Lung Cancer

Question 1

What is the difference between a primary and secondary pleural malignancy?

Answer 1

Mesothelioma

Metastases

Question 2

What is mesothelioma?

Answer 2

Cancer of pleural lining due to asbestos exposure gradually developing over 30-40 years

Question 3

How do you diagnose mesothelioma?

Answer 3

Thoracoscopy (biopsy) —> Histology - BLOODY PLEURAL FLUID

CXR/CT - PLEURAL THICKENING

Question 4

What are the common signs of mesothelioma?

Answer 4

Sweating
SOB
Reccurent pleural effusions
Chest pain
Weight loss
Fever

Question 5

Treatment options for mesothelioma…

Answer 5

Palliative care, chemo, and rarely radiotherapy/surgery

Question 6

The prevalence of lung cancer is low. True/False?

Answer 6

True Incidence is high, but patients do not live for very long

Question 7

List some risk factors for lung cancer…

Answer 7

Smoking
Atmospheric pollution
Nickel
Asbestos
Genetics

Question 8

List some signs for lung cancer…

Answer 8

Pneumonia, chest pain, haemoptysis, weight loss

Question 9

What does ectopic production of PTH suggest?

Answer 9

Squamous cell cancer

Question 10

What does ectopic production of ACTH suggest?

Answer 10

Small cell cancer

Question 11

What symptom arises due to damage of the recurrent laryngeal nerve?

Answer 11

Hoarse voice

Question 12

Pancoast tumours typically affect which part(s) of the lung? What does it manifest as?

Answer 12

Apex
Invasion of cervical sympathetic chain —>
Horners syndrome - unilateral ptosis, small pupil, anhydrosis

Question 13

Name the 4 types of lung tumour classifications in order of severity and give their main effect

Answer 13

Small cell carcinoma : —> ADH (HYPONATRAEMIA)
Large cell carcinoma : —> GYNAECOMASTIA
Squamous cell carcinoma —> HYPERCALCAEMIA (increased PT gland)
Adenocarcinoma —> BLUE MUCIN, HYPERTROPHIC PULMONARY OSTEOARTHROPATHY/ FINGER CLUBBING

Question 14

Are adenocarcinomas most assocated with smoking or non-smoking?

Answer 14

Non-smoking - smokers typically have squamous carcinomas

Question 15

Common sites of lung cancer metastases (5)

Answer 15

Liver Brain Bone Adrenals Skin

Question 16

Which LFT is particularly abnormal in liver metastasis?

Answer 16

Alkaline Phosphatase (ALP)

Question 17

How can hypercalcaemia arise? Signs?

Answer 17

Tumour produces a substance which mimics the effects of parathyroid hormone

Confusion (GROANS), constipation (MOANS), BONES, STONES, thirst

Question 18

Lung diseases causing clubbing (ABCDEF)

Answer 18

Abscess 
Bronchiectasis 
Cystic Fibrosis 
Don’t say COPD 
Empyema 
Fibrosis

Question 19

TTF-1 is expressed only in adenocarcinoma. True/False?

Answer 19

False Also in small cell carcinoma

Question 20

P63 is expressed in squamous cell carcinoma. True/False?

Answer 20

True

Question 21

Which type of lung cancer is responsive to chemotherapy?

Answer 21

Small cell carcinoma

Question 22

What is the treatment of choice for non-small cell carcinoma?

Answer 22

Surgery

Question 23

K-ras and EGFR mutations occur in which type of lung tumour?

Answer 23

Non-small cell cancer

Question 24

What characteristic of small cell carcinoma makes it susceptible to chemotherapy?

Answer 24

Rapid growth

Question 25

Surgery is only indicated if the disease is localised. True/False?

Answer 25

True

Question 26

What cells give rise to small cell carcinoma?

Answer 26

Neuroendocrine cells

Question 27

Which is the most common type of lung cancer?

Answer 27

Squamous cell carcinoma

Question 28

Who gets radical radiotherapy?

Answer 28

Early NSLC patients with adequate lung function but where surgery is not possible

Question 29

Describe the basic clinical picture for bronchial carcinoma...

Answer 29

Smoker Haemoptysis Abnormal CXR

Question 30

List some symptoms of bronchial carcinoma...(8)

Answer 30

``` Dyspnoea Haemoptysis Weight loss Non productive cough (>3 wks) Chest pain Recurent/prolonged pneumonia Lethargy Inspiratory stridor ```

Question 31

List some signs of bronchial carcinoma...

Answer 31

``` Cachexia Clubbing Lymphadenopathy Consolidation/ collapse/ pleural effusion Hepatomegaly ```

Question 32

What are the diagnostic techniques for bronchial carcinoma?

Answer 32

CXR, CT, biopsy, FBC, coag screen, medical thoracoscopy

Question 33

What are the staging techniques for bronchial carcinoma?

Answer 33

Bronchoscopy, mediastinoscopy, CT brain, CT thorax, PET scan

Question 34

What are the two types of surgery for lung cancer?

Answer 34

Pneumonectomy - remove whole lung | Lobectomy - remove lobe

Question 35

Give methods of endobronchial therapy...

Answer 35

Tracheal stenting Laser Brachytherapy

Question 36

Give preventative methods for lung cancer...

Answer 36

Stop smoking | Prevent occupational exposure to carcinogens