Lung tumors

Question 1

What stage of cancer do patients usually present with?

Answer 1

Advanced disease (stage III or IV)

Question 2

cancer which spreads to the lung

Answer 2

breast
colorectal
prostate
kidney
melanoma
thyroid
lymphoma

Question 3

tumors can be divided into b_______ and p_______

Answer 3

bronchial (95%)

pleural (5%)

Question 4

Aetiology

Answer 4

Smoking
Asbestos exposer
Radon inhalation

Question 5

Types of NSCLC

Answer 5

Squamous
Adenocarcinoma
Large cell

Question 6

What’s the 3rd most common cause of death in the UK?

Answer 6

Bronchial carcinoma

Question 7

Symptoms due to local disease

Answer 7

cough, chest pain, haemoptysis and breathlessness

Question 8

What would spread to the left recurrent laryngeal nerve cause?

Answer 8

hoarseness and bovine cough

Question 9

Where is it most likely to metastasise to?

Answer 9

Bone and brain

Question 10

Symptoms of non-metastatic manifestations

Answer 10

rare apart from finger clubbing

malaise, lethargy, weight loss

Question 11

What is paraneoplastic syndrome?

Answer 11

when a tutor secretes a protein that has a specific effects.

Classic Ca lung: low Na, high Ca, increased PTH

SIADH (syndrome of inappropriate ADH) secretion

Question 12

How to confirm the diagnosis?

Answer 12

CXR: tutors show as a round shadow, with a fluffy/spiked edge

Question 13

What would lymphangitis carcinomatis cause?

Answer 13

streaky shadowing throughout the lung

Question 14

How would you determine the histology?

Answer 14

cytological examination of sputum

Bronchoscopy: biopsies and washings

Question 15

How to assess the spread of the tutor?

Answer 15

TMN staging
Bronchoscopy
CT thorax
PET scan** to look for intrathoracic lymph node mets

Question 16

How to determine pt suitability for major op

Answer 16

physical ex + resp function tests

WHO performance status

Question 17

What is a synergistic effect?

Answer 17

when using 2 drugs, you have an amplified effect than just adding the 2 together — ? toxicity

Question 18

NSCLC Tx

Answer 18

early stage: surgery, radical RT

later stages: CT + RT, palliative chemo, palliative care

Question 19

What is CHART

Answer 19

continuous hyper-refracted accelerated radiotherapy

radical RT for NSCLC

Question 20

How to treat SCLC is confined to a single anatomical or radiation field?

Answer 20

combined chemo and RT

25% 5YSR

Question 21

How to treat extensive SCLC disease

Answer 21

chemo

Question 22

Why use prophylactic cranial irradiation?

Answer 22

10% of SCLCs have brain mets at Dx, but 65% have them at autopsy.

Question 23

SE’s of chemo

Answer 23

alopecia
nausea + vomiting
peripheral neuropathy
constipation + diarrhoea

Question 24

Chemo mechanism of action

Answer 24

cause cell death or prevent cell growth, through inhibiting microtubule function, protein function or DNA synthesis

Question 25

How does EGFR receptor inhibition work for NSCLCs?

Answer 25

Some NSCLCs have too much EGFR on their cell surface –> faster growth

This mutation can be targeted by some drugs

So at Dx, sent for test for 100 mutations

Question 26

Which has a worse prognosis SCLC or NSCLC?

Answer 26

SCLC