Lung cancer

Question 1

List the types of lung cancer?

Answer 1

• Small cell carcinoma (12%)
• Non-small cell carcinoma (87%)
• Adenocarcinoma (40%)
• Sqaumous cell ca (25%)
• Large cell ca (10%)
• Bronchial carcinoid tumour)

Question 2

Describe small cell carcinoma?

Answer 2

Path: neoplasm of neuroendocrine Kulchitsky cells
- undifferentiated, aggressive
Epi: 12%
Location: central
Complications: paraneoplastic syndromes (Cushings, paraneoplastic myelitis, encephalitis), SIADH

Question 3

Describe adenocarcinoma?

Answer 3

Path: malignant neoplasm with glandular differentiation, pneumocyte phenotype or mucin production
- tall, columnar cell containing mucin
- genes: KRAS, EGFR, ALK
- better prognosis
Location: peripheral
Epi: 40%, most common lung ca in non-smoker
Clinical: hypertrophic osetoarthropathy (clubbing)
CXR: hazy infiltrate

Question 4

Describe squamous cell ca?

Answer 4

Path: malignant neoplasm of squamous cells
- polygonal cells with intercellular bridges, crisp eosinophilic cytoplasm, keratin pearls, necrosis
Location: central - hilar mass arising from bronchus
Epi: 25%, smoking risk
Complication: hypercalcaemia (produced PTHrP)
CXR: cavitation

Question 5

Describe large cell carcinoma?

Answer 5

Path: malignant neoplasm originating from epithelial cells, lack features of SCC and glandular or squamous differentiation (undifferentiated group)
- pleomorphic giant cells
- can secrete bHCG
- anaplastic undifferentiated tumour -> poor prognosis
Location: peripheral
Epi: 10%

Question 6

Describe bronchial carcinoid tumours?

Answer 6

Path: malignant neoplasm of the lung arising from the epithelium of the bronchus or bronchiole
- nests of neuroendocrine cells
- mets rare, excellent prognosis
Location: bronchial
Clinical: mass effect or carcinoid syndrome (flushing, diarrhoea, wheezing)

Question 7

List some complications of lung cancers?

Answer 7

Complications (SPHERE):
S- SVC syndrome
P- Pancoast tumour
H- Horner syndrome
E- endocrine (paraneoplastic)
R- Recurrent laryngeal n compression (hoarseness)
E- effusions (pleural, pericardial)

Question 8

Describe the clinical presentation of lung ca?

Answer 8

• cough
• haemoptysis
• bronchial obstruction
• wheeze
• pneumonia
• CXR: “coin” lesion
• CT: non-calcified nodule