Oncology - Lung Cancer General

Question 1

How common is lung Ca?

Answer 1

MOST COMMON cancer

LEADING CAUSE of cancer death

Question 2

Describe clinical features of Adenocarcinoma

Answer 2

• 85% of NSCLC
• Typically peripheral
• assoc with SMOKING
  BUT
  most common type of lung Ca in NONSMOKERS

Question 3

Histo features of adenocarcinoma

Answer 3

Histo: signet ring, or clear cell

Question 4

Describe clinical features of Squamous Cell Carcinoma

Answer 4

Usually central

MORE COMMON in smokers

Question 5

Describe clinical features of small cell cancer and the poor prognostic features

Answer 5

• MORE AGGRESSIVE than NSCLC
• MORE SENSITIVE to chemo

Poor Px:

• Extensive stage
• Poor performance status
• Hyponatraemia
• Elevated ALP
• Elevated LDH

Question 6

Poor Prognosis Factors in NSCLC

Answer 6

• reduced performance status
• higher stage
• weight loss >10% in large 6 months
• presence of systemic symptoms
• histology:
  large cell (LEAST FAVOURABLE), Adenocarcinoma (MOST FAVOURABLE)

Question 7

Aside from hx of smoking (including passive) or exposure to indoor cooking fumes, what other risk factors for lung cancer?

Answer 7

Asbestos
Marijuana
Heavy metals
Radon
Radiation (esp breast and Hodgkins)

Question 8

Describe bronchial carcinoid Tumour: who gets them, how do they present

Answer 8

• Most common in CHILDREN and ADOLESCENTS
• Present with Sx of endobronchial narrowing or obstruction
• Carcinoid syndrome in 1-5%

Question 9

Features of Carcinoid syndrome

Answer 9

Release vasoactive substances ie serotonin
–> flushing, bronchospasm, diarrhoea

Assoc with:

• larger size
• presence of liver mets

Question 10

Describe mesothelioma

Answer 10

• Aggressive
• Most significant RF is asbestos exposure
• usually develop Sx from slowly enlarging pleural effusion

Question 11

How do you diagnose mesothelioma?

Answer 11

Either thoracentesis or closed pleural biopsy

Question 12

Where do pulmonary metastasis usually come from?

Answer 12

Carcinomas (colon, kidney, breast, testicle and thyroid)
Sarcoma
Melanoma

Question 13

Where do ENDOBRONCHIAL metastasis come from?

Answer 13

Usually renal cell carcinoma

Question 14

What tumours spread with lymphangitic spread?

Answer 14

Adenocarcinomas (esp lung, breast and GIT)

Question 15

If you see peripheral interstitial abnormality on HRCT which metastatic Cancers could you think of?

Answer 15

Melanoma
Lymphoma
Leukaemia

Question 16

DDx ANTERIOR mediastinal mass

Answer 16

1) Anterior mediastinal thymoma
2) lymphoma (usually younger, most commonly Hodgkins, then lymphoblastic then primary mediastinal diffuse large B Cell lymphoma)
3) teratoma

Question 17

Which paraneoplastic syndromes do you see in anterior mediastinal thymoma?

Answer 17

Usually in middle aged adults

• myasthenia gravis
• pure red blood cell aplasia
• nonthymic cancers
• acquired hypogammaglobulinaemia

Question 18

DDx middle mediastinal mass

Answer 18

Lymphadenopathy is most common

Cystic structures

Question 19

Where do NSCLC metastasise to?

Answer 19

Brain
Bone
Liver
Adrenal gland

Question 20

Which lung cancer do you NOT see finger clubbing in?

Answer 20

Small cell lung cancer

Question 21

Features of PANCOAST Tumour

Answer 21

• superior sulcus tumours
• usually NSCLC
• pain in shoulder and neuropathic arm pain
• Horner’s syndrome
• wasted hand muscles (T1)

Question 22

Difference between PET and MRI in diagnosis

Answer 22

PET

• does T well
• good NPV for N but poor PPV
• Very good for extrathoracic mets

MRI is superior for brain mets

Question 23

Small Cell Lung Ca STAGING

Answer 23

LIMITED: confined to ipsilateral hemithorax

EXTENSIVE: mets outside

Question 24

Small Cell Lung Ca TREATMENT

Answer 24

LIMITED:

• curable in 20-30% with chemoradiotherapy
• cisplatin and etoposide
• prophylactic cranial irradiation

EXTENSIVE:
incurable
Palliative chemoradiotherapy

Question 25

Staging of NSCLC

Answer 25

STAGE 1:
T<5cm and N0

STAGE 2:
T 5-9cm OR N1 (peribronchial or hilar LNs)

STAGE 3:
T <9cm OR invasion OR N2-3 (mediastinal or supraclavicular)

STAGE 4:
M1 including malignant effusion

Question 26

Treatment of resectable STAGE 1, 2 & 3 lung NSCLC

Answer 26

STAGE 1:
T<5cm and N0

STAGE 2:
T 5-9cm OR N1 (peribronchial or hilar LNs)

STAGE 3:
T <9cm OR invasion OR N2-3 (mediastinal or supraclavicular)

Surgery!
- lobectomy preferred

STAGE 2 ADD IN ADJUVANT CHEMO
- cisplatin based (plus vinorelbine)

Question 27

Why is LOBECTOMY preferred in Stage 1 and 2 NSCLC

Answer 27

WEDGE: higher rate local recurrence

PNEUMECTOMY: higher risk complications and mortality, ESP RIGHT SIDED

Question 28

Treatment of non-resectable Stage 2 or 3 Lung Ca

Answer 28

STAGE 2:
T 5-9cm OR N1 (peribronchial or hilar LNs)

STAGE 3:
T <9cm OR invasion OR N2-3 (mediastinal or supraclavicular)

Treat with CHEMORADIOTHERAPY

If N2 disease and pancoast can give chemo as neoadjuvant and then try surgery

Question 29

Treatment of Advanced NSCLC (stage 4)

Answer 29

Early referral to palliative care
(Survival benefit)

Look for targets for targeted therapy

If no targetable mutations:
First give double platinum chemo
Then use pemetrexed if squamous cell

Question 30

Contraindications to Lung Ca Surgery

Answer 30

• SVC obstruction
• FEV <1.5
• MALIGNANT pleural effusion
• Vocal cord paralysis
• Tumour near hilum
• Metastasis