Week 4: Neoplasia, Lung Ca, Pathology, Radiology

Question 1

Local Effects of Lung Tumours

Answer 1

1. Haemoptysis: central bronchial lung ca
2. Obstruction: collapse, 2º infection, abcess, bronchiecstasis
3. Lymph N. mets: common, widespread effects
4. Direct invasion: chest wall, nerve invasion: diaphgragm; voice; horner’s syndrome, panacoast T1 damage, cerebral oedema, paralysis
5. Pleural: mets, effusion, fibrosis, pleuritis

Question 2

Clinical Features of Lung Ca

Answer 2

1. Direct lung effects
2. Oesophageal effects
3. Paraneoplastic Effects (Ca, Na, Anaemia)
4. Systemic

Question 3

Horner’s Syndrome

Answer 3

condition characterized by miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). It is caused by damage to the sympathetic nerves of the face

Question 4

Define the types of lung carcinoma

Answer 4

Benign
Lymphoma
Carcinoid Tumour (low grade lung neoplasms)
Bronchial Glands
Alveolar Cell Ca
Mets
Sarcoma
Small cell carcinoma
Large cell carcinoma

Question 5

Describe the epidemiology and pathogenesis of primary lung cancer.

Answer 5

1. Tobacco, M > F, asbestos, environmental radon, occupational exposure
2. Genomic alterations in stem cell => multi-hit theory; inherited polymorph predisposition

PERIPHERAL BRONCHIOALV. EPITH. SC = ADENOCARCINOMA (kras)

CENTRAL BRONCHIAL SC = SQUAMOUS CELL CARCINOMA (complex)

Question 6

Describe how lung cancer spreads both within and outwith the thorax.

Answer 6

1. Metastise via lymph nodes and into the systemic circulation
2. Invasion of local structures and outwards, nerves, muscle, pleura

Question 7

Describe the investigation and staging process used to plan management of lung cancer.

Answer 7

1. cxr, bloods, renal/liver funct test, spirometry
2. CT
3. Tissue Dgn: biospies (guided/not)
4. Differentiate & Staging: TNM
5. Tx decision: Performance status; ECOG; Patient wishes; MDT; radical or palliative?

Question 8

Describe the types and causes of a localised opacities (coin lesion) on the chest xray.

Answer 8

1. PULMON NODULE: up to 3cm, no mediastinum adenopathy or atelectasis (unilateral collapse or closure of a lung resulting in reduced or absent gas exchange)
2. PULM. MASS: 3cm+ w/ no mediastinum adenopathy, atelectsasis

\+ mets
\+benign: carcinoid, harmatoma, calcium speckles
\+ infection
\+ vascular haemotoma
\+ previous cavitating illness
\+pulm emboli

Question 9

NSCLC Vs SCLC

Answer 9

1. NSCLC - More common, adenocarcinoma, squamous, (many pancoast tumours are NSCLC) doubling time 129days
2. SCLC similar pres but secretory symptoms more common, 29d doubling. Less common (15%)

Question 10

Treatment definitions

Answer 10

ADJUVANT: afer a definitive procedure

NEO-ADJ: pre-op

RADICAL: curative dose

SABR: ablative radiotherapy (similar outcomes to surgery! - tumours up to 4cm only)

Question 11

NSCLC Tx options

Answer 11

1. ADJUVANT chemotherapy, RT (mediastinal involvement)
2. NEOADJ. non
3. RADICAL. sfx: lethargy, oesophagitis, SOB, fibrosis
4. Concurrent ChemRT, greater survival but greater toxicity, increases radiosensitivity of tumor

Question 12

SCLC Tx Options

Answer 12

1. CRT

2. Extensive disease

Question 13

Palliative Rx in Lung Ca

Answer 13

1. ChemoT: doublet, regular check
2. ImmuT: PDL1, lowered fitness required,
3. TKI: adenocarcinoma with driver mutation (EGFR, ALK, BRAF, ROS); younger, non smoker
4. Palliative RT: symptom mgmt if bone involvement

Question 14

Side Effects of Lung Ca Tx

Answer 14

ChT: fast dividing cells affected, marrow suppression SEPSIS

RT: lethargy, surrounding organs, MI risk, 2º malignancies risk

ImmT: inflammation, colitis, dermatitis, pneumonitis

Question 15

Adenocarcinoma origin and progression

Answer 15

(peripheral origin)

bronchioalveolar epithelial stem cells > adenocarcinoma in situ > invasive adenocarcinoma of the lung

Question 16

Squamous cell carcinoma origin and progression

Answer 16

(central origin)

central bronchial stem cells > squamous cell carcinoma

Question 17

most common areas for lung cancer to spread to

Answer 17

The most common areas for lung cancer to spread to are:
nearby lymph nodes.
the brain.
bones.
the liver.
the adrenal glands (small hormone glands just above your kidney)
other parts of the lung or the other lung.