Lung Cancer

Question 1

Where does local invasion occur

Answer 1

Recurrent laryngeal nerve
Pericardium
Oesophagus
Brachial Plexus
Pleural Cavity
Superior Vena Cava

Question 2

Hypercalcaemia

Answer 2

High level of Ca2+

Question 3

Hypercalcaemia Treatment

Answer 3

Rehydration

IV Bisphosphonate

Question 4

PET scan

Answer 4

Assess function rather than structure
Analysis of tissue uptake of radio-labelled glucose
Tissues with high metabolic tissue light up

Question 5

Bronchial carcinoma

Answer 5

Asbestos + smoking synergistic

Question 6

Imaging features of lung cancer

Answer 6

Peripheral tumours (behind hilum)
Central tumours (at or close to hilum) can result in collapse of lobe and enlargement of hilum

Question 7

Early clinical features of lung cancer

Answer 7

Cough (3 weeks)
Breathless for no reason 
Chest infection doesn't clear up
Weight loss
Chest or shoulder pain
Tiredness
Coughing up blood
Hoarse voice

Question 8

Paraneoplastic

Non-metastatic effects that accompany malignant disease

Answer 8

Finger clubbing
Weight loss 
Thrombophlebitis
Hypercalcaemia
Hyponatraemia
Weakness

Question 9

Hyponatraemia

Answer 9

low sodium concentration

Question 10

4 common smoking associated types of lung tumours

Answer 10

Adenocarcinoma
Squamous carcinoma
Small cell carcinoma
Large cell carcinoma

Question 11

Hormone production

Answer 11

PTH - squamous cancer

ACTH - small cell cancer

Question 12

Prognosis

Answer 12

Small cell = worst

Large cell = worse that squamous or adenocarcinoma)

Question 13

Small Cell Lung Cancer treatment

Answer 13

Chemotherapy

Rapidly emerging resistance

Question 14

Small cell lung cancer genetic abnormalities

Answer 14

Oncogenes - myc

Tumour supressor genes - p53, Rb, 3p

Question 15

Non small lung cancer treatment

Answer 15

Surgery
Chemo
Radiotherapy

Question 16

Adenocarcinoma expresses

Answer 16

TTF

Question 17

Squamous cell cancer expresses

Answer 17

p63 and high molecular wt. cytokertins

Question 18

Genetic abnormalities of non small lung cancer

Answer 18

Oncogenes - myc, K-ras, her2(neu)

Tumour supressor genes - p53, 1q, 3p, 9p, 11p,

Question 19

TNM staging

Answer 19

Tumour - size?
Node - how many nodes involved?
Metastasis - has it?

Question 20

Carcinoid

Answer 20

Lung neoplasm in neuroendocrine system

Low grade malignancy

Question 21

Bronchial gland neoplasm

Answer 21

seen in salivary gland

Question 22

Small cell lung cancer

Answer 22

Rapidly progressive

Early metastases

Question 23

Surgery

Answer 23

If localised

Must look at staging

Question 24

Chemotherapy

Answer 24

Tissue sampling + staging + assess fitness first
Good response in small cell
Rarely curative
Targets rapidly dividing cells, treats whole body

Question 25

Side effects of chemo

Answer 25

Bone marrow suppression
Nausea
Tiredness
Hair loss
Pulmonary fibrosis

Question 26

Radiotherapy

Answer 26

Ionising radiation

Cure or delay

Question 27

Drawbacks of radiotherapy

Answer 27

Maximum cumulative dose
Collateral damage (oesophagus)

Question 28

Palliative Treatment

Answer 28

Stent insertion
Photodynamic therapy
Laser therapy
Radioactive therapy

Question 29

Investigations to determine staging

Answer 29

Bronchoscopy (vocal cord palsy, proximity to carina, cell type)
Mediastinoscopy (lymph nodes)
CT scan of brain (mets)
CT scan of thorax (tumour size, lymph nodes, mets, local invasion)
PET scan (mets)