Lung Cancer

Question 1

Levels of what peptide are elevated in squamous cell carcinoma?

Answer 1

Parathyroid hormone related peptide

Question 2

What can hypercalcaemia be seen in squamous cell carcinoma?

Answer 2

The release of parathyroid hormone related peptide resembles the structure of parathyroid hormone and therefore increases release of calcium

Question 3

How many carcinogens are there in tobacco?

Answer 3

60

Question 4

How many toxic chemicals are there in tobacco?

Answer 4

4000

Question 5

What carcinogens from tobacco cause adenocarcinoma?

Answer 5

N-nitrosamines

Question 6

What carcinogens from tobacco cause squamous cell carcinoma?

Answer 6

Polyaromatic hydrocarbons

Question 7

What are other types of tumours in the lung apart from carcinoma?

Answer 7

Carcinoid tumour (NSCLC and SCLC)
Benign causes of mass lesion
Sarcoma
Lymphoma
Metastasis
Tumours of bronchial glands - mucoepithelioid carcinoma, adenoid cystic carcinoma, benign carcinoma

Question 8

What is the most common type of lung cancer?

Answer 8

adenocarcinoma

Question 9

What are the main local effects of lung cancer?

Answer 9

Bronchial obstruction
Pleural effusion (inflammatory or malignant)
Direct invasion i.e. to chest wall or nerves causing brachial nerve palsy or horners syndrome
Lymph node metastasis i.e. lymphangitis carcinomatosa

Question 10

Where are the main places that lung cancer spreads to?

Answer 10

Brain
Adrenal glands
Lung
Bone
Skin

Question 11

Name some of the paraneoplastic effects of lung cancer.

Answer 11

humoral hypercalcaemia
syndrome of inappropriate ADHD secretion

Clubbing & hypertrophic pulmonary oesteoarthropathy 
Gynaecomastia
Stimulation of parathyroid-hormone (PTH)
Polyneuropathy 
Encephalopathy
Myasthenia
Nephrotic syndrome
Thrombophlebitis migrans
Eosinophilia
Granulocytosis
Dermatomyositis

Question 12

What does small call carcinoma trigger the release of and what does this cause?

Answer 12

ACTH = cushings
siADH = hyponatraemia

Question 13

What does squamous cell carcinoma trigger the release of?

Answer 13

Parathyroid hormone (causing increased levels of Ca)

Question 14

What is the likelihood of survival for 5 years after operation from stage I lung cancer and stage 2 cancer?

Answer 14

Stage 1 after 5 years - 60%

Stage 2 after 5 years - 35%

Question 15

What is the 5 year survival of NSCLC and SCLC?

Answer 15

10-25%

4% for SCLC

Question 16

Why are some tumours hard to target for immunotherapy?

Answer 16

Some cancers are not immunogenic so there is not an immune response

Question 17

what oncogene in lung cancer is associated with smoking?

Answer 17

KRAS

Question 18

what carcinogens are thought to be responsible for adenocarcinoma?

Answer 18

N-nitrosamines

Question 19

what carcinogens are thought to be responsible for squamous cell carcinoma?

Answer 19

Poly aromatic hydrocarbons (PAH)

Question 20

what type of treatment does squamous cell carcinoma not respond to?

Answer 20

molecular targeted therapy

Question 21

a patient with known lung cancer presents with nausea, headache and muscle ache. what is the most likely cause of this?

Answer 21

syndrome of inappropriate ADHD secretion

Question 22

in what type of lung cancer does syndrome of inappropriate ADHD secretion occur in?

Answer 22

small cell lung cancer

Question 23

in what type of lung cancer does humoral hypercalcaemia occur in?

Answer 23

squamous cell carcinoma