Bronchial Carcinoma (Lung Cancer)

Question 1

What are the main risk factors for Bronchial Carcinoma?

Answer 1

Male sex, increased age and active/passive smoking

Question 2

What are the common sites of metastasis of bronchial carcinoma?

Answer 2

Brain, liver and bone

Question 3

What are the main classifications of lung cancer?

Answer 3

Small cell and Non small cell (adenocarcinoma, squamous cell and large cell)

Question 4

What percentage of lung cancers do small cell account for?

Answer 4

25% of tumours

Question 5

What percentage of lung cancers do large cell account for?

Answer 5

10% of tumours

Question 6

What is the most common type of lung cancer?

Answer 6

Adenocarcinoma

Question 7

What is the second most common type of lung cancer?

Answer 7

Squamous cell

Question 8

What are the main symptoms of lung cancer?

Answer 8

• Cough
• Heamoptysis.
• Shortness of breath
• Chest pain
• Weight loss
• Symptoms of metastasis (Bone pain, Confusion, seizures and focal neurological deficits and Myopathy, peripheral neuropathy)

Question 9

What are the main signs of lung cancer?

Answer 9

Consolidation, collapse, and pleural effusion

Question 10

What mutation do small cell tumours express?

Answer 10

TT1

Question 11

What are small cell tumours?

Answer 11

Highly metastatic neuroendocrine tumours

Question 12

What type of diseases is small cell tumours associated with?

Answer 12

Numerous paraneoplastic syndromes (LEMS, SIADH ACTH secretion/cushings)

Question 13

What mutation do adenocarcinoma express?

Answer 13

TTF1

Question 14

Where do small cell tumours tend to grow?

Answer 14

Centrally then disseminate quickly

Question 15

What is the most common type of lung cancer seen in non smokers?

Answer 15

Adenocarcinomas

Question 16

What are adenocarcinomas?

Answer 16

Gland forming, mucous producing tumours that most commonly grow in the peripheries of the lungs

Question 17

What are squamous cell tumours?

Answer 17

Keratinized tumour that is found centrally and frequently cavitates

Question 18

What paraneoplastic syndrome is associated with squamous cell tumours?

Answer 18

PTH like hormone secretion (hypercalcemia)

Question 19

What is a large cell tumour?

Answer 19

Any non small cell tumour that does not fit the criteria for adenocarcinoma or squamous cell carcinoma is classed as large cell

Question 20

What are some complications of lung cancer?

Answer 20

• Compression of recurrent laryngeal (hoarseness)
• Invasion of the oesophagus (dysphagia)
• Invasion of sympathetic chain (Horners syndrome)
• Paraneoplastic syndromes (SIADH, Cushings, Addison, Hypercalcemia, Polymyositis, Lambert eaton syndrome and Hypertrophic pulmonary osteoarthopathy)

Question 21

What investigations can be used to confirm a diagnosis of lung cancer?

Answer 21

• Bloods (FBC, U/E, LFT)
• Imaging (CXR, CT CAP, CT head, PET CT, bone scan)
• Cytology (sputum, bronchoscopy, pleural tap, biopsy)

Question 22

What is the first line imaging used for diagnosing lung cancer?

Answer 22

CXR

Question 23

What can a CXR show in lung cancer?

Answer 23

A mass, pleural effusion or hilar lymphadenopathy

Question 24

What is the importance of CT and PET CT in diagnosing/treating lung cancer?

Answer 24

It allows for accurate staging

Question 25

What is the importance of bone scan/head CT in diagnosing/treating lung cancer?

Answer 25

It investigates suspected metastasis

Question 26

What is the general treatment of small cell tumours?

Answer 26

Chemotherapy +/- radiotherapy.

Question 27

What is the general treatment of non small cell tumours?

Answer 27

• If suitable for surgery then lobectomy +/- chemotherapy / radiotherapy
• If non suitable for surgery then radiotherapy +/- chemotherapy

Question 28

What type of tumours are most chemosensitive?

Answer 28

Small cell

Question 29

What type of tumours are most radiosensitive?

Answer 29

Non small cell