Lung Cancer

Question 1

What are the 3 main causes of lung cancer?

Answer 1

Tobacco
Asbestos
Environmental radon (from granite usually)

Question 2

What are less common example of substances from occupational exposure that can cause lung cancer? (2)

Answer 2

Chromates
Hydrocarbons
Nickel

Question 3

What are the 2 main types of carcinogenesis in the lung?

Answer 3

Adenocarcinoma

Squamous cell carcinoma

Question 4

What area does adenocarcinoma affect and what effect does it have on that area?

Answer 4

Lung periphery

Transforms bronchioloalveolar epithelial stem cells

Question 5

What area does squamous cell carcinoma affect and what effect does it have on that area?

Answer 5

Central lung airways

Transforms bronchial epithelial stem cells

Question 6

What is the carcinoma sequence of peripheral lung adenocarcinogenesis? (3)

Answer 6

1: Atypical adenomatous hyperlasia
2: Adenocarcinoma in situ
3: Invasive adenocarcinoma

Question 7

What are the 2 main key driver mutations in adenocarcinogenesis?

Answer 7

KRAS (smoking induced)

EGFR (not smoking related)

Question 8

What are the 4 main carcinomas of the lung in order of commonness?

Answer 8

Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma
Large cell carcinoma

Question 9

Are metastases to the lung common?

Answer 9

Yes

Question 10

How common are tumours of the bronchial glands and give an example of one?

Answer 10

Very rare

Adenoid cystic carcinoma

Question 11

What type of lung carcinoma is most likely to cavity?

Answer 11

Squamous

Question 12

What are 5 examples of the local effects of lung cancer in terms of bronchial obstruction?

Answer 12

Collapse
Infection
Abscess
Bronchiectasis
Endogenous lipoid pneumonia

Question 13

What are 2 examples of the local effects of lung cancer has pleurally?

Answer 13

Inflammation

Malignancy

Question 14

What are the 3 indicators of horner’s syndrome?

Answer 14

Dry on one side of the face
Droopy eyes
Different sizes of pupil

Question 15

What type of lung cancer does could a hoarse bovine cough indicate?

Answer 15

Left recurrent laryngeal lung cancer

Question 16

What 5 organs are most likely to be the sites of distant metastases of lung cancer?

Answer 16

Liver
Bone
Brain
Skin
Adrenals

Question 17

What does paraneoplastic effects of lung cancer mean?

Answer 17

A consequence of cancer not due to the local presence of cancer cells

Question 18

Give an example of a non-metastatic paraneoplastic effect of lung cancer for each of the following:

1. Skeletal
2. Endocrine
3. Neurological
4. Cutaneous
5. Haematological
6. Cardiovascular
7. Renal

Answer 18

1. Clubbing
2. Carcinoid syndrome
3. Polyneuropathy
4. Dermatomyositis
5. Eosiniphilia
6. Thrombophlebitis migrans
7. Nephrotic syndrome

Question 19

What are 3 non-imaging investigations that might be done when identifying lung cancer?

Answer 19

Bronchoscopy
Trans-thoracic fine needle aspiration
Trans-thoracic core biopsy

Question 20

What is a pulmonary mass?

Answer 20

An opacity in lung that is over 3cm with no mediastinal adenopathy (lymph enlargement) or atelectasis (collapse or incomplete inflation of lung)

Question 21

What is a pulmonary nodule?

Answer 21

An opacity in lung that is under 3cm with no mediastinal adenopathy (lymph enlargement) or atelectasis (collapse or incomplete inflation of lung)

Question 22

What is adenopathy?

Answer 22

Enlargement of lymph nodes

Question 23

what is atelectasis?

Answer 23

Partial collapse or incomplete inflation of the lung

Question 24

What does the T stand for in TNM staging of tumours?

Answer 24

Size and position of the tumour

Question 25

What does the N stand for in TNM staging of tumours?

Answer 25

Whether cancer cells have spread into the lymph nodes

Question 26

What does the M stand for in TNM staging of tumours?

Answer 26

Where the tumour has metastasised

Question 27

What is the best investigation for identifying the TNM of a tumour?

Answer 27

PET-CT

Question 28

``` What do the following stand for in TNM staging A: T0 B: T1 C. T2 D. T3 E. T4 ```

Answer 28

``` T0 - no evidence of tumour T1 - tumour between 0-3cm T2 - tumour between 3-5cm T3 - tumour between 5-7cm T4 - tumour between of larger than 7cm ```

Question 29

What do the following stand for in TNM staging A: N0 B: N1-3

Answer 29

N0 - no lymph node metastases | N1-3 - lymph node metastases present

Question 30

``` What do the following stand for in TNM staging A: M0 B: M1 C. M1b D. M1c ```

Answer 30

M0 - no distant metastasis M1 - distant metastasis M1b - single distant metastasis M1c - multiple distant metastases

Question 31

What are 3 investigations that can be used for the tissue diagnosis of tumours?

Answer 31

Bronchoscopy Endobronchial ultrasound (EBUS) Percutaneous image guided biopsy

Question 32

What are the 4 main causes for solitary pulmonary nodules?

Answer 32

Primary lung cancers Metastases Infections Pseudotumour

Question 33

What is a pseudotumour?

Answer 33

Gives the appearance of a mass that it isn't (i.e. pleural fluid giving the appearance of a tumour)

Question 34

Name at least 4 symptoms of lung cancers?

Answer 34

``` Cough Fatigue Weight loss Dyspnoea Haemoptysis Chest pain Chest infections ```

Question 35

What are 4 metastatic symptoms of lung cancer?

Answer 35

Bone pain Spinal cord compression Cerebral metastases Thrombosis

Question 36

Name 3 paraneoplastic symptoms of lung cancer?

Answer 36

Anaemia Hypercalcaemia Dermatomyositis

Question 37

Name at least 3 signs of lung cancer you may find on investigation?

Answer 37

``` Finger clubbing Lymphadenopathy Hepatomegally Skin nodules Pleural effusion ```

Question 38

What are the 3 main treatment options for lung cancer?

Answer 38

Surgery Radiotherapy Chemotherapy

Question 39

What is the main function of chemotherapy?

Answer 39

To downstage a tumour to make it operable

Question 40

What use does MRI have for lung cancer?

Answer 40

Determines degree of vascular and neurological involvement in Pancoast tumour

Question 41

What use does a Bone Scan have for lung cancer?

Answer 41

Indicates chest wall invasion and bony metastases

Question 42

What use does ECHO have for lung cancer?

Answer 42

Demonstrates presence or absence of pericardial effusion

Question 43

What are 4 consequences of lung cancer surgery that can lead to peri-operative death?

Answer 43

MI Pulmonary thromboembolism Pneumothorax Intrathoracic bleeding

Question 44

What are 4 consequences of lung cancer surgery that don't to peri-operative death?

Answer 44

Arterial fibrillation Empyema Wound infection Constipation

Question 45

``` What do the following mean in the ECOG performance status: A:0 B:1 C:2 D:3 E:4 ```

Answer 45

0 - asymptomatic; well 1 - symptomatic; able to do light work 2 - has to rest for less than half the day 3 - has to rest for more than half the day 4 - bedbound

Question 46

What does stage IV NSCLC mean?

Answer 46

Distant metastases

Question 47

What is clinically significant about stage IV NSCLC?

Answer 47

It is incurable and requires pallation

Question 48

What targeted drugs are used for adenocarcinoma with driver mutation: A - EGFR B - ALK

Answer 48

EGFR - erlotinib | ALK - certinib

Question 49

What is second line treatment for adenocarcinoma with progression?

Answer 49

Docetaxel + erlotinib

Question 50

What is the main treatment for SCLC (small cell)?

Answer 50

Chemotherapy

Question 51

What is the drug treatment for SCLC?

Answer 51

Cisplatin + etoposide