Respiratory

Question 1

What are the classifications of lung cancer?

Answer 1

Non-small cell lung carcinoma
-Adenocarcinoma
-Squamous cell carcinoma
-Others
Small cell carcinoma
Carcinoid tumours
Metastases

Question 2

What history indicates lung cancer?

Answer 2

Persistent cough
Haemoptysis
Breathlessness
-Increasing, on little exertion
Chest pain

General cancer symptoms
Unintentional weight loss
Fatigue
Lymphadenopathy

• Cushing’s syndrome - central obesity and skin thinning with small cell carcinoma
• SIADH - neurological symptoms in small cell carcinoma
• Hypercalcaemia - increased thirst, urination, abdo main, constipation, limb aching, confusion, fatigue in small cell carcinoma
• Clubbing
• Neurological syndromes

Question 3

Causal factors in lung cancer?

Answer 3

Tobacco smoking
Passive smoke exposure
Family history
Industrials exposures
-asbestos
-heavy metals
-coal
Radiation
Pulmonary fibrosis
Air pollution
Rare genetic 
Sporadic

Question 4

In what type of person is lung cancer common in?

Answer 4

Old age, male sex, low SES, smoking

Question 5

What is the commonest cause of tumours in the lungs?

Answer 5

Metastases and not primary tumours

Question 6

How can you tell what type of tumours it is?

Answer 6

Immunohistochemistry

Question 7

What is the commonest type of lung cancer?

Answer 7

Adenocarcinoma

Weaker smoking association

Question 8

What immunohistochemistry marker is positive in adrenocarcinoma?

Answer 8

TTF1+

Question 9

What is the survival rate of lung cancer after 10 years?

Answer 9

5%

Question 10

Are most cancers preventable or not?

Answer 10

Yes they are preventable and big link to major lifestyle factors

Question 11

What is more important in a smoking history of lung cancer, length or quantity?

Answer 11

Length of time of smoking is more important

Question 12

Which type of cancer has a strong smoking association?

Answer 12

Squamous cell carcinoma

Small cell carcinoma

Question 13

What does adenocarcinoma look like in pathology slides?

Answer 13

Glandular structures with mucin in middle, start of well differentiated and become poorer

Question 14

Describe lung adenocarcinoma

Answer 14

Its a non-small cell type
Usually peripheral mass
Most common type of cancer
Weaker smoking association 
Glandular, with mucin formation
TTF1+
Arises from mucous cells

Question 15

Describe squamous cell carcinoma

Answer 15

Very strong smoking association
Generally central cavitating mass
keratinisation (deep pink), intra and intercellular, crumbly
P63+, p40+

Question 16

Describe small cell carcinoma

Answer 16

Only around 10% of lung cancers
Very strong smoking association
Found mostly in larger ariways
Arise from neuroendocrine cells
Poorly differentiated, minimal cytoplasm and crushed
Massive mediastinal lymphadenoapthy
TTF1+. synaptophysin+, chromagranin A+

Question 17

What is the main difference in treatment between small and non-small cell?

Answer 17

Small cell - virtually all cases stage IV at diagnosis, very rare cases are localised, surgery + adjuvant chemo

Non-small cell - 50% curable in principle, but generally unwell patients so more like 20% curative
Curative treat with surgery and adjuvant chemo
AND molecular therapy - tests for EGFR, ALK, PD-L1, ROS1