Pahtology of lung cancers

Question 1

What are the leading causes of lung cancers in order?

Answer 1

Tobacco
Asbestos
Environmental radon exposure (granite)
Occupational exposures
Air pollution
Pulmonary fibrosis

Question 2

What quantity of lung cancers are attributable to smoking?

Answer 2

> 85%

Question 3

If a smoker has lung cancer, is smoking always the cause?

Answer 3

No

Question 4

Does risk of lung cancer drop after quitting smoking?

Answer 4

Yes, but slowly and takes place over a long period of time. 15 years+ down the line there is still a measurable risk among heavy smokers.

Question 5

What kind of cancer is caused by N-nitrosamines?

Answer 5

Adenocarcinomas

Question 6

What are the 2 kinds of epithelia in lungs?

Answer 6

Epithelium of the bronchi and bronchioles

Epithelium of the periphery

Question 7

Do more cancers occur in the periphery or the bronchi/bronchioles?

Answer 7

Periphery

Question 8

What kind of lung cancer would a non-smoker would be most likely to develop?

Answer 8

Adenocarcinoma

Question 9

What are the 4 main cell types of lung cancers?

Answer 9

Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

Question 10

What kind of cancer cell type is usually responsible cavitating cancers?

Answer 10

Squamous cell carcinomas

Question 11

List some local effects of lung cancer.

Answer 11

Bronchial collapse
Endogenous lipoid pneumonia
Infection/abscess
Bronchiectasis
Inflamed pleura
Damage to nerves
Lymphadenopathy

Question 12

Which nerves are commonly invaded by metastases?

Answer 12

Phrenic
Left recurrent laryngeal (weird cough)
Brachial plexus
Cervical sympathetic (Horner’s syndrome)

Question 13

Give some examples of some non-metastatic effects of lung cancer.

Answer 13

Clubbing
Gynecomastia
Nephrotic syndrome

Question 14

What kind of cancer leads cancer deaths in the UK?

Answer 14

Lung

Question 15

What proportion of cancer deaths in the UK are from lung cancer?

Answer 15

22%

Question 16

List some common symptoms of lung cancer?

Answer 16

Cough
SOB
Haemoptysis
Hoarse voice

Question 17

What are the 5 “red flag” symptoms doctors look out for in smokers which result in referral to a specialist/surgery

Answer 17

Any cough of smoker greater than 3 weeks
Haemoptysis
Shoulder pain
Change in voice
Unexplained weight loss

Question 18

What are the most common organs for cancer spread from lungs?

Answer 18

Liver and kidneys

Question 19

What does EBUS mean?

Answer 19

Endobronchial Ultrasound

Question 20

When would ultrasound be useful in diagnosis?

Answer 20

If the tumour is near the chest wall.

Question 21

Describe stage 1 cancers

Answer 21

Localised
Can be surgically removed
Can be tracked by CT or PET scans

Question 22

What does it mean if the cancer has metastasised to the liver?

Answer 22

Stage 4

Question 23

What is the performance status?

Answer 23

ECOG
PS1 is some cancer and some symptoms but doesn’t affect daily routine

PS2 Up and about for more than 50% of the day

PS3 Capable only of limited self care. Confined to bed or chair more than 50% of the day

PS4 Completely disabled. Unable to carry out self care.

Question 24

Important points while breaking bad news

Answer 24

Make the diagnosis very clear.

Explain the plan of action.

Question 25

How should mediastinum appear on X-ray?

Answer 25

Hilar vascular structures should be crisply defined Trachea should be central No widening of the mediastinum

Question 26

What kind of tumour often affects the brachial plexus?

Answer 26

Right apex/pancoast tumour

Question 27

What's the difference between a nodule and a mass

Answer 27

Mass is opacity >3cm | Nodule is oapcity <3cm

Question 28

What does TNM staging measure?

Answer 28

Size and position of the tumour (T) Whether tumour cells have spread to lymph nodes (N) Whether the tumour has metastasised (M)

Question 29

Describe T1 stage tumour.

Answer 29

Tumour less than 3 cm | Surrounded by lung or visceral pleura

Question 30

Describe T2 stage tumour.

Answer 30

Between 3 and 5 cm Involves main bronchus, but not carina Invades visceral pleura

Question 31

Describe T3 stage tumour.

Answer 31

``` Between 5 and 7 cm Invades chest wall Invades phrenic nerve Invades parietal pericardium Separate tumour nodules on the same lobe as the primary ```

Question 32

Describe T4 stage tumour.

Answer 32

``` Over 7 cm Invades any of the following: -Diaphragm -Mediastinum -Heart -Great vessels -Trachea -Recurrent Laryngeal Nerve -Oesphagus -Vertebral body -Carina ```

Question 33

Describe T4 stage tumour.

Answer 33

``` Over 7 cm Invades any of the following: -Diaphragm -Mediastinum -Heart -Great vessels -Trachea -Recurrent Laryngeal Nerve -Oesophagus -Vertebral body -Carina ```

Question 34

Describe N0 tumour.

Answer 34

No regional lymph node metastases

Question 35

Describe N1 tumour.

Answer 35

Ipsilateral peribronchal, hilar or intrapulmonary nodes including by direct extension

Question 36

Describe N2 tumour.

Answer 36

Ipsilateral mediastinal , subcarinal

Question 37

Describe N3 tumour.

Answer 37

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

Question 38

What proportion of patients present with metastases?

Answer 38

Approximately one third