Lung tumours

Question 1

What are the two parts of the lung that can develop primary tumours?

Answer 1

Bronchial or pleural tumours

Question 2

Risk factors for lung cancer?

Answer 2

Cigarette smoking 
Asbestos 
Chromium 
Arsenic 
Iron oxides
Radiation

Question 3

95% of lung cancers are malignant. There are two classes of malignant lung cancer, what are they?

Answer 3

Small cell

Non small cell

Question 4

Describe small cell lung cancers?

Answer 4

Arise from endocrine cells
Secrete polypeptide hormones
Metastasise early (poor prognosis)
Respond to chemo

Question 5

What are the 3 different types of non small cell lung cancer?

Answer 5

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

Question 6

What does the term adenoma describe?

Answer 6

Epithelial cell cancer

Question 7

Adenocarcinoma is a type of non small cell lung cancer. Describe adenocarcinomas in the lungs

Answer 7

Associated with asbestos
More common in non smokers
Usually occurs peripherally

Question 8

Squamous cell carcinoma is a type of non small cell lung cancer. How does it usually present?

Answer 8

Obstructive lesion

Question 9

Large cell carcinoma is a type of non small cell lung cancer. Describe large cell lung cancer?

Answer 9

Poorly differentiated tumour,

Metastasises early

Question 10

What is the prognosis of NSSC?

Answer 10

50% at 2 years with treatment

10% without treatment

Question 11

How does lung cancer present clinically?

Answer 11

Cough 
Dyspnoea 
Wheeze
Haemoptysis 
Dysphagia 
Hoarseness 
Chest pain 
Head, neck and arm swelling (SVCO)

Question 12

What symptoms of metastatic disease may present with lung cancer?

Answer 12

Bone pain
Headache
Hepatic/ abdominal pain
Seizures/ neurological deficit

Question 13

What are clinical signs of lung cancer?

Answer 13

Finger clubbing
Cachexia (weakness/ wasting of body in chronic illness)
Anaemia
Lymphadenopathy
Chest may show: consolidation, effusion or collapse

Question 14

What are none malignant causes of a nodule in lung on a chest X ray? (differential diagnosis)

Answer 14

Abscess 
Granuloma 
Carcinoid tumour 
Pulmonary hamartoma 
Cyst/ encysted effusion

Question 15

What is a hamartoma?

Answer 15

Benign malformation in a tissue that resembles a malignancy

Question 16

What 6 diagnostic tests would perform for lung cancer?

Answer 16

Cytology of sputum and pleural fluid
CXR
CT scan
PET scan
Bronchoscopy
Fine needle aspiration or biopsy

Question 17

What would CXR show in lung cancer?

Answer 17

Peripheral nodule 
Hilar enlargement 
Pleural effusion and consolidation
Lung collapse 
Bony secondaries

Question 18

What tests are used to determine staging of lung cancer?

Answer 18

Predominantly CT scan

PET scan

Question 19

How does a PET scan work?

Answer 19

Fluoro-2 deoxyglucose (FDG) taken up by rapidly dividing cells and not excreted)

Question 20

In TNM staging for NSCLC, how is T staged?

Answer 20

T0= none present

T1= under 3cm in bronchioles

T2= over 3cm and over 2cm from carina. Any size if pleural involvement/ obstructive pneumonitis.

T3=involves: chest wall, diaphragm, mediastinal pleura, pericardium or <2cm from carina. T >7cm and nodules in same lobe.

T4= involves mediastinum, heart, great vessels, trachea, oesophagus vertebral body, carina, malignant effusion, or nodules in another lobe

Question 21

In TNM staging for NSCLC how is N staged

Answer 21

N0= no nodes
N1= peribronchial or ipsilateral hilum
N2= Ipsilateral mediastinum or sub carinal 
N3= Contralateral mediastinum, hilum, scalene, supraclavicular

Question 22

Treatment for non small cell tumours?

Answer 22

Excision of peripheral tumours with no metastases (stage 1/2). If respiratory reserve is low radiotherapy may be curative.

For more advanced disease chemotherapy +- radiotherapy (not curative)

Question 23

How does TNM staging rank into a 1-4 staging?

Answer 23

1= T1/T2 N0 M0
2= T1/T2 N1 M0 or T3 N0 M0
3a= T3 N1 M0 or T1-3 N2 M0
3b= T1-4 N3 M0 or T4 N0-2 M0
4= anything with metastases

Question 24

How do you treat small cell tumours?

Answer 24

Usually already spread at presentation
May respond to chemo but will relapse
Chemotherapy (+- radiotherapy if chance of curing)

Question 25

Name some chemotherapy drugs used in small cell lung cancer treatment?

Answer 25

Cyclophosphamide
Doxorubicin
Cisplatin

Question 26

What is the difference between radical and palliative radiotherapy?

Answer 26

Radical= course of daily treatments, acute toxicity may be considerable (aims to cure)

Palliative radiotherapy= minimum number of visits compatible with symptom control, minimise acute toxicity

Question 27

Side effects of radiotherapy

Answer 27

Fatigue & anorexia
Cough
Oesophagitis
Systemic symptoms
Skin reactions
Nausea rare
Alopecia only if cranial irradiation

Question 28

What is the WHO performance status?

Answer 28

0 - normal activity without restriction
1 - restricted, can do light work
2 - self-caring but no work, up > 50% 
3 - limited self-care, in bed/chair > 50%
4 - no self-care, bed / chair bound

Question 29

Chemotherapy side effects

Answer 29

Alopecia
Nausea, vomiting, fatigue
Peripheral neuropathy
Constipation and diarrhoea
Mucositis
Rash
Bone marrow suppression (Anaemia, Neutropenia, Thrombocytopenia) 
Anaphylaxis

Question 30

Asides chemo and radiotherapy, what other measures are done in the palliation of lung cancer?

Answer 30

SVC stent for SVC obstruction
Pleural drainage
Drugs: analgesia, steroids, antiemetics, cough lintus (codeine), bronchodilators, antidepressants

Question 31

What are other lung tumours asides NSCC and SMC?

Answer 31

Hamartoma= rare and benign
Bronchial adenoma= rare, slow growing, requires surgery
Mesothelioma