Lung Cancer

Question 1

Does lung cancer generally have a good prognosis? Why or why not?

Answer 1

no, it generally has a poor prognosis because:

• it is aggressive, invasive and metastatic
• there is no screening, so it is usually detected in later stages

Question 2

What are the preferred sites of metastasis for primary lung cancer?

Answer 2

• brain
• bone
• liver

Question 3

What are the types of primary lung cancer? (5)

How are these types grouped?

Answer 3

A - non-small cell lung cancer

1) adenocarcinomas (~30%)
2) squamous cell carcinomas (~30%)
3) large cell carcinomas (~12%)

B - small cell lung cancer
4) small cell carcinoma (~22%)

also:
5) mixed group but this is not very prevalent

Question 4

What causes lung cancer?

Answer 4

gene mutation

risks:

• smoking (more than 80%)
• toxins (ex. aebestos)
• genetic predisposition

Question 5

What is the pathology of squamous cell carcinoma?

Answer 5

• arises in central bronchi (hilar region)
• spreads locally to hilar nodes
• more common in men
• can affect the heart, especially if tumour is on the left side (can put pressure on the heart and cause tamponade)

Question 6

What is the pathology of adenocarcinoma?

Answer 6

• peripheral origin (alveoli or bronchioles)

- common in women and non-smokers

Question 7

What is the pathology of large cell carcinoma?

Answer 7

• peripheral location of origin
• malignant cell is large, immature and undifferentiated
• metastasizes early, therefore there is poorer prognosis

Question 8

What is the pathology of small cell carcinoma?

Answer 8

• 99% in smokers
• aggressive, invasive, early metastasis (especially to brain)
• small, oval cells (also called oat cell carcinoma)
• usually metastasized by diagnosis
• not resectable (not a single, encapsulated mass)
• radiosensitive, can treat with radiation
• paraneoplastic syndromes (ex. SIADH, Cushing’s where the tumour secretes a hormone-like chemical)

Question 9

What are the manifestations of lung cancer?

Answer 9

vary by type, site, extent, metastasis and whether there are paraneoplastic syndromes

• if central, can impair ventilation (tumour can constrict bronchi), coughing, wheezing, dyspnea
• for all: hemoptysis due to impact on blood vessels
• pain from inflammation and because the tumours are space-occupying
• may have cardiac manifestations

Question 10

How is lung cancer diagnosed?

Answer 10

• history and presentation
• exclude infection, COPD, bronchitis and asthma
• chest x-ray (may be too small to see)
• US, CT, MRI
• bronchoscopy and needle biopsy
• cytology (sputum or bronchial wash)

Question 11

How is lung cancer treated?

Answer 11

NSCLC - surgery, radiation, chemo (in any combo)

SCLC - chemo and radiation