Lung cancer

Question 1

state the three types of non small cell lung carcinomas?

Answer 1

SCC (squamous cell carcinoma)
Adenocarincoma
Large cell

Question 2

what type of lung tumour is 90% of carcinoid tumours?

Answer 2

adenoma

Question 3

what are the % incidence of SCC, adenocarcinoma, large cell and small cell cancer?

Answer 3

SCC = 35%
adenocarcinoma = 25%
large cell = 10%
small cell = 20%

Question 4

where are SCC located ?

Answer 4

centrally located

Question 5

where are adenocarcinoma located ?

Answer 5

peripherally located

Question 6

where are small cell located ?

Answer 6

central location near bronchi

Question 7

what hormone is released by SCC?

Answer 7

PTHrP

Question 8

what does increased release of PTHrP lead to ?

Answer 8

hypercalcaemia

Question 9

what lung cancer present most with mets?

Answer 9

adenocarcinoma

Question 10

state some local complications of lung cancer?

Answer 10

􏰀 Recurrent laryngeal N. palsy
􏰀 Phrenic N. palsy
􏰀 SVC obstruction
􏰀 Horner’s (Pancoast’s tumour)
􏰀 AF

Question 11

what endocrine paraneoplastic conditions can be caused?

Answer 11

􏰁 ADH → SIADH ( euvolaemic ↓Na+)

􏰁 ACTH → Cushing’s syndrome

􏰁 Serotonin → carcinoid (flushing, diarrhoea)

􏰁 PTHrP → primary HPT (↑Ca2+, bone pain) – SCC

Question 12

what rheum paraneoplastic conditions can be caused?

Answer 12

Dermatomyositis / polymyositis

Question 13

what neuro paraneoplastic conditions can be caused?

Answer 13

􏰁 Purkinje Cells (CDR2) → cerebellar degeneration

􏰁 Peripheral neuropathy

Question 14

what dermatology paraneoplastic conditions can be caused?

Answer 14

􏰁 Acanthosis nigricans (hyperpigmented body folds)

􏰁 Trousseau syndrome: thrombophlebitis migrans

Question 15

what could be seen on CXR of lung cancer?

Answer 15

Coin lesion
􏰁 Hilar enlargement
􏰁 Consolidation, collapse 
􏰁 Effusion
􏰁 Bony secondaries

Question 16

what are the DD for coin lesion on CXR?

Answer 16

􏰀 Foreign body
􏰀 Abscess: Staph, TB, Klebsiella, Mycetoma
􏰀 Neoplasia (1O or 2O)
􏰀 Granuloma: RA, Wegener’s, TB, Sarcoid
􏰀 Structural: AVM

Question 17

what 4 biopsies can be done for lung cancers?

Answer 17

􏰀 Percutaneous FNA: peripheral lesions and LNs
􏰀 Bronchoscopy: biopsy and assess operability
􏰀 Endoscopic bronchial US biopsy: mediastinal LNS
􏰀 Mediastinoscopy

Question 18

who is involved in the lung cancer MDT?

Answer 18

pulmonologist, oncologist, radiologist,
histopathologist, cardiothoracic surgeon, specialist
nurses, palliative care, GP

Question 19

what palliation care is available for lung cancer?

Answer 19

􏰀 Radio: bronchial obstruction, haemoptysis, bone or CNS
mets

􏰀 SVC obstruction: stenting + radio + dexamethasone

􏰀 Endobronchial therapy: stenting, brachytherapy

􏰀 Pleural drainage / pleurodesis

􏰀 Analgesia

Question 20

what chemo and targeted agents are used for NSCLC?

Answer 20

􏰁 Platinum-based regimens

􏰁 MAbs targeting EGFR (e.g. cetuximab) or TKI
e.g. erlotinib

Question 21

what is T1-4 staging?

Answer 21

<3cm, in lobar or more distal airway

> 3cm and >2cm from carina or pleural involvement

<2cm from carina or involves chest wall, diaphragm

Involves mediastinum or malignant effusion is present

Question 22

what is N0-4?

Answer 22

None involved

Peribronchial or ipsilateral hilum

Ipsilateral mediastinum

Contralateral hilum or mediastinum or supraclavicular