Lung Cancer

Question 1

Prevalence of death with lung cancer?

Answer 1

1/3 of all death from cancer is related to lung cancer

Question 2

Where do mets from the lungs typically go?

Answer 2

Bone, liver, brain

Question 3

What are most lung cancers due to?

Answer 3

Smoking

Question 4

Do non-smokers develop lung cancer?

Answer 4

Yes

Question 5

Etiology of lung cancer?

Answer 5

• Smoking (>85%)
• environmental toxins (eg. asbestos)
• marijuana

Question 6

Asbestos?

Answer 6

Insulation used in older buildings. When it is inhaled, it forms tiny fibres within the lungs, it is not illegal in Canada.

Question 7

What type & percentage is the majority of lung cancer?

Answer 7

95% bronchogenic carcinoma (originates in the bronchiole epithelial tissue)

Question 8

What are the 4 major types of lung cancer?

Answer 8

1. small cell carcinoma
2. large cell carcinoma
3. squamous cell carcinoma
4. adenocarcinoma

Question 9

What is the category for each of the lung cancers?

Answer 9

Small cell carcinoma = SCLC (small cell lung cancer)

Large cell carcinoma; squamous cell carcinoma; adenocarcinoma = NSCLC (non small cell lung cancer)

Question 10

Prevalence of small cell carcinoma?

Answer 10

~12%

Question 11

What is small cell lung cancer also known as and why?

Answer 11

Oval cell carcinoma or “oat” cell carcinoma because the tiny malignant cells resemble grains of oat

Question 12

Who does small cell carcinoma occur in more?

Answer 12

• 99% of SCLC is in smokers

Question 13

Is there screening available?

Answer 13

No, about 70% of the time mets have occurred by the time it is diagnosed. Cancer is already advanced on discovery

Question 14

Paraneoplastic syndrome examples?

Answer 14

syndrome of inappropriate ADH release (SIADH); Cushing syndrome (hypersecretion of cortisol)

Question 15

Paraneoplastic syndrome?

Answer 15

These endocrine disorders occur because the tumour secretes hormone-like substances that have the same action as the affected hormone known as ectopic tumours.

Question 16

Prevalence of large cell carcinoma?

Answer 16

~12%

Question 17

What is the worst type of lung cancer to have and why?

Answer 17

Small cell carcinoma because it is aggressive, invasive and has early mets to the brain

Question 18

Large cell carcinoma?

Answer 18

• large, undifferentiated cells
• peripheral origin (alveoli, bronchioles)
• early mets -> poor prognosis

Question 19

Who is squamous cell carcinoma more common in?

Answer 19

Males

Question 20

Where does squamous cell carcinoma originate?

Answer 20

central bronchi; intraluminal (within the lumen of the bronchi)

Question 21

What is meant by “peripheral origin?”

Answer 21

the small airways are peripheral in respect to the respiratory tract. Ex. alveoli, bronchioles

Question 22

In which lung cancer do paraneoplastic syndromes occur?

Answer 22

Small cell carcinoma

Question 23

Which lung cancer spreads to the hilar lymph nodes?

Answer 23

Squamous lung carcinoma

Question 24

Hilus?

Answer 24

Refers to the area of the lung where vessels and bronchi enter

Question 25

Prevalence of squamous cell carcinoma?

Answer 25

~30%

Question 26

What is the most common type of lung cancer

Answer 26

adenocarcinoma

Question 27

Adenocarcinoma?

Answer 27

Cancer of the glandular epithelium (most common type of lung cancer

Question 28

Prevalence of adenocarcinoma?

Answer 28

~30%

Question 29

Who does adenocarcinoma mainly occur in?

Answer 29

Women and nonsmokers

Question 30

Where does adenocarcinoma originate?

Answer 30

In the alveoli or bronchioles (peripheral origin- bronchogenic carcinoma)

Question 31

Manifestations of lung cancer?

Answer 31

- Depends on: Type, site; extent, mets; paraneoplastic syndromes (endocrine disorders) - pain (peripheral mnft) - hemoptysis (peripheral mnft) - if central -> ventilation is impaired -> coughing, wheezing, dyspnea - cardiac manifestations d/t proximity of pericardium, cardiac function can be compromised

Question 32

Diagnostics for lung cancer?

Answer 32

- hx, px - xray, CT scan, MRI, US - Cytology (sputum or bronchial wash) - bronchoscopy, biopsy

Question 33

Treatment for lung cancer?

Answer 33

- SCLC : chemo and radiation - NSCLC : surgery, chemo and radiation (Both benefit from combination therapy but only NSCLC can be treated with surgery; generally poor prognosis)

Question 34

Hemoptysis?

Answer 34

Coughing up blood (CA damages blood vessels)