Lung Cancer

Question 1

Screening programe for lung cancer

Answer 1

no national screening programe

test screening in CT. However its not quick and uses a large dose

Question 2

Site Specific signs and symptoms

Answer 2

hoarseness due to the recurrent larygneal nerve (innervation of larynx) goes down the chest and comes back up

Question 3

Sign and symptoms

Answer 3

svco
pancoast tumour which can cause horners syndrome

Question 4

pancoast tumour

Answer 4

tumour at apex of lung

Question 5

horners syndrome

Answer 5

invasion of the preganglionic neurons exiting the ventral spinal roots.

Question 6

Some Signs/Symptoms of Horner Syndrome

Answer 6

MIOSIS:
PTOSIS / NARROWING PALPEBRAL FISSURE:
ANHIDROSIS:

Question 7

miosis

Answer 7

difference in size of pupils , accentuated in dim light as the effected pupil does not dilate

Question 8

PTOSIS / NARROWING PALPEBRAL FISSURE

Answer 8

lip drops due to paralysis of levator palpebrae.

Question 9

ANHIDROSIS:

Answer 9

lack of sweating on ipsilateral side

Question 10

Paraneoplastic Syndrome:
triggered by

Answer 10

abnormal immune system response to a cancerous tumour

Not directly related to invasion by the primary tumour or its metastases

Question 11

likely investigations for lung cancer?

Answer 11

sputum cytology = asked to cough up something

bronchoscipy w/ biopsy = camera down trachea into bronchi

CT or PET/CT

Question 12

staging NCCP Guidelines

Answer 12

• Contrast enhanced CT scanning of the chest and upper abdomen

Question 13

staging NCCP Guidelines:
PET/CT recommened

Answer 13

–patients with NSCLC w bone metastasis
-patients clinically limited satged SCLC, to exclude occult metastases

Question 14

staging NCCP guidelines:
brain metastases

Answer 14

contrast enchanced CT followed by contrast enhanced MRI

Question 15

LUNG CANCER PATHWAY : 1

Answer 15

presented at GP or A&E

urgent CXR

Question 16

LUNG CANCER PATHWAY : 2

Answer 16

Rapid access clincal assessment

clincal assess. = pulmonary fucntion tests PFT, performance status PS, bronchoscopy and CT thorax

Question 17

LUNG CANCER PATHWAY : 3

Answer 17

multi-disciplinary conference

tissue diagnosis , staging, PS ,weight loss, PFT

Question 18

LUNG CANCER PATHWAY : 4

Answer 18

primary treatment

surgery, combined chemo/RT , palliative care , chemo

Question 19

TNM Staging
types of staging assessments

Answer 19

clinical (c)- before tx
pathologic (p) -after resection
restaging (y) - after part or all tx given
reocurrence (r) - stage at time reoccurence
autopsy(a)-

Question 20

T1 : tumours less than 3cm in diameter

Answer 20

T1a(mi). - miniumly invasive adenocarcinoma
T1a(ss) superficial spreading tumour in central airways
T1a- less than 1cm
T1b-1cm - 2cm
T1c-2cm -3cm

Question 21

T2:

Answer 21

T2= 3cm - 5cm OR involved with visceral pluera or main bronchus

T2a=3cm -4
T2b=4cm - 5cm

Question 22

likely investigations for lung cancer:
CLINICAL

Answer 22

Hx and physical exam (Co-morbidities)
performance score
PFT
ECG
FBC

Question 22

likely investigations for lung cancer:
Radiological

Answer 22

-CXR
-CT chest and abdomen
- +/-PET Scan
– +/- MRI Brain

Question 23

likely investigations for lung cancer:
histology

Answer 23

-sputum cytology
-bronchoscopy w biopsy
-Bronchial brushings and washings
-EBUS (ENDOSCOPIC ULTRASOUND)

Question 24

histology : How is the diagnosis confirmed?

Answer 24

-imaged-guided biopsy -EBUS -bronchial washings -fine needle aspiration(takes sample of lymph node) -plueral fluid aspiration (remove pleural fluid for investigation)

Question 25

Small Cell Lung Cancer

Answer 25

12-15% of lung cancers -small cell carcinoma -Mixed small cell/large cell carcinoma. -Combined small cell carcinoma (SCLC combined with neoplastic squamous)

Question 26

Non-Small Cell Lung Cancer

Answer 26

85-88% of lung cancers – Squamous cell carcinoma – Adenocarcinoma – Large cell carcinoma

Question 27

Mesothelioma

Answer 27

plueral based lesions

Question 28

Staging of SCLC

Answer 28

limited stage extensive stage

Question 29

limited stage

Answer 29

tumour confined to the hemi-thorax of origin

Question 30

extensive stage

Answer 30

tumour that is too widespread

Question 31

Histology Mesothelioma (plueral based tumours)

Answer 31

--Relatively rare – 80% related to asbestos exposure – Treated by chemotherapy – palliative RT generally

Question 32

Patterns of Spread

Answer 32

local- intrathoracic Regional - Lymphatic (eg mediastinal ,hilar ,lobar) Distant - Haematogenous. ( most common lung,liver,brain,bone)

Question 33

Patterns of Spread Related to cell histology: SCLC adenocarcinomas

Answer 33

-higher incidence of brain mets than NSCLC (15% of ptx at presentation ,further 50% go on to develop them) -highest potential of brain mets in NSCLC