Lung Cancer

Question 1

Smoking is responsible for what percentage of primary lung cancers?

Answer 1

90% (heavy smokers are 40 times more likely to get it than a non smoker)

Question 2

What other risk factors?

Answer 2

Exposure to radon gas, asbestos, industrial/chemical occupation, passive smoking,air pollution I.e. Living in urban areas

Question 3

Where can a bronchial carcinoma originate from?

Answer 3

Bronchial epithelium or mucus glands

Question 4

What percentage originate from squamous cells?

Answer 4

35% most common

Question 5

How likely is it to be an Adenocarcinoma?

Answer 5

30 second most common

Question 6

Small cell bronchial carcinoma make up what percentage of bronchial carcinoma?

Answer 6

20%

Question 7

Large cell bronchial carcinoma make up what percentage of bronchial carcinoma?

Answer 7

15% least common form of bronchial carcinoma

Question 8

Is It better for it to occur in the large or small bronchi?

Answer 8

Large as it causes symptoms earlier and therefore is noticed and treated earlier

Question 9

Which type of bronchial carcinoma undergo cavitation and look like a look like a lung abscess on a CXR?

Answer 9

Squamous cell carcinoma

Question 10

What other areas may become involved?

Answer 10

The chest wall, lymphatics, pleura and intercostal nerves (this causes pain)

Question 11

Where do bronchial carcinoma metastases occur?

Answer 11

Liver, blood, bone, adrenals and skin

Question 12

Which cancer exhibits the most likelihood to form metastases?

Answer 12

Small cell bronchial carcinoma

Question 13

Name 4 clinical signs of lung cancer?

Answer 13

Clubbing, anaemia, cachexia (wasting), superclavicular or axillary lymph nodes, HPOA causing wrist pain, bronchus obstruction, pleural effusion

Question 14

Clinical features of metastasis? Name 5

Answer 14

Bone pain/tenderness, hepatomegaly, jaundice, confusion, fits, seizures, proximal myopathy, hyper calcaemia, pathogical fracture,

Question 15

Complications include? Name 5

Answer 15

Local: recurrent laryngeal+phrenic nerve palsy, SVC obstruction, rib erosion, pericarditis, horner’s syndrome, AF
Metastatic: addisons, anaemia, hypercalcaemia etc the signs are the complications etc

Question 16

Radiological findings that may present on CXR include?

Answer 16

Unilateral hilar enlargement, peripheral pulmonary opacity, lung or lobe collapse, pleural effusion, rib destruction, broadening of mediastinum

Question 17

What investigation would you do?

Answer 17

Cytology, CXR, fine needle aspiration and biopsy, CT bronchoscopy, bloods and lung function tests and LFTs

Question 18

Contraindications to surgical resection include?

Answer 18

Distant metastasis, invasion of mediastinum, malignant pleural effusion, contra lateral mediastinal nodes, FEV

Question 19

What is the optimal treatment?

Answer 19

Surgical resection

Question 20

What would be an alternative for those who can’t have surgery but still have a non metastatic T1/2 tumour?

Answer 20

Curative radiotherapy

Question 21

What is the treatment for more advanced disease?

Answer 21

Radiotherapy and chemotherapy

Question 22

Small cell cancers are often what on presentation and what problems does this raise?

Answer 22

Often disseminated and cannot be operated on, while they may respond to chemo, they usually relapse

Question 23

What is done for palliation?

Answer 23

Stunting to open up airway, pleural drainage, analgesia, steroids, antiemetics, laser ablation

Question 24

Name the common chemotherapy agents used?

Answer 24

IV cyclophosphamide, doxorubicin, vincristine, cisplatin

Question 25

Prognosis

Answer 25

Very poor only 5% can be cured, 70% die in the first year and only 6-8% survive 5 years post diagnosis

Question 26

Where do many secondary tumours in the lung arise from?

Answer 26

Primaries in the breast, kidney, uterus, ovaries and thyroid