Lung cancer

Question 1

How common is lung cancer

Answer 1

3rd in the UK

Question 2

How many people survive lung cancer (%)

Answer 2

10%

Question 3

where can a primary lung cancer invade locally

Answer 3

Pericardium
Oesophagus 
Recurrent laryngeal nerve 
brachial plexus 
pleural cavity 
SVC
Chest wall

Question 4

Common sites of metastases

Answer 4

Brain
Liver
Bone 
Adrenal gland 
Skin 
Lung

Question 5

paraneoplatic presentation of lung cancer

Answer 5

finger clubbing
HPOA - aches in legs due to thickening and detachment of periosteum from rest of bone
Weight loss
Hypercalcaemia

Question 6

What condition can small cell cancer bring about

Answer 6

DIADH - syndrome of inappropriate antidiuretic hormone

low sodium Concn

Question 7

what does SIADH present as and how is it treated

Answer 7

Lethargy/confusion
Nausea and vomiting 
Seizures/coma 
Myoclonus 
Fluid restriction

Question 8

How is cancer commonly presented

Answer 8

Cough > 3 weeks
Weight loss
Hoarseness
Stridor
Haemoptysis
Unexplained tiredness 
breathlessness
Chest infection that doesn't clear 
Chest/shoulder pain

Question 9

What would lung cancer patients present with on examination

Answer 9

finger clubbing 
stridor 
dull percussion
tracheal deviation
hoarseness
weight loss
bloated face
cough 
breathless

Question 10

How can a PET scan help to diagnose cancer

Answer 10

analyses tissue uptake of radiolabelled glucose, so shows areas of high metabolic activities such as cancers

Question 11

What investigations can be carried out to look for cancers

Answer 11

CT/CXR/PET
bronchoscopy
CT guided biopsy - risky
Endobronchial ultrasound 
thoracoscopy

Question 12

Symptoms of hypercalcaemia

Answer 12

Bones
Stones
Groans
Thrones 
Psychiatric overtones
Cardiac arrythmia

Question 13

What type of cancer usually causes hypercalcaemia

Answer 13

squamous cell

Question 14

breathlessness, AF and pericardial effusion suggests a tumour has infiltrated the _________

Answer 14

pericardium

Question 15

if a tumour invades the oesophagus what would it potentially cause

Answer 15

dyspagia

Question 16

a pancoast tmour is one that has invaded the _________ and causes ______

Answer 16

Brachial plexus

Muscle wasting

Question 17

True/false - a pleural effusion can be causes when a tumour infiltrates the pleural cavity

Answer 17

true

Question 18

SVC invasion would cause

Answer 18

engorged veins in neck and distended abdominal veins

Question 19

if a patient had a PC of chest wall pain it is likely the tumour has infiltrated?

Answer 19

yes

Question 20

if a lung metastasis entered the brain what could it cause

Answer 20

fits, weakness, visual disturbance, not photophobic headaches

Question 21

if a lung metastasis entered the liver what could it cause

Answer 21

jaundice
enlarged liver
pain

Question 22

How common is a benign primary lung tumour

Answer 22

rare

Question 23

how common is a malignant primary lung tumour

Answer 23

common

Question 24

how common is a secondary metastatic lung tumour

Answer 24

common

Question 25

what can cause lung cancer

Answer 25

``` tobacco smoke - polycyclic hydrocarbons Asbestos Radiation Genes Pollutants ```

Question 26

What hormone does squamous cell cancer produce

Answer 26

PTH

Question 27

What hormone does small cell cancer produce

Answer 27

ACTH

Question 28

4 types of smoking related lung cancer

Answer 28

Adenocarcinoma Large cell carcinoma Small cell carcinoma squamous cell carcinoma

Question 29

how does ademocarcinoma appear

Answer 29

forming a gland

Question 30

how does squamous cell carcinoma appear

Answer 30

ketatinising

Question 31

how does large cell carcinoma appear

Answer 31

less dense and more spread out

Question 32

how does small cell carcinoma appear

Answer 32

small | tightly packed and dense

Question 33

What type of carcinoma has the worst prognosis

Answer 33

small cell carcinoma

Question 34

what type of carcinoma is most common

Answer 34

adenocarcinoma

Question 35

true/false - small cell carcinoma is the only carcinoma that can be surgically removed

Answer 35

false - all others can be surgically removed but small cell

Question 36

what carcinoma has initial response to chemo but rapid resistance

Answer 36

small cell

Question 37

what does adenocarcinoma express that is useful for immunohistochemistry

Answer 37

TTF1

Question 38

what does squamous carcinoma express that is useful for immunohistochemistry

Answer 38

p63 | high molecular weight cytokeratins

Question 39

Treatment targets for small cell carcinoma

Answer 39

oncogenes - myc | Tumour suppressor - p53, Rb, 3p

Question 40

Treatment targets for non small cell carcinoma

Answer 40

oncogenes - myc, K-ras, EGFR | Tumour suppressor - p53, Rb, 1,3,9,11q

Question 41

what oncogene is often activates by non smokers in adenocarcinoma and how is it identified

Answer 41

EGFR | biopsy or cytology, treated with tyrosine kinase inhibitors

Question 42

What fusion oncogene can be used to identify a drug treatment target

Answer 42

EML4-ALK

Question 43

how do some lung cancers activate the cytoxic immune response

Answer 43

PD-L1 binds to PD receptor on T cells | inhibited by targeted therapy

Question 44

what is a primary malignant neoplasm

Answer 44

mesothelioma

Question 45

true/false - pleural neoplasia is commonly malignant

Answer 45

true

Question 46

what is a carcinoid

Answer 46

neuroendocrine neoplasm with low grade malignancy

Question 47

where is a bronchial gland neoplasm often found

Answer 47

salivary glands

Question 48

where would a pripheral adenocarcinoma be found and how common is it

Answer 48

becoming more common | neoplastic cells along alveolar walls

Question 49

what is squamous metaplasia

Answer 49

ciliated columnar epithelium changing to squamous

Question 50

true/false - a higher TNM stage means better prognosis

Answer 50

false - higher means worse prognosis

Question 51

how long before half of lung cancer patients are dead

Answer 51

6 months

Question 52

which type of lung cancer is best suited for chemo

Answer 52

small cell, it is rapidly progressive so rarely suited for surgery Chemo will recede cancer but will not go away

Question 53

what can be used to treat non small cell lung cancer

Answer 53

palliative chemotherapy | surgery and radical radiotherapy

Question 54

what factors will be considered prior to surgery

Answer 54

``` will patient make it? can tumour be cut out? residual function? staging/metastases? proximity to carina? ```

Question 55

what surgeries could be performed?

Answer 55

lobectomy pneumonectomy - less common thoracotomy or by VATS

Question 56

most common type of chemotherapy for lung cancer?

Answer 56

palliative

Question 57

what must be collected in order to correctly select a type of chemotherapy

Answer 57

tissue sample - usually from biopsy

Question 58

how curative is cytotoxic chemotherapy

Answer 58

not very, better response in small cell cancer

Question 59

chemotherapy target cells that divide rapidly/slowly

Answer 59

rapidly

Question 60

radical radiotherapy has what intent

Answer 60

to cure

Question 61

palliative radiotherapy aims to?

Answer 61

shrink tumours and reduce effect of symptomatic metastases

Question 62

does radiotherapy have a limit

Answer 62

yes, damage can be caused by too much radiation

Question 63

where can collateral damage from radiotherapy occur?

Answer 63

oesophagus - dysphagia spinal cord - paralysis fibrosis of lung tissue

Question 64

what is SABR

Answer 64

small doses of radiation combining to one large dose

Question 65

what is endobronchial therapy

Answer 65

photodynamic therapy, laser therapy and stent insertions

Question 66

how is a treatment plan determined

Answer 66

cell type, extent of cancer and patient wishes

Question 67

co-morbidities of lung cancers

Answer 67

smoking related disease - COPD | ischaemic heart disease