lung cancer

Question 1

what is the aetiology of lung cancer?

Answer 1

tobacco
asbestos 
air pollution
radiation
diseases such as pulmonary fibrosis

Question 2

what are the 2 main pathways of lung cancer?

Answer 2

lung periphery- bronchioalveolar epithelial stem cells transform to create an adenocarcinoma
central lung airways- bronchial epithelial stem cells transform to create squamous cell carcinoma

Question 3

what are the main 4 carcinomas of the lung?

Answer 3

squamous cell
adenocarcinoma
small cell carcinoma
large cell carcinoma

Question 4

what are the three tumours of the bronchial gland?

Answer 4

adenoid cystic carcinoma
mycoepidermal carcinoma
benign adenoma

Question 5

what are the local effects of bronchial obstruction on the lungs?

Answer 5

collapse
pneumonia
infection/absess
brochiestasis

Question 6

whats the indirect effect of cancer on the pleura?

Answer 6

inflammation

Question 7

whats the direct effect of lung cancer on the pleura ?

Answer 7

malignant invasion

Question 8

what are the non metastatic side effects of lung cancer?

Answer 8

finger clubbing
hypertrophic pulmonary osteoarthropathy
endocrine ACTH in small cell carcinoma
endocrine PTH in squamous cell

Question 9

whats the life expectancy after being diagnosed with small cell carcinoma?

Answer 9

9 months

Question 10

what are biomarkers used for?

Answer 10

selecting patients for therapy

Question 11

what biomarkers are used in adenocarcinomas?

Answer 11

EGFR
KRAS
HER2
BRAF mutation
ALK & ROS1 translocator

Question 12

what are the main symptoms of lung cancer?

Answer 12

chronic cough
coughing up blood
wheeze
chest and bone pain
recurrent chest infections
hoarseness and dyspnea
unexplained weight loss
nail clubbing

Question 13

what metastatic effect can lung cancer have?

Answer 13

bone pain
spinal cord compression
cerebral metastases
thrombosis

Question 14

what non-metastatic (paraneoplastic) effect can lung cancer have?

Answer 14

hyponatraemia (low sodium)
anaemia
hypercalcaemia (high calcium)
dermatomycosis (fungal infection of skin)
sensomotor neuropathy

Question 15

what are some clinical signs that someone may be suffering from lung cancer?

Answer 15

lymphadenopathy (abnormal lymph nodes)
horners syndrome (decreased pupil size and droopy eyelid)
superior vena cava obstruction
skin nodules

Question 16

what investigations must be carried out in order to diagnose someone with lung cancer?

Answer 16

chest xray
ct
full blood count
renal and liver function test
calcium levels
spirometry

Question 17

what are the two aims of treatment

Answer 17

radical- cure the disease

palliative- control the disease

Question 18

what are the review areas on a chest X-ray?

Answer 18

hila
apices
behind the heart and diaphragm
between ribs
compare lobes
ensure trachea is central

Question 19

what should you do after discovering an abnormality on a chest X-ray?

Answer 19

compare with previous imaging, confirm it is in the lung and get a CT

Question 20

whats the difference between a pulmonary mass and pulmonary nodule?

Answer 20

mass- opacity in lung over 3CM

nodule- 3CM or less

Question 21

explain TNM staging

Answer 21

T- size and position of Tumour
N- has it spread to lymph Nodes?
M- has is Metastasised

Question 22

what kind of tumour invades the mediastinum ?

Answer 22

T4

Question 23

whats the purpose of a PET/CT scan?

Answer 23

whole body scanning, discloses metastases and other pathologies which are not detected by other means

Question 24

in surgical management of cancer what techniques are used to determine the staging?

Answer 24

TNM
CXR
blood tests
CT

Question 25

in the surgical management of cancer what do you look for in X-rays in order to determine the staging off the cancer?

Answer 25

pleural effusion chest wall invasion phrenic nerve palsy collapsed lobe or lung

Question 26

in the surgical management of cancer what do you look for in blood tests in order to determine staging?

Answer 26

anaemia abnormal LFT's abnormal bone profile

Question 27

in the surgical management of cancer what do you look for in CT's to determine staging?

Answer 27

is the diaphragm involved? pleural/pericardial effusion which would make it inoperable size of tumour mediastinal nodes metastatic disease proximity to important structures that cannot be resected eg. brachial plexus

Question 28

what test will determine fitness for surgery but also the presence or absence of significant pericardial effusion?

Answer 28

ECHO

Question 29

what scan do you use to check for chest wall invasion or bony metastasis?

Answer 29

bone scan

Question 30

what test is used for determining the degree of vascular or neurological involvement of a tumour ?

Answer 30

MRI

Question 31

what procedure is used to ensure the tumour is not invading the carina?

Answer 31

bronchoscopy

Question 32

in the surgical management of cancer whats included in respiratory function testing?

Answer 32

spirometry diffusion studies ABG on air VIQ scan

Question 33

what are the main reasons for peri-operative death?

Answer 33

``` ARDS(acute respiratory distress syndrome) bronchopneumonia myocardial infarction PTE intrathoracic bleeding pneumothorax ```

Question 34

how are non-small cell lung cancer treated non-surgically?

Answer 34

adjuvant immunotherapy very high dose SABR chemo radiotherapy

Question 35

in regards to non-surgical management of cancer what is meant by adjuvant?

Answer 35

after definitive treatment

Question 36

what are some forms of palliative treatment?

Answer 36

chemo immunotherapy TKI palliative radiotherapy

Question 37

whats the aim of palliative care?

Answer 37

improve quality of life management of bone metastasis prevent cord compression and haemoptysis

Question 38

whats the doubling time for non-small and small cell lung cancer ?

Answer 38

non-small cell lung cancer- 129 days | small cell lung cancer- 29 days

Question 39

what are some side effects of chemotherapy ?

Answer 39

sepsis nausea/vomitting/fatique renal impairment weight loss

Question 40

what are some side effects of radiotherapy?

Answer 40

lethargy pneumonitis fibrosis 2nd malignancies