Lung Cancer

Question 1

2 main pathways of carciogenesis?

Answer 1

In the lung periphery, bronchioloalveolar cells transform = adenocarcinoma.

In the central lung, bronchial epithelial stem cells transform = squamous cell carcinoma.

Question 2

Risk factors of lung cancer?

Answer 2

Male
Smoker
Occupational
Pollution 
Radiation (radon)
Asbestos
Pulmonary fibrosis

Question 3

What are the two main subdivisions of lung tumours? How are they divided? Why are they divided?

Answer 3

Small cell carcinoma
Non small cell carcinoma

Divided based on the histological appearances of the cells

Divided because they behave differently and can be treated differently

Question 4

What is non-small cell further divided into?

Answer 4

squamous cell
adenocarcinoma
large cell carcinoma

Question 5

Squamous cell carcinoma features?

Answer 5

Arises from epithelial cells.

Can cause obstructive lesions of bronchus, leading to infection.

Question 6

Large cell features?

Answer 6

Poorly differentiated

Question 7

Symptoms of lung cancer? When do they show?

Answer 7

Show when disease is advanced

cough
haemoptysis
weight loss
dyspnoea
chest pain
recurrent chest infections
wheeze / hoarse voice / dysphalgia (difficult to swallow)

Question 8

Signs of lung cancer?

Answer 8

Clubbing
Lymphadenopathy
Superior vena cava obstuction
hepatomegaly 
tracheal deviation

Question 9

When does a cough merit an x-ray?

Answer 9

3 weeks

Question 10

What causes dyspnoea and wheeze?

Answer 10

Tumours can cause AFO

Question 11

Why blood in cough?

Answer 11

Tumour bleeds into airway

Question 12

Why chest pain?

Answer 12

Peripheral tumors invade pleura

Question 13

Why a hoarse voice?

Answer 13

Tumour invasion of the mediastinum results in compression of the left recurrent laryngeal nerve.

Question 14

What causes the muscle wasting and nerve compression in arm?

Answer 14

Pancost tumours in lung apex invades brachial plexus

Question 15

What causes horners syndrome

Answer 15

compression of the sympathetic chain

Question 16

Why recurrent infections?

Answer 16

Tumour AFO results in post-obstructive pneumonia.

Question 17

Common met sites?

Answer 17

Liver 
Bone 
Brain
Adrenal glands 
Lymph nodes
Kidney
Pleura

Question 18

What does mets to the pleura cause?

Answer 18

Malignant pleural effusion

Question 19

What investigations are used to diagnose and stage lung cancer?

Answer 19

CxR
Bronchoscopy
CT/PET CT
MRI

Question 20

What is the lung cancer staging system?

Answer 20

TNM

Primary tumour
Regional lymph nodes
Distant mets

These are all taken into account and the overall cancer is staged up to stage 4.

Question 21

What does T mean and how is it scored?

Answer 21

T - Primary Tumour

Scored between TX/T0 to T4, depending on the size and invasion of the tumour.

Question 22

What does N mean and how is it scored?

Answer 22

N - Regional Lymph Nodes

Scored between NX/N0 to N3 depending on invasion of the nodes.

Question 23

What does M mean and how is it scored?

Answer 23

M - Distant Metastases

Scored between M0 and M1 depending on the present of mets.

Question 24

When is surgery is used to treat lung cancer?

Answer 24

Used in Non small cell - stages 1,2 and maybe sometimes 3A

Never if mets

Question 25

What can be done to manage stage 3 cancers that can’t be operated on?

Answer 25

Chemoradiation in the attempt to “downsize” the disease and render it operable

Question 26

When would radiotherapy be used?

Answer 26

To cure

Palliative care

Question 27

Complications from radiotherapy

Answer 27

Radiation pneumonitis.

Radiation fibrosis.