Lung cancer

Question 1

What are the two main types of lung cancer? And which is more common?

Answer 1

Small cell and non-small cell. Non-small cell more common

Question 2

Where are small cell lung cancers found?

Answer 2

Centrally, near mediastinum, often as solitary nodule

Question 3

Define paraneoplastic syndrome

Answer 3

Set of clinical features caused by altered immune response due to systemic metastasis or substances released by tumours

Question 4

What are the paraneoplastic syndromes caused by small cell lung cancer?

Answer 4

SIADH, Lambert-Eaton syndrome, Cushing syndrome

Question 5

What are the sub-sets of non-small cell lung cancer?

Answer 5

Adenocarcinoma, Squamous cell carcinoma, Large cell carcinoma, Bronchial carcinoid, Mesothelioma

Question 6

Where are adenocarcinomas found?

Answer 6

Peripherally (in lung), solitary nodule

Question 7

What genetic mutations are involved in adenocarcinoma?

Answer 7

KRAS, EGFR, ALK

Question 8

What are the characteristics of hypertrophic osteoarthopathy and what form of lung cancer causes it?

Answer 8

Clubbing, periostitis, distal expansion of long bones. Adenocarcinoma

Question 9

What is the histological feature of adenocarcinoma?

Answer 9

Glandular (tall, columnar), positive mucin

Question 10

Where are squamous carcinomas found?

Answer 10

Centrally, hilar mass near bronchus, associated with smoking

Question 11

What are the paraneoplastic syndromes caused by squamous cell cancer?

Answer 11

Hypercalcemia, low PTH,

Question 12

What is the histological feature of squamous cell carcinoma?

Answer 12

Keratin pearls, intracellular bridges

Question 13

Where are large cell carcinomas found?

Answer 13

Peripheral nodule, undifferentiated, poor prognosis, unresponsive to chemo/surgery preferred

Question 14

What are the paraneoplastic syndromes caused by small cell lung cancer?

Answer 14

Increase beta-hCG

Question 15

Where are bronchial carcinoid found?

Answer 15

Originates from intestine. Good prognosis and rarely metastasises

Question 16

What are the paraneoplastic syndromes caused by bronchial carcinoid?

Answer 16

Increased serotonin, flushing, right sided valvular defect, diarrhoea, bronchospasms

Question 17

Where are mesotheliomas found?

Answer 17

Malignancy of lung pleura, caused by asbestos,

Question 18

What is the histological feature of mesotheliomas?

Answer 18

Calcium deposits, positive cytokeratin + calretinin (positive in mesotheliomas but negative in most other cancers)

Question 19

What are some of the causes of lung cancer?

Answer 19

Smoking, exposure (e.g. asbestos, radon, arsenic, uranium), idiopathic (especially adenocarcinoma)

Question 20

What are the clinical features of lung cancer?

Answer 20

Cough, haemoptysis, progressive dyspnea, chest pain

Question 21

What are some extra pulmonary symptoms of lung cancer?

Answer 21

Superior vena cava syndrome, swelling of arms and face, compression of recurrent laryngeal nerve, Horner’s, pleural effusion

Question 22

How are lung cancers staged?

Answer 22

TNM staging. NSCLC staged via TNM. SCLC based on whether there is spread to other hemithorax

Question 23

How are lung cancers diagnosed?

Answer 23

Chest X-ray (nodule, hilar enlargement, consolidation, lung collapse, pleural effusion), cytology of sputum and pleural fluid, fine needle aspiration/biopsy, CT staging

Question 24

What are the treatments of lung cancer?

Answer 24

NSCLC: Lobectomy (small tumours), radical radiotherapy, radiotherapy with chemotherapy(e.g. cetuximab) (advanced)
SCLC: Surgery, chemo/radiotherapy