Lung Cancer (30)

Question 1

70-year-old male smoker, COPD with small cell lung cancer. Histology report saying carcinoid invading pleura and lymph nodes

What other lung cancers do you know?

Answer 1

Small cell and non-small cell

Question 2

70-year-old male smoker, COPD with small cell lung cancer. Histology report saying carcinoid invading pleura and lymph nodes

What are the signs of aggressiveness in the report?

Answer 2

• Invading pleura
• Lymph nodes involved

Question 3

Pathogenesis of clubbing?

Answer 3

• Higher plasma growth hormone levels in patients with lung carcinoma and clubbing than patients without clubbing
• Megakaryocyte or platelet clusters, lodged in the peripheral vasculature of the digits, release platelet-derived growth factor (PDGF) and lead to the increased vascularity, permeability, and connective tissue changes that are the hallmark of clubbing

Question 4

Pancoast paraneoplastic syndrome, what hormones?

Answer 4

ACTH causing Cushing syndrome

Question 5

Now the patient presents with metastasis, poorly differentiated, how to tell its epithelial origin?

Answer 5

Immunohistochemistry

Question 6

FISH technique?

Answer 6

• Fluorescence in situ hybridization (FISH) is a kind of cytogenetic technique which uses fluorescent probes binding parts of the chromosome to show a high degree of sequence complementarity
• Fluorescence microscopy can be used to find out where the fluorescent probe bound to the chromosome

Question 7

If the tumour was epidermal growth factor positive, what would be the chemotherapeutic agent?

Answer 7

Tyrosine kinase inhibitor (imatinib)

Question 8

6 month later he came with back pain. Why?

Answer 8

Bone metastasis

Question 8

What other tumour metastasis to the bone?

Answer 8

BLT with mayo, mustard and kosher pickle

Breast
Lung
Thyroid
Multiple Myeolma
Kidney (renal cell)
Prostate

Question 9

Define adenocarcinoma

Answer 9

Cancer that forms in mucus-secreting glands throughout the body

Question 9

Define emphysema

Answer 9

• A progressive Lung condition that causes shortness of breath
• Alveoli are damaged, weakening and rupturing over time

Wiki:
- Emphysema is a lower respiratory tract disease,[7] characterised by enlarged air-filled spaces in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alveoli, which replace the spongy lung tissue.

Question 10

Paraneoplastic syndromes? Give examples.

Answer 10

• Symptom complexes that occur in patients with cancer and that cannot be readily explained by local or distant spread of the tumor or by the elaboration of hormones indigenous to the tissue of origin of the tumor are referred to as paraneoplastic syndromes
• Examples:
  
  • Hypercalcemia
  • Cushing syndrome
  • Nonbacterial thrombotic endocarditis
• Neoplasms most often associated with these and other syndromes are lung and breast cancers and hematologic malignancies
• Paraneoplastic syndromes also may manifest as hypercoagulability, leading to venous thrombosis and nonbacterial thrombotic endocarditis
• Other manifestations are clubbing of the fingers and hypertrophic osteoarthropathy in patients with lung cancer

Question 10

Examples of Paraneoplastic syndromes

Answer 10