Lung Cancer

Question 1

What are the two main groupings of Lung Cancer? What are the proportions of each in the UK? Can they be subdivided into further sub-types?

Answer 1

Small Cell Lung Cancer (SCLC) - 15%
Non-Small Cell Lung Cancer (NSCLC) - 85%
1. Adenocarcinoma
2. Squamous cell
3. Large cell 
4. Carcinoid tumours

Question 2

Which of the five types of cancers are peripherally, centrally located or found thoughout?

Answer 2

Centrally located: Small cell lung cancer, squamous cell lung cancer

Peripherally located: Adenocarcinoma

Thoughout: Carcinoid tumours, large cell carcinoma

Question 3

What are common sites of metastasis in lung cancers?

Answer 3

Mediastinum
Hilar lymph nodes
Lung pleura
Heart
Breasts
Liver
Brain
Adrenal Glands
Bone

Question 4

What are some risk factors of Lung Cancer?

Answer 4

• Smoking (dose dependent)
• Radon exposure
• Asbestos
• Air pollution
• Ionising radiation i.e. X-Ray, CTs
• Genetics
• Age
• Natural background incidence

Question 5

How many mutations are required to generate a malignant clone in lung cancer?

Answer 5

5

Question 6

Give examples of genes commonly mutated in Lung Cancer

Answer 6

KRAS
EGFR
ALK
BRAF
PIK3CA
HER2
ROS1
RET

Question 7

What is the most common Non-small cell carcinoma?

Answer 7

Adenocarcinoma

Question 8

Which type of lung cancer has gynaecomastia as a symptom?

Answer 8

Adenocarcinoma

Question 9

What is the most common type of cancer in non smokers?

Answer 9

Adenocarcinoma

Question 10

Which two cancers has the strongest associated with smoking?

Answer 10

Small cell
Squamous cell

(Both centrally located)

Question 11

What is the best investigation for lung cancer when deciding upon treatment?

Answer 11

PET

Question 12

How many times does smoking alone raise the chances of lung cancer?

Answer 12

10 fold

Question 13

Small cell lung cancer develops from what cell type?

Answer 13

Immature endocrine cells

Question 14

What 3 substances can Small Cell Lung Cancers typically produce to cause what symptoms / syndromes?

Answer 14

• ACTH, causing a rise in Cortisol and thus Cushing’s syndrome. This leads to hyperglycaemia and HTN
• ADH, causing a rise in water reabsorption. This leads to oedema, HTN and dark urine
• Antibodies, causing Lambert Eaton syndrome. This leads to neuronal destruction

Question 15

Centrally located tumours typically cause compression of what?

Answer 15

Superior Vena Cava (SVC) Obstruction

- Symptoms of facial swelling, headaches, upper limb oedema, venous distention in the neck

Question 16

What cancers can cause SVC obstruction?

Answer 16

Small cell lung cancer

Squamous cell lung cancer

Question 17

Which cancer is involved in thyroid / parathyroid hormone release?

Answer 17

Squamous cell lung cancer

Question 18

Which cancer is involved in serotonin release?

Answer 18

Carcinoid tumours

Question 19

Which two cancers can cause Pancoast tumours? Where are they located? What are their effects?

Answer 19

Adenocarcinomas
Squamous cell lung cancer

Located in the apex of the lung. Can compress the thoracic inlet, brachial plexus and central sympathetic nerves (Horner’s Syndrome)

Question 20

Horner’s Syndrome is a triad of what three symptoms?

Answer 20

Miosis (pupil constriction)
Ptosis (eyelid drooping)
Anhidrosis (excessive sweating)

Question 21

What is the most common type of lung cancer?

Answer 21

Adenocarcinoma

Question 22

Describe Trosseau’s syndrome of malignancy (Paraneoplastic syndrome)

Answer 22

Palpable nodule caused by migratory thrombophlebitis

Question 23

Why are calcium levels raised in Squamous cell carcinoma?

Answer 23

Due to Parathyroid hormone-like hormone release (Paraneoplastic syndrome)

Question 24

What is the first imaging investigation performed in suspected lung cancer patients?

Answer 24

CXR

Question 25

What is the limitation to using CXR as first-line to diagnose lung cancer?

Answer 25

Can only detect lung cancers greater than 1 cm in size

Question 26

Why might a pneumonectomy instead of a lobectomy be performed in lung cancer patients?

Answer 26

When the cancer crosses the oblique fissure

Question 27

What is the classification system for NSCLC and SCLC?

Answer 27

NSCLC - TNM staging

SCLC - Limited vs Extensive

Question 28

What is the prognosis / treatment options for SCLC?

Answer 28

Almost always incurable by presentation

Hence surgical resection is not an option, however does respond to chemotherapy +/- radiotherapy

Question 29

What genetic mutation is associated with Mesothelioma? What proportion of patients with mesothelioma have it?

Answer 29

Chromosome 22 monosomy (40%)

Question 30

Aside from radiotherapy and chemotherapy, what other treatment options are there for SVC obstruction?

Answer 30

Stent placement

Question 31

What are the CXR and CT scan findings of a patient with mesothelioma?

Answer 31

• Decreased chest cavity
• Pleural thickening
• Pleural effusion

Question 32

What are the Pleural fluid findings of a patient with mesothelioma?

Answer 32

• High protein and normal LDH content

- WBC, RBC and malignant cells present

Question 33

What is the prognosis of mesothelioma?

Answer 33

Poor prognosis, 11 months survival

Question 34

Cannonball lung lesions are indicative of…

Answer 34

Lung metastasis

Most commonly caused by renal cell cancer, choriocarcinoma and prostate cancer