Cancer of the Lungs, Heart and Blood Vessels

Question 1

What is an angiosarcoma?

Answer 1

malignancy of vascular endothelial cells

Question 2

What is a myoxma?

Answer 2

benign tumour of connective tissue containing mucus or gelatinous material

Question 3

Why are cardiac cancers so rare?

Answer 3

low exposure to carcinogens
low turnover rate
strong selective advantage against things that compromise function

Question 4

In what age group is lung cancer most prevalent?

Answer 4

75-90

Question 5

In what sex is lung cancer most prevalent?

Answer 5

male

Question 6

Are populations of lower or higher socioeconomic status more likely to develop lung cancer?

Answer 6

lower socioeconomic status

Question 7

What is a huge factor (apart from sex age and socioeconomic status) that can increase risk of lung cancer?

Answer 7

smoking

duration, intensity, stopped/continued

Question 8

What factors other than smoking can cause lung cancer?

Answer 8

passive smoking
asbestos exposure
radon exposure
indoor cooking fumes
chronic lung diseases
immunodeficiency
family history/genetic

Question 9

List the pathophysiologies of lung cancer.

Answer 9

squamous cell carcinoma
adenocarcinoma
large cell lung cancer
small cell lung cancer

Question 10

Most common lung cancer is?

Answer 10

adenocarcinoma

Question 11

Small cell lung cancer originates from what cells?

Answer 11

pulmonary neuroendocrine cells

Question 12

Squamous cell carcinoma originates from what cells?

Answer 12

bronchial epithelium, centrally located

Question 13

Adenocarcinoma originates from what cells?

Answer 13

mucus-producing glandular tissue, more peripherally located

Question 14

What is metaplasia?

Answer 14

reversible change in which one adult cell type replaced by another adult cell type; adaptive

Question 15

What is dysplasia?

Answer 15

abnormal pattern of growth in which some of the cellular and architectural features of malignancy are present; pre-invasive stage with intact basement membrane

Question 16

Describe a model of lung cancer development.

Answer 16

normal epithelium > hyperplasia > squamous metaplasia > dysplasia > carcinoma in situ > invasive carcinoma

Question 17

What is important oncogene in adenocarcinoma?

Answer 17

EGFR epidermal growth factor receptor tyrosine kinase

Question 18

EGFR important in what population?

Answer 18

women
Asian ethnicity
never smokers

Question 19

What is important oncogenes in non-small cell lung cancer?

Answer 19

anaplastic lymphoma kinase (ALK) tyrosine kinase
c-ROS oncogene 1 (ROS1) receptor tyrosine kinase
BRAF (downstream cell-cycle signalling mediator)

Question 20

ALK/ROS1 is important in what population?

Answer 20

younger patients

never smokers

Question 21

BRAF is important in what population?

Answer 21

smokers

Question 22

What are common symptoms of lung cancer?

Answer 22

cough
weight loss
breathlessness
fatigue
chest pain
haemoptysis

Question 23

What are features of advanced/metastatic disease?

Answer 23

neuro (focal weakness, seizures, spinal cord compression), bone pain, paraneoplastic syndromes (clubbing, hypercalcaemia, hyponatraemia, Cushing;s)

Question 24

What is cachexia?

Answer 24

weakness and wasting of the body due to severe chronic illness

Question 25

What is Pemberton's sign?

Answer 25

used to evaluate venous obstruction in patients with goiters | +ve when bilateral arm elevation causes facial plethora

Question 26

PET scanning is most useful for?

Answer 26

excluding occult metastases

Question 27

How to choose biopsy method?

Answer 27

based on accessibility, availability and impact on staging

Question 28

List types of biopsy?

Answer 28

bronchoscopy endobronchial ultrasound + transbronchial needle aspiration of mediastinal lymph nodes CT guided lung biopsy

Question 29

When is bronchoscopy used?

Answer 29

for tumours of central airway | where tissue staging not important

Question 30

When is EBUS (TBNA) used?

Answer 30

To stage mediastinum +/- achieve tissue diagnosis

Question 31

When is CT guided lung biopsy used?

Answer 31

access peripheral lung tumours

Question 32

How is cancer staged?

Answer 32

T1-4 tumour size/location N0-3 lymph node involvement M0-1c metastases and number

Question 33

What are determinants of treatment?

Answer 33

``` Patient fitness Cancer histology Cancer stage Patient preference Health service factors ```

Question 34

How is patient fitness assessed?

Answer 34

WHO performance status comorbidities lung function

Question 35

What treatment options are there for cancer?

Answer 35

surgical radiological pharmacological supportive

Question 36

When is surgical resection the standard of care? Usual approach?

Answer 36

early stage disease | lobectomy + lymphadenectomy

Question 37

At what stage is sublobar resection appropriate?

Answer 37

stage 1

Question 38

What is an alternative to surgery in early stage disease?

Answer 38

radical radiotherapy

Question 39

When is radical radiotherapy appropriate?

Answer 39

if there is comorbidity

Question 40

What is the technique of choice for radical radiotherapy?

Answer 40

Stereotactic ablative body radiotherapy (SABR)

Question 41

When the disease is locally advanced, what is the treatment?

Answer 41

surgery + adjuvant chemo | radio + chemo +/- immunotherapy

Question 42

How is metastatic disease with a targetable mutation (e.g. EFGR, ALK, ROS1) treated?

Answer 42

tyrosine kinase inhibitor | also palliative care

Question 43

How is metastatic disease with no mutation, PDL-1 +ve treated?

Answer 43

immunotherapy | also palliative care

Question 44

How is metastatic disease with no mutation, PDL-1 -ve treated?

Answer 44

'standard' chemotherapy | also palliative care

Question 45

Overall prognosis of lung cancer, what % of lung cancer patients live >10 years?

Answer 45

only 10%