Lung Cancer

Question 1

what is it called when biologically active molecules are released from tumour cells and mimic the effects of naturally occuring hormones?

Answer 1

paraneoplastic syndromes

Question 2

compare incidence and prevalence of lung cancer?

Answer 2

incidence is high

prevalence is low (because patients dont live for long)

Question 3

as the tumour enlarges what happens to the lung?

Answer 3

loses volume and gets smaller

in CXR, smallest lung is likely to be the diseased one

Question 4

is stridor an inspiratroy or expiratroy sound?

Answer 4

inspiratory sounds

Question 5

what 6 structures can a lung tumour locally invade into?

Answer 5

recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural caivty
superior vena cava

Question 6

why might a patient with a lung cancer get a hoarse voice?

Answer 6

tumour invaded into reccurent laryngeeal nerve

Question 7

what can tumour invasion into the pericardium cause?

Answer 7

breathlessness
AF
pericardial effusion

Question 8

what can tumour invasion into the oesphagus cause?

Answer 8

dysphagia

Question 9

what is a pancoasts tumour?

Answer 9

a tumour of the lung apex

Question 10

why can a patient with a lung cancer present with weakness in upper limbs?

Answer 10

invasion of brachial plexus

Question 11

what often happens when a primary tumour invades the pleural space?

Answer 11

generates a large volume of pleural fluid

can enhance SOB

Question 12

when a tumour has invaded bone (causing bone erosion) when will the patient complain the pain is worse?

Answer 12

pain worse at night

Question 13

where are common sites of metastases from a primary lung cancer?

Answer 13

liver
brain
bone
adrenals
skin
lung

Question 14

what 4 symptoms can be caused by brain metastases?

Answer 14

weakness
visual distrubances
headaches
fits

Question 15

why can a headache occur in brain mets?

Answer 15

due to raised intracranial pressure

usually worse in the morning

Question 16

what hormone does a tumour mimic to cause hypercalcaemia?

Answer 16

parathyroid hormone

Question 17

what can hypercalcaemia cause?

Answer 17

headaches
confusion
thirst
constipation

Question 18

what hormone does a tumour mimic to cause hyponatraemia (abnormally low Na levels)?

Answer 18

ADH

Question 19

what is the name of a syndrome which mimics myaesthenia gravis? (and is a paraneoplastic syndrome caused by an underlying -usually small cell- lung carcinoma)

Answer 19

Eaton Lambert syndromeq

Question 20

what can be some important symptoms of lung cancer? (name 7)

Answer 20

haemoptysis
weight loss
recurrent pneumonia
stridor
hoarse voice
breathlessness
cough

Question 21

why must any patient with new finger clubbing have a CXR?

Answer 21

because lung cancer is the commonest cause

Question 22

what paraneoplastic condition affects the bones? (not due to metastatic disease)

Answer 22

hypertrophic pulmonary osteoarthropathy

Question 23

why is there pain and tenderness of the long bones in hypertrophic pulmonary osteoarthropathy

Answer 23

due to elevation of the periosteum away from the bbones surface

Question 24

what is thrombophlebitis?

Answer 24

a blood clot in the vein

Question 25

why is thrombophlebitis a paraneoplastic syndrome?

Answer 25

because of the increased coaguability of blood in cancer patients

Question 26

what diagnostic investigation should be carried out if there is a possibility of lung cancer?

Answer 26

``` CXR + CT (regardless of CXR results) +/- PET scan + bronchoscopy (if patient has a central lesion and is fit enough, if patient isn't fit enough- sputum cytology) +/- percutaneous FNA biopsy ```

Question 27

what does a PET scan allow you o see?

Answer 27

tissues with high metabolic activity

Question 28

what are the 2 broad types of lung neoplasms?

Answer 28

benign (rare) | malignant (very common)

Question 29

what are 6 risk factors for lung cancer?

Answer 29

``` smoking asbestor chromates radiation atmospheric pollution genetics ```

Question 30

what local effect of a lung cancer causes pneumonia?

Answer 30

obstruction of airways

Question 31

what local effect of a lung cancer cause localised pain?

Answer 31

invasion of the chest wall

Question 32

what local effect of a lung cancer causes haemoptysis?

Answer 32

ulceration

Question 33

what is the name of hormone production from a site it shouldnt be? (ie paraneoplastic syndrome)

Answer 33

ectopic hormone production

Question 34

what hormones does a squamous carcinoma release?

Answer 34

PTH | parathyroid hormone

Question 35

what does release of PTH from a squamous carcinoma cause?

Answer 35

hypercalcaemia

Question 36

what hormones does a small cell carcinoma release?

Answer 36

ACTH (adrenocorticotrophic hormone) ADH (anti-diuretic hormone)

Question 37

what does release of ACTH from a small cell carcinoma cause?

Answer 37

cushings syndrome

Question 38

what does releases of ADH from a small cell cardinoma cause?

Answer 38

hyponatremia

Question 39

how does immunohistochemistry help to subtype lung cancers on small biopsies?

Answer 39

by identifying specific antigens

Question 40

what factor is expressed in small cell carcinomas and adenocarcinomas?

Answer 40

TTF-1 | thyroid transcription factor

Question 41

what factor is expressed in squamous cell carcinoma?

Answer 41

P63

Question 42

what is the worst subtype of lung cancer in terms of prognosis?

Answer 42

small cell carcinoma

Question 43

what is the treatment of choice in non-small cell cancers?

Answer 43

surgery

Question 44

what drug is a tyrosine kinase inhibitor which shows some activity in non-small cell lung cancer patients?

Answer 44

gefitnib

Question 45

why is getfitnib effective in non-small cell lung cancer patients?

Answer 45

because non-small cell lung cancers usually have mutated epidermal growth factor receptor (EGFR) and getfitnib only works in tumours with mutated EGFR

Question 46

what is the pathogenesis of a squamous carcinoma?

Answer 46

squamous metaplasia dysplasia carcinoma in situ invasive malignancy

Question 47

what are carcinoids?

Answer 47

neuroendocrine neoplasms of low grade malignancy

Question 48

what are the 2 types of pleural neoplasia?

Answer 48

benign (rare) | malignant mesothelioma

Question 49

what happens if a tumout suppresses the nerves to the faces?

Answer 49

horners syndrome

Question 50

where are small cell lung cancers more likely to be found?

Answer 50

centrally

Question 51

what are the 4 main features of small cell lung cancer which effect the method of treatment?

Answer 51

rapidly progressive early metastases rarely suitable for surgery good initial response to chemotherapy

Question 52

why are small cell carcinomas more susceptible to cytotoxic chemotherapy compared to other types of lung cancer?

Answer 52

because of the rapid growth | chemotherapy targets dividing cells

Question 53

what is the treatment of choice in small cell lung cancer?

Answer 53

chemotherapy | often backed up with radiotherapy

Question 54

what are the 4 major management options for lung cancer?

Answer 54

surgery radiotherapy chemotherapy palliative care

Question 55

what lung cancer patients do well with surgery?

Answer 55

localised disease | very little co-morbidity

Question 56

what is the role of bronchoscopy within staging for cancer resection?

Answer 56

too look for: vocal cord palsy proximity to carina cell type

Question 57

what is the role of mediastinoscopy within staging for cancer resection?

Answer 57

to look for lymph nodes with mets

Question 58

what is the role of a CT scan of the brain within staging for cancer resection?

Answer 58

to look for brain mets

Question 59

what is the role of a CT scan of the tohorax within staging for cancer resection?

Answer 59

tumour size lymph nodes affected mets local invasion

Question 60

what is the role of PET scan within staging for cancer resection?

Answer 60

metastases

Question 61

how distal to the carina must a lung cancer tumour be in order to be operable?

Answer 61

2cm

Question 62

if tumour is in a main bronchus, why do you need 2cm of disease free bronchus distal to the carina?

Answer 62

because you need at least 2cm of disease free bronchis to close the hole that will be left from ressection

Question 63

what is the name for a whole lung resecection?

Answer 63

pneumonectomy

Question 64

for chemotherapy, how often do you need IV infusions?

Answer 64

every 3/4 weeks

Question 65

what are the 5 major side effects from chemotherapy?

Answer 65

``` nausea and vomiting tiredness bone marrow suppression hair loss pulmonary fibrosis ```

Question 66

what is the result of bone marrow suppression? (which can be secondary to chemotherapy)

Answer 66

opportunistic infection | anaemia

Question 67

when is radiotherapy (x-rays usually) used as a curative method for cancer?

Answer 67

if target is less than 5 cm in diameter

Question 68

what are the 3 major cons about radiotherapy?

Answer 68

maximum cumulative dose collateral damage only goes where you point the beam (not good for subclinical mets)

Question 69

where is the most common collateral damage from radiotherapy on a lung tumour?

Answer 69

spinal cord oesophagus adjacent lung tissue

Question 70

what 4 type of endobronchial therapies are good palliative techniques?

Answer 70

stent insertion for stridor photodynamic therapy other laser therapy radioactive pellets

Question 71

what is treatment of lung cancer determined by?

Answer 71

patients wishes type of cancer staging of cancer co-morbidity