Lung Cancer

Question 1

What is primary and secondary lung cancer

Answer 1

Primary - lungs (bronchi/alveoli/bronchioles/lung tissue)
secondary - spread to liver and breast

Question 2

Cancer epidemiology

Answer 2

3rd most common cancer in the UK
Most common cause of death in the UK

Question 3

What are the risk factors for Lung Cancer

Answer 3

-age (peak 50-60)
-family history
-occupational exposure
-ionising radiation (0.5% radon)
-air pollution
-smoking (86%)

Question 4

How does smoking increase the risk of lung cancer

Answer 4

chemicals in tobacco have the potential to cause DNA damage in lung cells
Failure to repair DNA damage can lead to the formation of cancer
inhaling tobacco smoke can cause alveoli damage

Question 5

2 types of lung cancer

Answer 5

small cell lung cancer (20%)
non small cell lung cancer (80%) - adenocarcinoma (40%), squamous cell carcinoma (20%), large cell carcinoma (10%) other types (10%)

Question 6

features of small cell carcinoma

Answer 6

Oat cell cancer
Smoking linked
Most aggressive - high recurrence rate
Granules release ACTH/ADH/PTH

Question 7

Features of squamous cell carcinoma

Answer 7

keratinised
mitotic figures

Question 8

Adenocarcinoma

Answer 8

begins in the cells that line the alveoli e.g. make mucus
most comon type of lung cancer in non-smokers

Question 9

squamous cell carcinoma

Answer 9

epidermoid carcinoma
start in squamous cells (thin/fat) which line airways
linked to smoking

Question 10

large cell carcinoma

Answer 10

spreads quickest and found in lungs

Question 11

What is a pancoast tumour

Answer 11

tumour in the apical region of the lung (non small cell carcinomas)
compresses:
-cervical sympathetic nerves (vagus)
-brachial plexus
-superior vena cava
-laryngeal nerves
-subclavian arteries and veins

Question 12

Where is asymptomatic lung cancer detected

Answer 12

only in x-rays

Question 13

non specific symptoms of lung cancer

Answer 13

weight loss
fever
weakness
lethargy

Question 14

symptoms of metastatic disease

Answer 14

fracture (bone)
jaundice
CNS symptoms (blue)

Question 15

pulmonary symptoms of cancer

Answer 15

-coughing (not improved by medication)
-shortness of breath
-chest pain
-hemoptysis (blood / in sputum)

Question 16

What are the extrapulmonary symptoms of lung cancer

Answer 16

-recurrent laryngeal nerve palsy (hoarse voice)
-phrenic nerve palsy (diaphragm weakness/SOB)
-superior vena cava obstruction - facial swelling (Pemberton’s sign where raising hands over head causes congestion and cyanosis)

Question 17

What is horner’s syndrome

Answer 17

partial ptosis (lid droop)
anhidrosis (eye dryness)
miosis (pupil constriction)
via pancoast tumour pressing on sympathetic ganglion

Question 18

What is paraneoplastic syndrome

Answer 18

cancer cells become neuroendocrine cells
-syndrome of inappropriate ADH - hyponatraemia
-cushing’s syndrome (high cortisol)
-hypercalcaemia (ectopic parathyroid hormone secreted by a squamous cell carcinoma)

Question 19

What does a chest x ray show

Answer 19

solitary pulmonary nodule/mass
80% of solitary pulmonary nodules (<4cm diameter) in over 50s are cancer
tumour
thickened lung

Question 20

How is lung cancer diagnosed

Answer 20

chest x-ray
CT scan
biopsy - determines type of cancer and grade

Question 21

How is a biopsy obtained

Answer 21

fibreoptic bronchoscopy (via mouth through trachea/bronchus/bronchioles)
-transthoracic fine needle aspiration (if tumour in lung periphery)

Question 22

What are the stages of small cell lung cancer

Answer 22

limited stage SCLC - present in one lung (may spread to surrounding lymph nodes) chemo & radiotherapy
extensive stage SCLC - cancer spread to both lungs and lymph nodes, not curable

Question 23

stages of non small cell lung cancer

Answer 23

I-IV

Question 24

How can cancer spread

Answer 24

bloodstream and lymph system

Question 25

Common sites for lung cancer metastasis

Answer 25

brain
bones
liver
adrenal glands

Question 26

lung cancer prevention

Answer 26

-quit smoking
-avoid second hand smoke
-eating healthy
-getting screening

Question 27

Screening types

Answer 27

CT scan - 20% risk in mortality with low dose CT vs chest radiography
Blood - early CDT lung (blood test only in USA)

Question 28

Prognosis

Answer 28

most metastasised to distant sites (70%)
25% have regional lymph node involvement
most inoperable (75% NSCLC)
1 year survival - (30%)
5 year survival (9%)
5yr survival for localised lung lesion 45%