Lung Cancer

Question 1

What are the risk factors for lung cancer?

Answer 1

• male
• tobacco
• alcohol
• HPV
• hygiene
• repeated trauma

Question 2

What are the most common cancers of the lung and what are the possible consequences?

Answer 2

• squamous carcinoma
• lymph node spread
• local recurrence

Question 3

What are the 2 conditions that encompass COPD?

Answer 3

• emphysema

- chronic bronchitis

Question 4

What is emphysema, the different types and the consequences of this?

Answer 4

• enlargement of air spaces by destroying tissue, results in less surface area for gas exchange
• capillary space around the alveoli decreases resulting in shunting of blood that does not get oxygenated
• centriobular emphysema
• panacinar emphysema (associated with host defect in protection against reactive oxygen species)

Question 5

What are some examples of interstitial lung disease with their features?

Answer 5

• hypersensitivity pneumonitis (type III/IV, bird fancier, farmer’s lung)
• sarcoidosis (granulomas)
• idiopathic pulmonary fibrosis (honeycomb lung around the base of the lung)

Question 6

What is interstitial lung disease?

Answer 6

• spectrum of changes where interstitium between alveoli become inflamed and over time become fibrotic
• restrictive lung disease

Question 7

What is the most common type of benign lung tumour and its features?

Answer 7

• mesenchymoma
• big nodule of cartilage
• due to maldevelopment of mesenchyme elements in the lung

Question 8

Where can primary malignant lung tumours arise?

Answer 8

• epithelium (metaplasia and dysplasia)
• vessels
• muscles
• cartilage
• lymphoid
• pleura

Question 9

What is metaplasia?

Answer 9

change from one differentiated cell type to another

Question 10

What is dysplasia?

Answer 10

• disordered proliferation and maturation of cells

- pre-malignant

Question 11

What are some key secondary lung tumours?

Answer 11

• sarcoma
• renal carcinoma
• lymphoma

Question 12

What are the different types of primary epithelial tumours of the lung?

Answer 12

• squamous
• adeno
• small cell undifferentiated
• carcinoid
• large cell undifferentiated

Question 13

What are the causes of squamous NSCLC?

Answer 13

• smoking
• air pollution
• asbestos
• fibrosing lung disease

Question 14

What are the causes for adenocarcinoma?

Answer 14

• smoking
• lung scar
• air pollution
• asbestos

Question 15

Describe the important consequences/paraneoplastic effects of small cell undifferentiated (SCLC)

Answer 15

• neuroendocrine (neurological consequences)

- paraneoplastic effects:may produce bioactive amines or peptides

Question 16

Describe the key features of carcinoid lung tumours

Answer 16

• malignant spectrum
• typical: towards less aggressive end of spectrum
• atypical: smoking realted, towards malignant end of spectrum

Question 17

What are paraneoplastic syndromes?

Answer 17

• a set of signs and symptoms not caused directly by the cancer
• may be related to the factors produced by the cancer
• may be immunological

Question 18

What are the different manifestations of the paraneoplastic syndromes?

Answer 18

• neurological
• endocrine
• skin (acanthosis nigricans EGF)
• connective tissue/bone: finger clubbing
• haematological (EPO)
• kidney disease (immune complex GN)

Question 19

What does molecular pathology look for?

Answer 19

• EGFR amplification
• BRAF mutation
• RAS mutation
• ALK rearrangements

Question 20

Describe PD1 and PDL1 checkpoint inhibition

Answer 20

PD1 and PDL1 bind to lymphocytes inhibiting the immune response so inhibiting it would prevent the inactivation of the immune response

Question 21

What are the current treatments of lung cancer?

Answer 21

• conventional chemotherapy
• immuno-oncology and checkpoint inhibitors
• targeted small molecule