Neoplasia

Question 1

What are the RISK FACTORS for lung cancer?

Answer 1

1) Smoking ( > 85%)
2) Passive Smoking
3) Occupational Exposure to Noxious Gases, Chemicals, Materials, etc (Asbestos)
4) Radiation
5) Air Pollution
6) Pulmonary Fibrosis

Question 2

What are the SIGNS of lung cancer?

Answer 2

1) Finger Clubbing
2) Lymphadenopathy
3) SVC Obstruction
4) Hepatomegaly
5) Wheeze
6) Dysphonia (Hoarseness)
7) Dysphagia
8) Haemoptysis
9) Weight Loss
10) Horner’s Syndrome
11) Skin Nodules (Metastases)

Question 3

What are the SYMPTOMS of lung cancer?

Answer 3

1) Chronic Cough
2) Dyspnoea
3) Chest Pain
4) Bone Pain
5) Recurrent Chest Infections

Question 4

What are the INITIAL INVESTIGATIONS for lung cancer?

Answer 4

1) CXR - Compare with Previous Films
2) FBCs - Serum Biochemistry (LFTs, Us and Es, Ca2+)
3) Clot Screening
4) Spirometry

Question 5

What FURTHER INVESTIGATIONS can be performed in the DIAGNOSIS of lung cancer?

Answer 5

1) CT Thorax and Abdomen
2) Bronchoscopy
3) Endobronchial Ultrasound (EBUS)
4) Image Guided Lung and Liver Biopsies
5) Fine Needle Aspiration of Cervical Lymph Node or Skin Metastases
6) Bone Biopsy
7) Mediastinoscopy

Question 6

What are the MAIN TYPES of lung cancer?

Answer 6

Non-Small Cell Lung Cancer (NSCLCs) - 85%:

Adenocarcinoma - 55%
Squamous Cell Carcinoma - 30%
Large Cell Carcinoma - 5%
*Others: Pleural Mesothelioma

Small Cell Lung Cancer (SCLC) - 15%

Question 7

What is a KEY INVESTIGATION in the STAGING of lung cancer?

Answer 7

CT Thorax/CT-PET Scan

Question 8

What is a pulmonary MASS?

Answer 8

Opacity in the Lung > 3cm

Question 9

What is a pulmonary NODULE?

Answer 9

Opacity in the Lung, Less Than or Equal to 3cm

Question 10

What is the PATHWAY of CARCINOGENESIS of ADENOCARCINOMA?

Answer 10

Lung Periphery

Bronchoalveolar Epithelial Stem Cells Transform

Question 11

What is PATHWAY of CARCINOGENESIS of SQUAMOUS CELL carcinoma?

Answer 11

Central Lung Airways

Bronchial Epithelial Stem Cells Transform

Question 12

ADENOCARCINOMA is, mostly, ASSOCIATED with which COHORT?

Answer 12

Non-Smokers

Question 13

SQUAMOUS CELL CARCINOMA is strongly ASSOCIATED with which COHORT?

Answer 13

Smokers

Question 14

What is the PATHOGENESIS of PRIMARY lung cancer?

Answer 14

1) Grows ‘Clinically Silent’
2) Presents LATE
3) Little to No Signs or Symptoms, Unless Very Advanced
4) Found Incidentally

Question 15

What are the LOCAL EFFECTS of lung cancer?

Answer 15

1) Bronchial Obstruction - Collapse; Infection/Abscess; Bronchiectasis
2) Pleura - Inflammation and Malignancy
3) Direct Invasion of Chest Wall - Nerve Impairment; Mediastinal and/or Pericardial Obstruction
4) Hilar Lymph Node Metastases

Question 16

What are the MAIN AREAS of DISTANT METASTASES, secondary to lung cancer?

Answer 16

Liver
Adrenals
Skeletal
Cerebral
Skin

Question 17

What does the TNM STAGING SYSTEM CATEGORISE?

Answer 17

T - Tumour
Size and Position

N - Nodes
Mediastinal Lymph Node Involvement

M - Metastases
Distant Metastases

Question 18

What are the PRINCIPLES to consider in the PALLIATIVE MANAGEMENT of lung cancer?

Answer 18

1) Symptom Control
2) Quality of Life
3) Community Support
4) Decisions and Planning, i.e. Resuscitation Status
5) End of Life Care
6) Multidisciplinary Involvement

Question 19

What does T1 STAGING indicate?

Answer 19

Dimension of the Tumour = Less than or Equal to 3cm

Question 20

What are the MAIN NON-METASTATIC EFFECTS of lung cancer?

Answer 20

Finger Clubbing

Hypertrophic Pulmonary Osteoarthropathy (HPOA)

Endocrine Dysfunction

Question 21

What does T2 STAGING indicate?

Answer 21

Dimension of the Tumour = > 3cm, but < 5cm

Question 22

What does T3 STAGING indicate?

Answer 22

Dimension of the Tumour = > 5cm, but < 7cm

Question 23

What does T4 STAGING indicate?

Answer 23

Dimension of the Tumour = > 7cm

Question 24

What are the TREATMENTS for lung cancer?

Answer 24

1) Chemotherapy, i.e. Cisplatin
2) Radiotherapy - Radical (Curative), Palliative
3) Surgery - Wedge Resection; Lobectomy; Pneumonectomy
4) Combination Therapies
5) Targeted Therapies - Specific Drugs for Cancers with Driver Mutations, i.e. Tyrosine Kinase Inhibitors for EGFR
6) Best Supportive Care

Question 25

What are the CONSIDERTIONS for the TREATMENT of lung cancer?

Answer 25

1) Performance Status
2) Patient Wishes
3) Type and Stage of Cancer
4) Multidisciplinary Team Input
5) Aims of Treatment, i.e. Radical or Palliative