Lung cancer

Question 1

What is a paraneoplastic association with small cell lung cancer that produces a type II hypersentivity reaction against neurmuscular junctions?

Answer 1

Lambert - Eaton syndrome

Anti bodies against the Ca2+ channels in the PREsynaptic neuron

Question 2

What are the most common Mutations in lung cancer?

Answer 2

p53

• squamous cell carcinoma
• small cell carcinoma

KRAS oncogene
- adenocarcinoma

PDL1

AML4 ALK

• non- small cell carcinnoma
• FISH identifies

EGFR:
non small cell - often adenocarcinoma

Question 3

What other factors may be implicated outwith smoking?

Answer 3

Ionising radiation

Air pollution

Asbestos

Question 4

What are some common symptoms of lung cancer?

Answer 4

Cough

Haemoptysis

Recurrent Pneumonia

Shortness of breath

Atelectasis

Question 5

List some paraneoplastic disorders associatted with lung cancer:

Answer 5

SIADH
- small cell

Ectopic ACTH
- small cell

Hypercalcemia
- squamous cell

Question 6

What investigations should be done when lung cancer is suspected?

Answer 6

Chest x-ray

Rule out TB

CT Scan

Fibreoptic Bronchoscopy
- with biopsy

Transthoracic fine needle aspiration

Bloods
- looking for paraneoplastic effects

Bronchial Washing

Video assisted thoracoscopic surgery

Question 7

What are some emergency complications of lung cancer?

Answer 7

paraneoplastic

Spinal cord compression

SVC compression

Question 8

What cells do small cell carcinomas derive from and what is their appearance?

Answer 8

neuroendocrine

small cells
hyperdense nuclei
very little cytoplasm
ovale shaped

Question 9

What are the stages of small cell lung cancer?

Answer 9

limited

• confined to one hemithorax
• 30% of cases

Extensive:
- all other patients

Question 10

What cells do sqaumous cell carcinomas derive from and what is their appearance?

where do they usually develop?

Answer 10

Central bronchial cells
- often from metasplastic squamous cells that were columnar

Stain pink - high keratin

Around the bronchi
- around the cartilage

Question 11

What cells do Adenocarinoma derive from?
what is their appearance?

where do they usually develop?

Answer 11

Glandular cells such as mucus/ goblet cells.

large mucin glands

usually around the peripheral of the lungs.
- pleuritic pain

Question 12

What cells do Large cell carcinoma derive from? what is their appearance and where do they usually develop?

Answer 12

poorly differentiated cells, mixture of SCC and adenocarcinomas.

Centrally located. highly aggressive.

Question 13

Prior to treatment, what things need to be considered?

Answer 13

Heart functioning
Lung functioning
- to see if they are able survive without a lung.

• lung function
• ECG
• Echo

Question 14

List some genetic treatments for lung cancer?

Answer 14

EGFR drugs:

• cetuximab
• Erlotinib

EML4 ALK inibitors
- Crizotinib

PDL1
- nivolumab

Question 15

What cancers develop around the pleura of the lung?

Answer 15

Mesothelioma

most commonly associated with asbestos

Question 16

What lung cancer is most likely to produce PTH like hormone, leading to hypercalcaemia?

Answer 16

Squamous Cell

Question 17

What paraneoplastic syndromes are most associated with Small Cell lung cancer?

Answer 17

ATCH - Cushings

SIADH

Question 18

What is the most common lung cancer over all?

Answer 18

adenocarcinoma

Question 19

What cancer is least likely to metastasis?

Answer 19

Squamous cell

Question 20

Which cancer produces large amounts of mucin?

Answer 20

Adenocarcinoma

Question 21

What mutation is common associated with adenocarcinoma?

Answer 21

KRAS

Question 22

Which type of lung cancer tends to undergo nuclear moulding?

Answer 22

Small cell carcinoma

Question 23

What initial investigations are done in suspicion of lung cancer?

Answer 23

X-ray

CT - looking for nodal involvement

PET CT - looking for metastasis

Biopsy

• transthoracic aspiration
• bronchoscopy
• CT guided if on peripheral
• ultra sound guided of lymph nodes

Spudem

Bronchial wash

Question 24

What cancers are highly associated with central masses?

Answer 24

Small cell

Squamous

Question 25

Which cancers are most associated with smoking?

Answer 25

Small cell

Squamous

Question 26

What cancer is TTF-1 positive?

Answer 26

Adenocarcinoma

Question 27

What are the treatment options for Non small cell lung cancer, and which stages are operated on?

Answer 27

Surgery
- stages I and II (only some of 2 though)

Platinum based chemotherapy 
or 
Radiotherapy 
or 
Both

Question 28

Name some side effects of radiation therapy for the lung:

Answer 28

Radiation pneumonitis

Radiation fibrosis

Question 29

One of the types of cancer is also genetically tested, and there are three relatively common mutations found, which have medications. Which are they?

Answer 29

Adenocarcinoma

EGFR
- Erlotinib

ALK
- Crizotinib

PDL1
- Nivolumab

Question 30

What is the treatment for Small cell Carcinoma?

Answer 30

Radiotherapy
Chemotherapy

Palliative care

Question 31

Outwith chemotherapy and radiation what other palliative care treatments could be given?

Answer 31

Bronchial Stents

Question 32

What are some common metastasis points of lung cancer?

Answer 32

Lymph nodes - mediastinal

Pleural space

Adrenal glands

Liver

Bone

Brain

Question 33

What are the symptoms of Superior vena cava syndrome and how is it treated?

Answer 33

Dyspnea
Swollen face
Swollen Arm
Venous neck congestion

Steroids 
Vascular stents 
Anti-coagulation 
Surgery 
Chemotherapy

Question 34

Which cancer is linked to p53 mutation

Answer 34

Squamous cell