Intrathoracic Malignancy

Question 1

What cell type is a carcinoma a malignancy of?

Answer 1

Epithelial cells

Question 2

what cell type is involved in a sarcoma?

Answer 2

Soft tissue or mesenchyme

Question 3

What percentage of primary lung malignancies do carcinomas make up?

Answer 3

> 90%

Question 4

What percentage of lung carcinomas are caused by smoking?

Answer 4

90%

Question 5

What occupations put some people at a higher risk of radon exposure?

Answer 5

occupations like air crew, nuclear fuel plant and power station workers

Question 6

What is the name given to mutations that are essential for tumour cell survival

Answer 6

Driver mutations

Question 7

In an adenocarcinoma of the lung which mutations are common in non-smokers?

Answer 7

EGFR
ALK
RET
ROS1

Question 8

In an adenocarcinoma of the lung, whcih mutations are common in smokers

Answer 8

KRAS

BRAF

Question 9

List some cellular/molecular processes seen in squamous cell carcinoma.

Answer 9

loss of heterozygosity (LOH) of 3p and 9p.
Oncogene SOX2 amplification in 3q.
TP53 inactivation
LOH of 8p and 5q

Question 10

What mutations would you see occurring in a small cell carcinoma

Answer 10

inactivation of TP53 and RB1 in all tumours.
RB1 mutation is a hallmark of small cell carcinoma
PTEN mutations
FGFR1 amplifications and SOX2 amplifications.
mutations in SLIT and EPHA7.

Question 11

What mutation is a hallmark of small cell carcinoma?

Answer 11

RB1 mutation

(RB1 gene normally makes a protein called pRB which acts as a tumour suppressor.

Question 12

List some common symptoms of lung cancer

Answer 12

progressive shortness of breath
cough
weight loss
chest pain
hoarseness
increased sputum production
haemoptysis
paraneoplastic manifestation
symptoms referable to metastases

Question 13

If a tumour obstructs the airway what clinical features may occur?

Answer 13

Pneumonia, abscess, lobar collapse

Question 14

If a tumour spreads to the pleura what clinical features may occur?

Answer 14

pleural effusion

Question 15

if a lung tumour invades the recurrent laryngeal nerve what clinical feature may be seen?

Answer 15

Hoarseness

Question 16

oesophageal invasion of a lung tumour may cause what?

Answer 16

dysphagia

Question 17

phrenic nerve invasion may cause what?

Answer 17

diaphragm paralysis

Question 18

chest wall invasion of a lung carcinoma may cause what?

Answer 18

Rib destruction

Question 19

SVC compression by tumour may cause what?

Answer 19

SVC syndrome - swelling of face and upper limbs, SOB, coughing etc.

Question 20

Horner syndrome may be seen when a tumour invades what? What tumours most commonly do this?

Answer 20

Sympathetic ganglia invasion.

Tends to be by apical (Pancoast) tumours

Question 21

If a lung carcinoma affects the heart what clinical features might you see?

Answer 21

Pericarditis

tamponade (fluid in the pericardium builds up, resulting in compression of the heart).

Question 22

Where do carcinomas of the lung tend to metastasise to?

Answer 22

lymph nodes, bone, brain, liver, skin, adrenal glands

Question 23

What is meant by a paraneoplastic syndrome?

Answer 23

symptoms that occur at sites distant from a tumour or its metastasis

Question 24

In what ways can cancers spread/metastasise?

Answer 24

1. direct route
2. lymphatic route
3. haematogenous routes

Question 25

Lung cancer cells can produce hormones ectopically - true or false?

Answer 25

True

Question 26

ADH can be produced by lung cancer cells (syndrome of inappropriate ADH secretion) - what would it cause?

Answer 26

hyponatraemia - clinical manifestations are primarily neurologic due to an osmotic shift of water into brain cells causing oedema.

Question 27

If you see a patient with Cushing-syndrome what may be causing it in terms of malignancy?

Answer 27

lung cancer cells producing ACTH

Question 28

Humoral hypercalcaemia of malignancy is caused by a tumour producing what hormone ectopically?

Answer 28

Parathyroid hormone (PTH)

Question 29

Humoral hypocalcaemia of malignancy is caused by a tumour producing what hormone ectopically?

Answer 29

calcitonin

Question 30

What paraneoplastic disorder can small cell carcinomas of the lung cause which may present as weakness in the limbs?

Answer 30

Lambert-Eaton myasthenic syndrome

Question 31

What is Trousseau syndrome?

Answer 31

a thromboembolic disorder associated with malignancy. Makes thromboembolisms more likely as it is a hypercoagulability syndrome.

Question 32

What percentage of lung carcinomas are small cell and what are non-small cell?

Answer 32

small cell carcinomas = 13% | non-small cell carcinomas = 87%

Question 33

What is an adenocarcinoma?

Answer 33

A malignant tumour formed from glandular structures in epithelial tissue

Question 34

What is the first line therapy for non-small cell carcinomas?

Answer 34

surgery

Question 35

What is first line therapy for small cell carcinomas?

Answer 35

Chemotherapy

Question 36

What is the second line therapy for non-small cell lung cancers?

Answer 36

radiotherapy

Question 37

what is the 5 year survival rate for non-small cell lung cancers TNM stages I-II

Answer 37

23-60%

Question 38

what is the 5 year survival rate for patients with advanced lung carcinoma TNM stages III-IV?

Answer 38

<1%

Question 39

what is the median survival time of patients diagnosed with limited small cell carcinoma?

Answer 39

18 months

Question 40

What class of drugs may be used if a EGFR mutation is present?

Answer 40

tyrosine kinase inhibitors | e.g. erlotinib, gefitinib, osimertinib

Question 41

What carcinogen are 90% of malignant mesotheliomas associated with exposure to?

Answer 41

asbestos

Question 42

What cellular processes might carcinogenic substances cause?

Answer 42

chronic inflammation and fibrosis

Question 43

what type of lung cancer might you see pleurisy and plural effusion in?

Answer 43

malignant mesothelioma

Question 44

When taking a history of a patient with suspected malignant mesothelioma, what is a good question to ask?

Answer 44

Occupational history and whether they've had any exposure to asbestos

Question 45

What is pleurodesis?

Answer 45

a treatment for a pleural effusion caused by a malignant mesothelioma where a sclerosing agent, e.g. sterile talc, is instilled into the plural cavity which irritates the pleura and causes fibrosis to occur so the pleura sticks together and fluid can no longer accumulate in the cavity.

Question 46

What is meant by secondary lung cancer?

Answer 46

Where cancer cells have spread to the lungs from a cancer that started somewhere else in the body.