Lung Cancer

Question 1

Where in the lung do tumours most commonly arise from?

Answer 1

From the epithelium of large & medium-sized bronchi (rarely from lung parenchyma

Question 2

What is the most common kind of lung cancer?

Answer 2

Adenocarcinoma (NSCLC)

Question 3

What is the NSCLC SCLC split?

Answer 3

85% non-small cell lung cancer (adenocarcinoma, SSC, large cell)
15% Small cell

Question 4

ADENOCARCINOMA

1. Where are tumours located?
2. Who is it common in?
3. What mutations may be present?

Answer 4

1. Tumours often peripheral
2. More frequent in women, non-smokers & asbestos exposure
3. EGFR, ALK, Rhos

Question 5

SQUAMOUS CELL CARCINOMA

1. Where are tumours usually located?
2. Who does it most commonly affect?
3. Why may it lead to hypercalcaemia?

Answer 5

1. Close to the bronchi (may present with bronchial obstruction)
2. SMOKERS
3. Can secrete PTH related peptide, causing hypercalcaemia

Question 6

LARGE CELL CARCINOMA

1. How common?
2. Where are tumours located?
3. Why bad?

Answer 6

1. 8% of NSCLC
2. Peripheral tumours
3. Metastasize early

Question 7

SMALL CELL LUNG CANCER

1. Why bad?
2. How chemosensitive?

Answer 7

1. Highly aggressive & rapidly-growing. Usually mets prior to diagnosis
2. Can be v chemosensitive, but high chance of relapse

Question 8

What prophylactic treatment may be considered in people with SCLC?
What is a risk of this?

Answer 8

Prophylactic radiotherapy to the brain

Risk: significant memory impairment

Question 9

What may be associated with SCLC?

Answer 9

Paraneoplastic syndromes: SIADH, Cushing’s, Lambert-Eaton

Question 10

What types of lung cancer are most commonly associated with the following presentations?

1. Miosis, anhidrosis, partial ptosis
2. Recurrent laryngeal nerve palsy & SVC obstruction

Answer 10

1. Pancoast tumour (apical), horner’s syndrome

2. Mediastinal disease

Question 11

What is SIADH?

What is it characterised by?

Answer 11

syndrome of inappropriate antidiuretic hormone

hypotonic hyponatraemia, concentrated urine, and a euvolaemic state

Question 12

What cancer is most commonly associated with SIADH?

Answer 12

Small cell lung cancer

Question 13

What is EBUS and why is it used?

Answer 13

Endobroncial Ultrasound

Biopsy of lymph nodes in the mediastinum

Question 14

What treatment can reduce haemoptysis?

Answer 14

Radiotherapy

Question 15

Surgery for NSCLC

Answer 15

80% 5 year survival in stage 1 or 2 diseae, but only 30% are suitable for surgery
Mediastinal involvement: CI for surgery

Question 16

What is the most common treatment for people with stage 2 or 3 NSCLC?

Answer 16

Concurrent chemo-radiotherapy

Question 17

SABR can be used to treat which type of tumours?

Answer 17

Peripheral tumours

Question 18

What is the mainstay of treatment for patient with mets/ locally advanced disease?

Answer 18

Chemotherapy

Question 19

When could Pembrolizumab be used for patients with advanced NSCLC?

Answer 19

If there is high PDL expression

Question 20

Why do most patients with SCLC recieve palliative chemo?

Answer 20

Usually a systemic disease at presentation

Question 21

What is PCI?

Answer 21

Prophylactic cranial irradiation, used when there is a chance of brain mets in SCLC

Question 22

How chemosensitive is SCLC?

Answer 22

Very (around 80% will respond) but high chance of relapse

Question 23

Lambert-eaton syndrome is an autoimmune disorder associated with SCLC. How does it present?

Answer 23

involves muscles of the proximal arms and legs

Weakness affects legs > arms