Lung Tumours

Question 1

What % of lung tumours are squamous cell carcinomas?

Answer 1

30-50%

Question 2

State the genetic mutations commonly found in lung squamous cell carcinomas

Answer 2

p53/c-myc

Question 3

Where are lung squamous cell carcinomas usually found?

Answer 3

Proximal bronchi

Question 4

Describe the appearance of lung squamous cell carcinoma on histology

Answer 4

Keratinisation, intercellular prickles (desmosomes)

Question 5

Name at least two subtypes of lung squamous cell carcinoma

Answer 5

Papillary, basaloid

Question 6

Which biochemical abnormality is associated with lung squamous cell carcinoma?

Answer 6

Hypercalcaemia

Question 7

Describe the progression to squamous cell carcinoma

Answer 7

Normal epithelium -> hyperplasia -> squamous metaplasia -> angiosquamous dysplasia -> carcinoma in sity -> invasive carcinoma -> local spread -> late metastases

Question 8

Which group is lung adenocarcinoma most common in?

Answer 8

Female non-smokers

Question 9

What is lung adenocarcinoma?

Answer 9

Malignant epithelial tumour with glandular differentiation or mucin production

Question 10

Describe the histology of lung adenocarcinoma

Answer 10

Glandular differentiation with cells containing mucin vacuoles

Question 11

Which mutation is typically found in lung adenocarcinoma?

Answer 11

EGFR mutation

Question 12

Describe the progression to adenocarcinoma

Answer 12

Normal epithelium -> atypical adenomatous hyperplasia -> non-mucinous BAC -> mixed pattern adenocarcinoma -> early metastases

Question 13

What % of lung tumours are adenocarcinomas?

Answer 13

20-30%

Question 14

What % of lung tumours are small cell carcinomas?

Answer 14

20-25%

Question 15

What % of lung tumours are large cell carcinomas?

Answer 15

10-15%

Question 16

Which cells do small cell lung carcinomas arise from?

Answer 16

Neuroendocrine cells

Question 17

Where do small cell lung carcinomas commonly metastasise to?

Answer 17

Bone, adrenals, liver, brain

Question 18

Which mutations are commonly found in small cell lung carcinomas?

Answer 18

p53, RB1

Question 19

What is the prognosis of small cell carcinoma and why?

Answer 19

Poor due to rapid metastases, despite being very chemosensitive

Question 20

Describe the histological appearance of large cell lung carcinoma

Answer 20

Large cells with large nuclei and prominent nucleoli, no evidence of glandular or squamous differentiation

Question 21

Which paraneoplastic syndrome is produced by tumour cells secreting ADH?

Answer 21

Syndrome of inappropriate ADH (SIADH)

Question 22

Which paraneoplastic syndrome is produced by tumour cells secreting ACTH?

Answer 22

Cushing’s syndrome

Question 23

Which paraneoplastic syndrome is produced by tumour cells secreting PTH or PTH related peptide?

Answer 23

Primary hyperparathyroidism

Question 24

Which paraneoplastic syndrome is produced by tumour cells secreting calcitonin?

Answer 24

Hypercalcaemia

Question 25

Which paraneoplastic syndrome is produced by tumour cells secreting serotonin?

Answer 25

Carcinoid syndrome

Question 26

Which paraneoplastic syndrome is produced by tumour cells secreting bradykinin?

Answer 26

Cough

Question 27

What are the features of carcinoid syndrome?

Answer 27

Flushing, diarrhoea, bronchoconstriction

Question 28

Name two mutations found in adenocarcinomas associated with no response to tyrosine kinase inhibitors

Answer 28

K-ras mutation, EML4-ALK mutation

Question 29

Name a mutation found in non-small cell lung cancer associated with a poorer response to cisplatin

Answer 29

ERCC1

Question 30

Where do mesotheliomas arise?

Answer 30

Parietal or visceral pleura

Question 31

What are the symptoms of mesothelioma?

Answer 31

Pleural effusion, chest pain, dyspnoea