Lung Cancer

Question 1

State the 2 main categories of lung cancer.

Answer 1

Small cell carcinoma.

Non-small cell carcinoma.

Question 2

State 3 cells found in the lining of the airways.

Answer 2

Ciliated cells - sweep particles and pathogens to the throat.
Goblet cells - secrete mucus.
Basal cells - differentiate into other cells.
Neuroendocrine cells - secrete hormones into the blood.
Club cells - protect the bronchiolar epithelium.

Question 3

What is a small cell carcinoma?

Answer 3

Small immature, neuroendocrine cell that divides and spreads rapidly.

Question 4

State the 4 types of non-small cell carcinomas.

Answer 4

Adenocarcinoma - goblet cells.
Squamous cell carcinoma - squamous cells.
Large cell carcinoma.
Carcinoid tumour - mature neuroendocrine cell.

Question 5

Where do small cell carcinomas arise from?

Answer 5

Endocrine cells (Kulchitsky cells).

Question 6

State 3 paraneoplastic syndromes associated with small cell carcinomas.

Answer 6

Cushing’s syndrome - tumour produces ACTH.
SIADH - tumour produces ADH.
Lambert-Eaton Myasthenic Syndrome - tumour produces autoantibodies (type 2 hypersensitivity).

Question 7

What is Lambert-Eaton Myasthenic Syndrome?

Answer 7

It is an autoimmune disease — a disease in which the immune system attacks the body’s own tissues. The attack occurs at the connection between nerve and muscle (the neuromuscular junction) and interferes with the ability of nerve cells to send signals to muscle cells. It can cause weakness in the upper legs and hips, leading to difficulty walking, and weakness in the upper arms and shoulders, which can make self-care difficult.

Question 8

Which types of non-small cell carcinomas can be a pancoast tumour (form on the upper lung)?

Answer 8

Squamous cell carcinoma. Adenocarcinoma.

Question 9

What hormone is released by the adenocarcinoma, resulting in bones to become brittle?

Answer 9

Parathyroid hormone (PTH).

Question 10

What can the pancoast tumour result in?

Answer 10

Damage to the cervical sympathetic nerve - Horner’s syndrome (drooping eyelid and constricted pupil).

Question 11

Is the squamous cell carcinoma or the adenocarcinoma found centrally?

Answer 11

Squamous cell carcinoma.

Question 12

State a complication of a bronchial carcinoid.

Answer 12

Increased peristalsis and diarrhoea. Broncho-constriction - asthma.

Question 13

State 3 risk factors for lung cancer.

Answer 13

Cigarette smoking. Passive smoking. Occupational emergencies - asbestos, radon, vinyl chloride, air pollution. Diet. Genetics.

Question 14

State 3 sites of secondary tumours as a result of metastasis.

Answer 14

Mediastinum (a membranous partition between two parts of an organ).
Hilar (the wedge-shaped area on the central portion of each lung) lymph nodes.
Lung pleura.
Heart.
Breasts.
Liver.
Adrenal glands.
Brain.
Bone.

Question 15

What is the hilium?

Answer 15

The wedge-shaped area on the central portion of each lung.

Question 16

What is the mediastinum?

Answer 16

A membranous partition between two parts of an organ).

Question 17

State 3 symptoms lung cancer.

Answer 17

Cough. 
Haemoptysis - coughing up blood.
Dyspnoea.
Chest pain.
Pneumonia.
Lethargy. 
Weight loss.

Question 18

State 3 signs lung cancer.

Answer 18

Cachexia - weakness/wasting of the body.
Anaemia.
Clubbing.
Metastasis - bone tenderness, hepatomegaly, confusion.

Question 19

State 3 complications of a lung cancer tumour.

Answer 19

Tumour in immune system - weight loss, fever, night sweats.
Tumour obstructing airway - cough, shortness of breath, pneumonia.
Tumour compresses nerve - recurrent laryngeal nerve (changes in voice), phrenic nerve (difficulty breathing).
Tumour on pulmonary apex (pancoast tumour) - Horner’s syndrome - droopy eyelid, constricted pupil.
Tumour compresses blood vessel e.g. the superior vena cava (backup of blood) - facial swelling, shortness of breath.
If tumour releases hormones - paraneoplastic syndrome - SIADH, Cushing’s syndrome, hypertrophic pulmonary osteoarthropathy (digital clubbing/painful large joints), Eaton-Lambert syndrome (weakness in the upper arms and shoulders).
Metastasis.

Question 20

State 3 ways lung cancer is diagnosed.

Answer 20

Chest x-ray - peripheral nodule, hilar enlargement, consolidation, lung collapse, pleural effusion.
Cytology - tissue biopsy, pleural fluid.
Bronchoscopy.
CT guided fine needle aspiration.
Endobronchial ultrasound.

Question 21

State 2 ways to obtain a lung cancer biopsy.

Answer 21

Bronchoscopy.
CT guided fine needle aspiration.
Endobronchial ultrasound.

Question 22

State 2 treatments for lung cancer.

Answer 22

Surgery - penumonectomy, lobectomy, segmentectomy, lung-conserving procedures.
Chemotherapy - gemcitabine, docetaxel, elimpta, vinarelbine.
Radiotherapy.

Question 23

State 2 others lung tumours.

Answer 23

Bronchial adenoma - tumour in the lung bronchi (airways).
Hamartoma - growth of a non-cancerous tissue (fat, connective tissue and cartilage) in a region of the lung.
Malignant mesothelioma - tumour in the mesothelial cells lining the lungs.

Question 24

What is believed to be the main causes of malignant mesothelia?

Answer 24

Asbestos.

Question 25

State 2 things identified on a chest x-ray for malignant mesothelia.

Answer 25

Pleural thickening.

Pleural effusion.

Question 26

State 2 symptoms of malignant mesothelia.

Answer 26

Chest pain.
Dysnoea.
Clubbing.