Pathology of Lung Cancers Part 2

Question 1

Where can distant metastases of lung cancer occur

Answer 1

Liver
Adrenals
Brain
Bone
Skin

Question 2

What secondary effects can occur due to lung cancer

Answer 2

Secondary effects to neural and vascular structures

Question 3

What other effects can lung cancer cause

Answer 3

Non-metastatic effects

Question 4

What will most patients with lung cancer present with

Answer 4

Systemic metastatic disease

Question 5

What kind of skeletal non-metastatic paraneoplastic effects can lung cancer have

Answer 5

Clubbing

HPOA

Question 6

What kind of cardiac non-metastatic paraneoplastic effects can lung cancer have

Answer 6

Thrombophlebitis migrans

Question 7

What kind of endocrine non-metastatic paraneoplastic effects can lung cancer have

Answer 7

ACTH, siADH, PTH
Carcinoid syndrome
Gynecomastia

Question 8

Where is ACTH and siADH seen

Answer 8

Small cell carcinoma

Question 9

Where is PTH seem

Answer 9

Squamous carcinoma

It produces hormone similar to PTH which produces calcium in the blood

Question 10

What is HPOA

Answer 10

Hypertrophic Pulmonary

Osteoarthropathy

Question 11

What type of investigations can be done

Answer 11

Chest X-Ray
Sputum Cytology rarely used
Bronchoscopy
Trans-thoracic Fine Needle Aspiration
Trans-thoracic Core Biopsy
Pleural effusion
Advanced Imaging Techniques

Question 12

What type of bronchoscopy can be done

Answer 12

Bronchial biopsy
Bronchial brushings and Washings
Endobronchial US-guided aspiration (EBUS)

Question 13

What type of advances imaging techniques are there

Answer 13

CT scanning
MRI
PET
Other imaging

Question 14

What prognostic factors can be used in lung cancer

Answer 14

STAGE of disease
CLASSIFICATION:  Type of disease
Markers/Oncogenes /Gene expression profiles
Growth Rate
Cell Proliferation
DNA Aneuploidy
Immune Cell Infiltration

Question 15

What can be used to select patients for adjuvant therapy

Answer 15

Prognostic markers

Question 16

What is the 5 year survival rate for people with lung cancer in Scotland and USA

Answer 16

Scotland - Under 9.8%

USA - Over 15%

Question 17

What is the 5 year survival rate for people with stage 1 operable lung cancer

Answer 17

Over 60%

Question 18

What is the 5 year survival rate for people with stage 2 operable lung cancer

Answer 18

35%

Question 19

How many patients with lung cancer in Scotland receive surgical treatment

Answer 19

10-12%

Question 20

What is the 5 year survival rate for non-small cell carcinomas

Answer 20

Anywhere between 10-25%

Some cell types do badly

Question 21

What is the 5 year survival rate for small cell carcinomas

Answer 21

4%

Median survival is 9 months

Question 22

What can be used to help select patients therapy

Answer 22

Predictive biomarkers

Question 23

What are the key biomarkers for patients with adenocarcinomas

Answer 23

EGFR
KRAS
HER2
BRAF mutations
ALK translocations
ROS1 translocations

Question 24

How much effective molecular targeted therapy is there for squamous cell carcinomas

Answer 24

Very little

Question 25

What has immunotherapy been found to be helpful in

Answer 25

Advanced stage 4 NSCLC

Question 26

What is the PDL1/PD-L1 axis immune checkpoint useful for in NSCLC

Answer 26

It is an important biomarker

Important therapeutic target

Question 27

Drugs which are effective against what are gaining increased use in lung cancers

Answer 27

PD1, PD-L1 and CTLA4 checkpoints