Lung Tumours

Question 0

What other types of lung cancers Give the percentages of likelihood?

Answer 0

Adenocarcinoma 40% > 
Squamous cell carcinoma 30% > 
Small cell lung carcinoma 15% >
Large cell carcinoma 10% >
Bronchial carcinoid 5%

Question 1

What are the risk factors of lung tumours?

Answer 1

Cigarette smoke – polycyclic aromatic hydrocarbons
Arsenic=increase p(squamous cell carcin. of lung)

Asbestos – lung cancer >mesothelioma

Radon: soil/uranium miners – >uranium radioactive decay – > (usually go to atmosphere) + (accumulate in closed spacesas odourless colourless gas = radon– >Go to lung – >Lung cancer

Metals: arsenic beryllium cadmium chromium,

Air pollution

TB,
SecondHHHHand smoke,

Ionising radiation, Family history

Question 2

Where other metastatic sites for long cancer?

Answer 2

Hilar lymph-node >
Adrenal >
Liver >
Brain >
Bone osteolytic

Question 3

How does a lung cancer present as ?

Answer 3

Haemoptysis bronchial obstruction dyspnoea coin like lesion

If coin like lesion is same size compared to old x-ray ddx= granuloma (TB, histoplasmosis) or bronchial hamartoma metastatic/primary cancer >50 years

SVC syndrome,
Pancoast tumour – SVC syndrome, sensorimotor issues, hoarseness due to recurrent laryngeal nerve compression,
damage sympathetic ganglion = Horner syndrome = ipsilateralptosis, ipsilateral miosis, ipsilateral anhydrosis
Paraneoplastic syndrome e.g. hypertrophic (osteoarthropathy = bronchogenic carcinoma) + (Eaton Lambert = small-cell carcinoma)
Ectopic hormone secretion
Effusion of the pleua/pericardial

Question 4

How do we treat small-cell and non-small cell cancers?

Answer 4

@Microscope:

if see small cells = small CC = 15% – need chemo
see large cells = non-small CC = 85%– Need surgery

Question 5

Histologically what do you see for each of the NON-small CC?

Answer 5

Adenocarcinoma – glands/mucus production

SquamousCC – keratin pearls + INTERcellular bridges

Large-cell cc:
no glands/mucus
No keratin pearls,
No INTER cellular bridges

Question 6

At CXR what do you see all the types of cancers?

Answer 6

Central mass = small/squamous CC

Peripheral mass = adenocarcinoma, scar carcinoma, large CC

Question 7

Explain pathophysiology of small-cell carcinoma

Answer 7

Small cc central neoplasm smoking

Kulchitsky cells = darkblue cells – >Necrosis, mitotically active, poorly differentiated, aggressive – >

Paraneoplastic’s :
SIADH, ACTH = Cushing’s,
Eaton Lambert (AB’s against presynaptic calcium channels = myasthenic syndrome)
Paraneoplastic myelitis/and cephalitis of neurons

Question 8

Explain pathophysiology of squamous CC

Answer 8

Squamus smokers Central Hilar

Keratin pearls, inter cellular bridges – >produce parathyroid hormone related peptide – >Hypocalcaemia

Question 9

Explain adenocarcinoma

Answer 9

ALK, KRAS, EGFR – > Hypertrophic osteoarthropathy

Bronchioloalveolar subtype = adenocarcinoma in situ from Clara cell – >cancergrows along alveolar septa– > Thickening of alveolar walls– >CXR = hazy infiltrates

Question 10

Explain large CC

Answer 10

Large cell carcinoma – >smoking – > Surgery

Question 11

Explain bronchial carcinoid tumour

Answer 11

Central//peripheral well-differentiated neuroendocrine cells chromogranin positive = polyp like maths

Question 12

Where is metastasis to lung likely to derive from ?

Answer 12

Breast colon prostate bladder

Question 13

Percentage survival of lung cancer?

Answer 13

15% Non-small CC >small cc