Lung Cancer

Question 1

Which two cancers does lung cancer kill more than combined?

Answer 1

Prostate and breast

Question 2

What is the usual aetiology of lung canceR?

Answer 2

Environmental

Question 3

What environmental factors usually are the aetiology of lung cancer?

Answer 3

• Smoking - Asbestos - Environmental radon - Occupational exposure- Pollution

Question 4

What precondition can result in a lung tumour?

Answer 4

Pulmonary fibrosis

Question 5

What percentage of lung cancer cases are related to smoking tobacco?

Answer 5

85%

Question 6

What percentage of smokers get lung cancer?

Answer 6

10%

Question 7

Which gender is more at risk of developing lung cancer from smoking?

Answer 7

Males

Question 8

What percentage risk does passive smoking increase the chances of developing lung cancer by?

Answer 8

50-100%

Question 9

What percentage of non-smoker lung cancer is related to passive smoking?

Answer 9

25%

Question 10

What are the 2 major chemical carcinogens in cigarettes?

Answer 10

• Polycyclic aromatic hydrocarbons - N-nitrosamines

Question 11

What are polycyclic aromatic hydrocarbons said to be linked to?

Answer 11

Squamous small cell lung cancer

Question 12

What are N-nitrosamines said to be linked to?

Answer 12

Adenocarcinomas

Question 13

What cells are effected by tobacco smoke?

Answer 13

Epithelial cells

Question 14

Where do adenocarcinomas usually form?

Answer 14

• Lung periphery - Bronchioalveolar epithelial stem cells transform

Question 15

What are the stages of invasive bronchogenic carcinoma?

Answer 15

• Squamous dysplasia - Carcinoma in situ Then invasive bronchogenic carcinoma

Question 16

What are the stages of invasive adenocarcinoma?

Answer 16

• Atypical adenomatous hyperplasia- Adenocarcinoma in situ Then invasive carcinoma

Question 17

What tumours can occur in the lung?

Answer 17

• Benign tumours - Carcinoid tumour- Tumours of bronchial gland (really rare)- Lymphoma - Sarcoma - Secondary tumours

Question 18

What could cause a benign growth in the lung?

Answer 18

Fibroma during pneumonia

Question 19

Examples of bronchial gland tumours

Answer 19

• Adenoid cystic carcinoma- Mucoepidermoid carcinoma - Benign adenoma

Question 20

4 main carcinomas of the lung?

Answer 20

• Adenocarcinoma (NSCLC)- Squamous cell (SCLC & NSCLC) - Small cell carcinoma (SCLC)- Large cell carcinoma (NSCLC)

Question 21

What are the two histological categorisations of lung cancer?

Answer 21

• Small cell carcinoma (SCLC)- Non small cell carcinomas (NSCLC)

Question 22

What is the biggest problem with regards to primary lung cancer?

Answer 22

They grow silently for many years and then present later when they are advanced

Question 23

Local effects of lung cancer?

Answer 23

• Bronchial obstruction - Pleural invasion- Direct invasion- Lymph node metastasis

Question 24

What effect can cancer have on the pleura?

Answer 24

• Inflammation- Metastasis

Question 25

What anatomical structures can be the location of direct invasion in lung cancer?

Answer 25

- Chest wall - Nerves - Mediastinum

Question 26

What nerve structures can be affected by invasion of lung cancer?

Answer 26

- Phrenic nerve- Left recurrent laryngeal- Brachial plexus - Cervical sympathetic

Question 27

What will phrenic nerve invasion result in?

Answer 27

Diaphragmatic paralysis

Question 28

What will left recurrent laryngeal invasion result in?

Answer 28

Hoarse, bovine cough

Question 29

What is cervical sympathetic invasion better known as?

Answer 29

Horner's syndrome

Question 30

What structures can be affected by mediastinum invasion from lung cancer?

Answer 30

- Superior Vena Cava - Pericardium

Question 31

What common locations does lung cancer spread to?

Answer 31

- Liver- Adrenal gland - Bone- Brain- Skin

Question 32

What non metastatic paraneoplastic effects of lung cancer are apparent in the SKELETAL system?

Answer 32

- Clubbing- HPOA (hypertonic pulmonary osteoarthropy)

Question 33

What non metastatic paraneoplastic effects of lung cancer are apparent in the ENDOCRINE system?

Answer 33

- Carcinoid syndrome- Gynecomastia

Question 34

What non metastatic paraneoplastic effects of lung cancer are apparent in the NERVOUS system?

Answer 34

- Polyneuropathy- Encephalopathy - Cerebellar degeneration - Myasthenia

Question 35

What non metastatic paraneoplastic effects of lung cancer are apparent in the CUTANEOUS system?

Answer 35

- Acanthosis nigricans- Dermatomyositis

Question 36

What non metastatic paraneoplastic effects of lung cancer are apparent in the HEAMOTOLOGICAL system?

Answer 36

- Granulocytosis- Eosinophilia

Question 37

What non metastatic paraneoplastic effects of lung cancer are apparent in the CARDIOVASCULAR system?

Answer 37

Thrombophlebitis migrans

Question 38

What non metastatic paraneoplastic effects of lung cancer are apparent in the RENAL system?

Answer 38

Nephrotic syndrome

Question 39

What does hypertonic pulmonary osteoarthropy cause?

Answer 39

Sore ankles and wrists

Question 40

What initial tests are done in lung cancer?

Answer 40

- CXR- Bronchoscopy - Trans thoracic fine needle aspiration - Trans thoracic core biopsy - Pleural effusion

Question 41

What types of bronchoscopies can be carried out in lung cancer?

Answer 41

- Bronchial biopsy- Bronchial brushings and washings - Endobronchial ultrasound guided aspiration

Question 42

Prognoses of type 1 and 2 lung cancers with surgical intervention

Answer 42

- Type 1 >60% 5yrS- Type 2 = 35% 5yrS

Question 43

5yr survival rate for small cell lung cancer

Answer 43

10-25%

Question 44

What do immune checkpoints do?

Answer 44

Control immune responses

Question 45

How do tumours use immune checkpoints?

Answer 45

Hide from immune destruction