Lung Cancer

Question 1

What complications can arise from small cell lung cancer (SCLC)?

Answer 1

Complications from small cell lung cancer (SCLC) include: - Disease spread or recurrence - Paraneoplastic syndromes (e.g., ACTH secretion, SIADH) - Lambert-Eaton syndrome - Cerebellar degeneration - Other syndromes like hypertrophic pulmonary osteoarthropathy and Trousseau syndrome in non-small cell lung cancer.

Question 2

What types of lung cancer are most commonly associated with smoking?

Answer 2

The types of lung cancer most commonly associated with smoking are: - Small cell lung cancer (SCLC) - Squamous cell carcinoma - Adenocarcinoma - Large cell lung cancer These cancers are linked to the carcinogens found in cigarette smoke.

Question 3

What tissue sampling procedures are available for diagnosing lung cancer?

Answer 3

Tissue sampling procedures for diagnosing lung cancer include: - Bronchoscopy: Quick, samples endobronchial lesions - EBUS (Endobronchial Ultrasound): Samples endobronchial lesions and lymph nodes, takes longer, higher risk - CT Guided Biopsy: Samples peripheral lesions, low failure rate, but has pneumothorax risk

Question 4

What are some paraneoplastic syndromes associated with lung cancer?

Answer 4

Paraneoplastic syndromes associated with lung cancer include: - Ectopic ACTH secretion (Cushing’s syndrome) - Lambert-Eaton myasthenic syndrome - Hypercalcemia (from squamous cell carcinoma) - Trousseau syndrome (migratory thrombophlebitis) - Horner’s syndrome (Pancoast tumor)

Question 5

What is the importance of family history in assessing lung cancer risk?

Answer 5

Family history is important in assessing lung cancer risk because: - Identifies inherited genetic factors (8% of cases) - Helps evaluate risk alongside environmental factors (e.g., smoking, pollution) - Guides screening and prevention strategies based on familial patterns

Question 6

What are the differential diagnoses that should be considered when evaluating a lung mass?

Answer 6

Differential diagnoses for a lung mass include: - Lung cancer (primary or secondary) - Infection (bacterial, viral, fungal) - Interstitial lung disease (e.g., IPF, TB) - Pulmonary embolism - Pneumonia (non-infectious types) - Vascular issues (e.g., infarction)

Question 7

What is the role of bronchoscopy in the diagnosis of lung cancer?

Answer 7

Bronchoscopy plays a key role in diagnosing lung cancer by: - Allowing direct visualization of airways - Enabling tissue sampling from visible endobronchial lesions - Providing quick results (15-20 minutes) - Assisting in staging by sampling lymph nodes, though not all lesions are accessible.

Question 8

What preventive measures can be taken to reduce the risk of lung cancer?

Answer 8

Preventive measures to reduce lung cancer risk include: - Quit smoking - Avoid second-hand smoke - Implement smoking bans in workplaces - Improve environmental policies to reduce pollution - Regular health check-ups for early detection

Question 9

What distinguishes Non-Small Cell Lung Carcinoma from Small Cell Lung Carcinoma in terms of management and prognosis?

Answer 9

Non-Small Cell Lung Carcinoma (NSCLC): - Management: surgery, chemotherapy, radiotherapy based on stage - Prognosis: varies by stage, generally better than SCLC Small Cell Lung Carcinoma (SCLC): - Management: primarily chemotherapy, radiation for extensive disease - Prognosis: aggressive, often metastatic at diagnosis, shorter survival (6-12 months)

Question 10

What is the significance of ECOG status in lung cancer management?

Answer 10

ECOG status is significant in lung cancer management as it assesses a patient’s performance level, guiding treatment decisions. It helps determine: - Suitability for surgery (ECOG 0-1) - Chemotherapy eligibility (ECOG 0-2) - Overall prognosis and palliative care needs.

Question 11

What are the advantages and disadvantages of bronchoscopy as a biopsy method?

Answer 11

Advantages of Bronchoscopy: - Quick procedure (15-20 min) - Can sample visible endobronchial lesions Disadvantages: - Not all lesions accessible (e.g., peripheral) - Cannot sample lymph nodes (LNs)

Question 12

What is the median survival time for extensive stage SCLC?

Answer 12

The median survival time for extensive stage small cell lung cancer (SCLC) is typically between 6 to 12 months.

Question 13

How does age influence the risk of developing lung cancer?

Answer 13

Age increases lung cancer risk, especially after 65. Older individuals have longer exposure to risk factors like smoking and pollution, leading to more mutations. The immune system also weakens with age, making it harder to fight cancer.

Question 14

How does smoking contribute to the development of lung cancer?

Answer 14

Smoking contributes to lung cancer by introducing 73 carcinogens into the body, leading to oncogenic mutations. It is the primary cause, responsible for 85% of cases. Passive smoking and pollution also increase risk. Small cell lung cancer is almost exclusively linked to smoking.

Question 15

What risk factors are associated with lung cancer?

Answer 15

Risk factors for lung cancer include: - Smoking (active and passive) - Age over 65 - Occupational exposure (radon, asbestos) - Genetic factors (8% hereditary) - Air pollution (PM 2.5, radon gas)

Question 16

What are the characteristics of a suspicious lung mass on imaging studies?

Answer 16

Characteristics of a suspicious lung mass on imaging studies include: - Size: larger than 10 mm - Solid component - Irregular or spiculated borders - Enlarged mediastinal lymph nodes - Comparison with previous imaging for changes

Question 17

What occupational exposures increase the risk of lung cancer?

Answer 17

Occupational exposures that increase lung cancer risk include: - Radon gas - Asbestos - Hard metal dust - Other carcinogenic chemicals (e.g., benzene, formaldehyde)

Question 18

What are common pitfalls when interpreting PET scans in lung cancer patients?

Answer 18

Common pitfalls in interpreting PET scans for lung cancer include: - Non-cancerous conditions can also appear “hot” - High FDG uptake may result from inflammation or infection - Misinterpretation of metabolic activity due to other factors like high calcium levels or paraneoplastic syndromes

Question 19

What role do inhaled carcinogens play in the pathogenesis of lung cancer?

Answer 19

Inhaled carcinogens, primarily from smoking, cause oncogenic mutations in lung cells, leading to lung cancer. They damage DNA, promote uncontrolled cell growth, and contribute to tumor formation. Key carcinogens include nicotine, tar, and various chemicals in cigarette smoke.

Question 20

How is lung cancer diagnosed and what investigations are appropriate for its diagnosis?

Answer 20

Lung cancer is diagnosed through: - Chest X-ray (CXR): Initial imaging to identify abnormalities - CT scan: Detailed imaging for suspicious lesions - Tissue sampling: Biopsy via bronchoscopy, EBUS, or CT-guided methods to confirm diagnosis These investigations help assess the cancer’s presence and stage.

Question 21

How aggressive is small cell lung cancer compared to non-small cell lung cancer (NSCLC)?

Answer 21

Small cell lung cancer (SCLC) is more aggressive than non-small cell lung cancer (NSCLC). SCLC often metastasizes quickly, with 95% of patients having metastasis at diagnosis, while NSCLC’s aggressiveness varies by stage. SCLC has a median survival of 6-12 months in extensive stages, compared to NSCLC’s longer survival based on stage.

Question 22

What factors influence treatment options for lung cancer?

Answer 22

Factors influencing lung cancer treatment options include: - Cancer subtype - Stage of the disease - Patient’s overall health (ECOG performance status) - Presence of nodal disease - Response to previous treatments - Patient preferences and quality of life considerations

Question 23

What types of surgeries are available for lung cancer, and under what conditions are they performed?

Answer 23

Types of lung cancer surgeries include: - Lobectomy: removal of one lobe - Wedge resection: removal of a small section - Pneumonectomy: removal of an entire lung Conditions for surgery: no nodal disease, preserved lung function, and ECOG performance status 0-1.

Question 24

What resources are available for further reading on lung cancer management?

Answer 24

For further reading on lung cancer management, consider these resources: - RCSI Handbook of Clinical Medicine - NICE guidelines for pneumonia management - ECOG status assessment (bit.ly/3dugmxv) - Palliative care studies (bit.ly/3dWYw6x) These provide insights on treatment options, staging, and patient care.

Question 25

What are the key clinical features of lung cancer?

Answer 25

Key clinical features of lung cancer include: - Persistent cough - Weight loss - Dyspnea (shortness of breath) - Chest pain - Hemoptysis (coughing blood) - Bone pain - Symptoms of paraneoplastic syndromes These symptoms may vary based on cancer type and stage.

Question 26

What does PET-CT imaging look for in relation to lung cancer?

Answer 26

PET-CT imaging for lung cancer looks for: - SUV MAX: a marker of cell turnover - High FDG uptake: indicates high metabolic activity, appearing ‘hot’ on scans - Helps differentiate cancer from other conditions that may also light up on PET

Question 27

What are the risks associated with CT-guided biopsy?

Answer 27

Risks associated with CT-guided biopsy include: - 20% chance of pneumothorax - Potential bleeding - Infection at the biopsy site - Damage to surrounding tissues - Need for pre-procedure pulmonary function tests (PFTs) if lung function is low

Question 28

What staging system is used for non-small-cell lung cancer (NSCLC)?

Answer 28

The staging system used for non-small-cell lung cancer (NSCLC) is the TNM system, which assesses: - T: Tumor size and local invasion - N: Lymph node involvement - M: Presence of metastasis

Question 29

What palliative care options are available for lung cancer patients?

Answer 29

Palliative care options for lung cancer patients include: - Symptom management (pain, breathlessness) - Psychological support - Nutritional guidance - Coordination of care - Early palliative care improves quality of life and may extend survival.

Question 30

How does hypercalcemia relate to squamous cell lung cancer?

Answer 30

Hypercalcemia in squamous cell lung cancer is often due to parathyroid hormone-related peptide (PTHrP) or bone metastases. It can indicate advanced disease and is associated with increased calcium levels, affecting patient management and prognosis.

Question 31

What imaging techniques are used in the investigation of suspected lung cancer?

Answer 31

Imaging techniques for suspected lung cancer include: - Chest X-ray (CXR): Initial screening and comparison with previous images - CT scan: Detailed imaging for worrisome features - Bronchoscopy: Direct visualization and biopsy - EBUS: Endobronchial ultrasound for lymph node assessment - CT-guided biopsy: For lesions not accessible by other means

Question 32

What are the common symptoms experienced by patients with lung cancer?

Answer 32

Common symptoms of lung cancer include: - Cough - Weight loss - Dyspnea (shortness of breath) - Chest pain - Hemoptysis (coughing up blood) - Bone pain - Seizures - Symptoms of paraneoplastic disease

Question 33

How can passive smoking affect an individual’s risk for lung cancer?

Answer 33

Passive smoking increases lung cancer risk by exposing individuals to harmful carcinogens found in cigarette smoke. It contributes to DNA damage and inflammation in lung tissues, similar to direct smoking, raising the likelihood of developing lung cancer over time.

Question 34

What laboratory tests are commonly used to support the diagnosis of lung cancer?

Answer 34

Common laboratory tests for lung cancer diagnosis include: - Chest X-ray (CXR) - CT scan of the thorax - Bronchoscopy or EBUS for tissue sampling - PET-CT for metabolic activity - Blood tests: FBC, CRP, calcium, U&E, and specific antibodies for paraneoplastic syndromes.

Question 35

What is the significance of tumor staging in lung cancer?

Answer 35

Tumor staging in lung cancer is crucial because it: - Determines the extent of disease spread - Guides treatment options (surgery, chemotherapy, radiotherapy) - Helps predict prognosis and survival rates - Facilitates communication among healthcare providers during management discussions

Question 36

How does EBUS differ from bronchoscopy in terms of sampling capabilities?

Answer 36

EBUS (Endobronchial Ultrasound) differs from bronchoscopy in that it can sample lymph nodes for staging, while bronchoscopy only samples visible endobronchial lesions. EBUS is more comprehensive but takes longer and has higher risks. Bronchoscopy is quicker but limited in sampling capabilities.