachexia, clubbing, hypertrophic pulmonary osteoarthropathy (HPOA) with adenocarcinoma, hoarse voice, Horner’s syndrome, cervical and supraclavicular lymphadenopathy, tracheal deviation, superior vena cava obstruction, and clinical signs of pleural effusion.

Question 23

What are some chest x-ray findings of concern in lung cancer?

Answer 23

Some chest x-ray findings of concern in lung cancer include a mass, cavitating lesion, unilateral pleural effusion, non-resolving consolidation, and solitary pulmonary nodule.

Question 24

What is the essential imaging technique for the initial staging of lung cancer?

Answer 24

CT of the thorax and abdomen with contrast is essential for the initial staging of lung cancer.

Question 25

What is a PET scan and how is it useful in lung cancer?

Answer 25

A PET scan uses FDG, which is taken up by rapidly metabolizing cells, including cancer cells. It releases positrons that are detected by a gamma camera. PET is good at detecting distant metastases except brain metastases. The sensitivity of PET for lung cancer is 80% and the specificity is 97%.

Question 26

What are some other imaging techniques used in lung cancer diagnosis and management?

Answer 26

Some other imaging techniques used in lung cancer diagnosis and management include a bone scan to assess bone metastases and pathological fractures, MRI thorax to assess structural changes prior to surgery, and a brain CT scan if brain metastases are suspected and prior to radical treatment.

Question 27

What are some blood tests that can be done for patients with lung cancer?

Answer 27

Some blood tests that can be done for patients with lung cancer include full blood count, urea & electrolytes, liver function tests, and calcium levels.

Question 28

What is the paraneoplastic syndrome and what are some examples of hormone secretion in lung cancer?

Answer 28

The paraneoplastic syndrome is a collection of symptoms caused by a substance produced by a tumor, which is not directly related to the primary tumor mass. Some examples of hormone secretion in lung cancer include anti-diuretic hormone (ADH) causing hyponatremia, parathyroid hormone (PTH)-related peptide causing hypercalcemia, and adrenocorticotrophic hormone (ACTH) causing raised cortisol (Cushing’s syndrome).

Question 29

Why are pulmonary function tests important for patients with suspected lung cancer?

Answer 29

Pulmonary function tests are important for patients with suspected lung cancer because most patients with lung cancer have COPD. FEV1, FVC, FEV1/FVC, and TLCO are required prior to obtaining a CT guided lung biopsy or prior to considering surgery or radiotherapy.

Question 30

What are some histological types of lung cancer and how do they differ in prognosis?

Answer 30

Some histological types of lung cancer include non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and malignant carcinoid. NSCLC has a better prognosis than SCLC. Molecular mutation testing improves treatment options (immunotherapy) and has improved survival in recent years.

Question 31

What is small cell lung cancer and what is its prognosis?

Answer 31

Small cell lung cancer (SCLC) arises from the neuroendocrine cells and has usually metastasized at presentation. It is very aggressive with a poor prognosis.

Question 32

What are the main factors to consider in the management of lung cancer?

Answer 32

Histology of lung cancer
Staging of cancer (TNM)
WHO performance status of patient
Lung function
Co-morbidities
Wishes of patient
Decision made in the Lung Cancer MDT (respiratory physician, radiologist, histopathologist, thoracic surgeon, medical oncologist, clinical oncologist, palliative care doctor, lung cancer clinical nurse specialist)
Radical therapy with curative intent
palliative therapy

Question 33

What are the treatment options for non-small cell lung cancer?

Answer 33

Surgery (lobectomy, pneumonectomy, wedge resection, or segmentectomy)
Radiotherapy
Chemotherapy
Immunotherapy
Palliative care

Question 34

What are the treatment options for small cell lung cancer?

Answer 34

Chemotherapy
Immunotherapy
Palliative radiotherapy
Palliative chemotherapy

Question 35

What is the aim of palliative care in lung cancer patients?

Answer 35

Relieve symptoms (pain, breathlessness, cough, nausea, excessive secretions)
Improve quality of life
Early identification, assessment and treatment of symptoms
The prevention and relief of physical suffering, psychological/emotional suffering, spiritual, and social suffering.

Question 36

What is the overall 1 year survival rate for lung cancer?

Answer 36

The overall 1 year survival rate for lung cancer is 30% for men and 35% for women.

Question 37

What are some ways to prevent lung cancer?

Answer 37

Smoking cessation
Reduce exposure to passive smoking exposure
Reduce exposure to radiation
Legislation in the workplace: ban asbestos, reduce exposure to coal dust
Good nutrition

Question 38

What are some ways to detect lung cancer early?

Answer 38

Recognition of symptoms of lung cancer
Education of patient re symptoms and early review by doctor
Education of healthcare professionals re early symptoms and signs
Early chest X-ray
Low dose CT Screening

Question 39

What is immunotherapy for lung cancer and what proteins does it target?

Answer 39

Immunotherapy for lung cancer is the use of drugs that stimulate the patient’s immune system to recognize and attack cancer cells. It targets proteins such as:

Epithelial Growth Factor Receptor (EGFR) mutation
Vascular Endothelial Growth Factor (VEGF)
Checkpoint inhibitors.