reducing the impact of cancer

Question 1

primary prevention of cancer

Answer 1

physical activity
diet
tobacco cessation
sunscreen use

Question 2

secondary prevention of cancer

Answer 2

NSAIDs
colonoscopy
mammography
pap smear/cytology
endoscopy

Question 3

tertiary prevention

Answer 3

adjuvant intervention
targeted therapies
palliative care

Question 4

wilson/who criteria for screening

Answer 4

IATROGENIC:
important health problem
acceptable treatment
treatment available
recognisable early stage
who to treat
guaranteed safety
examination acceptable
natural history of disease known
inexpensive
continuous screening

Question 5

standard biopsy vs liquid biopsy?

Answer 5

standard is time intensive, localised, not easily obtained, includes some pain/risk, and is invasive.

liquid is quick, comprehensive, easily obtained, less pain/risk, less invasive

Question 6

lung cancer symptoms?

Answer 6

cough/haemoptysis
shortness of breath
hoarse voice
non resolving pneumonia
weight loss
fatigue
paraneoplastic effects
seizures
pathological features

Question 7

signs of lung cancer

Answer 7

cachexia
finger clubbing
lymphadenopathy
reduced air entry
hoarseness
stridor
distended neck veins
signs of metastasis

Question 8

radiology tests for lung cancer

Answer 8

x-ray, then CT to confirm.

Question 9

TNM classification?

Answer 9

Tumour
Nodes
Metastases

Question 10

likely places lung cancer will metastasise to?

Answer 10

pleura
lymph nodes
adrenal gland
brain

Question 11

different types of lung cancer?

Answer 11

small cell
non-small cell (localised, regional, distant)

Question 12

lung cancer - risks of obtaining a biopsy

Answer 12

pneumothorax
haemorrhage
air embolism (air in blood vessel)

Question 13

2 ways of obtaining a tissue sample in lung cancer

Answer 13

bronchoscopy
bronchial ultrasound to sample lymph nodes
CT guided biopsy
pleural aspirate
surgical

Question 14

2 types of tissue specimens?

Answer 14

histology (normal, preserved formation)
cytology (cells spread across glass)

Question 15

first diagnostic differentiation in lung cancer biopsies

Answer 15

small cell or non small cell carcinoma

Question 16

types of non small cell carcinoma (lung cancer)

Answer 16

squamous cell carcinoma
adenocarcinoma
poorly differentiated NSCLC

Question 17

adenocarcinoma appearance? diagnostic marker?

Answer 17

malignant cells lining central spaces in glandular structures. marker called TF.

Question 18

immunostaining used in squamous cell carcinoma?

Answer 18

P40

Question 19

poorly differentiated NSCLC - diagnosis?

Answer 19

immunohistochemistry

Question 20

lung cancer treatment - localised disease?

Answer 20

surgery
radical radiotherapy

Question 21

lung cancer treatment - advanced disease?

Answer 21

chemotherapy
immunotherapy
targeted therapies

Question 22

what is EGFR?

Answer 22

epidermal growth factor receptor (chromosome 7)
invokes cell proliferation and survival.

Question 23

EGFR mutation features?

Answer 23

loss of stability of inactive form
ligand-independent activation
oncogene addiction (cancer cells need EGFR signalling to survive)

Question 24

normal function of PD1 an PDL1

Answer 24

PD1 t (on T cell) binds with PDL1 (on tumour cell), this switches the immune recognition off.

Question 25

what happens when PDL1 is blocked

Answer 25

cannot bind to PD1, allows T cell to resume killing tumour cell

Question 26

factors in deciding treatment in lung cancer

Answer 26

patient choices
patient fitness/co-morbidities
stage of disease
histological diagnosis
molecular/environment phenotype

Question 27

lung cancer risk factors

Answer 27

tobacco smoke
air pollution
occupational (asbestos, silica etc)
ionising radiation
chronic lung inflammation
genetics