Lung cancer

Question 1

How common in lung cancer?

Answer 1

It is the most common malignant tumour worldwide and the 3rd most common cause of death in the UK after IHD and cerebrovascular disease

Question 2

What are the two types of bronchial carcinoma?

Answer 2

1. Small cell lung carcinoma

2. Non small cell lung carcinoma

Question 3

What type of cancer make up the non small cell?

Answer 3

• Squamous carcinoma
• Adenocarcinoma
• large cell and differentiated carcinoma
• Carcinoid tumours and neuroendocrine

Question 4

Where can the tumours locally spread to?

Answer 4

The chest and may directly involve the pleura and ribs resulting in bone pain and fractures

Question 5

What is the location of SCLC?

Answer 5

Central bronchus

Question 6

What cell type is involved in SCLC?

Answer 6

Neuroendocrine cells

Question 7

What do SCLC’s tend to excrete?

Answer 7

Polypeptide hormones e.g ADH and adrenocorticotropic

Question 8

In general terms what is the rate of metastasis like in SCLC?

Answer 8

Very fast and widespread

Question 9

What is the prognosis like in SCLC?

Answer 9

Poor

Question 10

What is NSCLC associated with?

Answer 10

Smoking

Question 11

Which NSCLC is mostly associated with smoking?

Answer 11

Squamous cell carcinoma

Question 12

Where are squamous cell carcinomas most commonly located?

Answer 12

central

Question 13

What cell type is involved in squamous cell carcinoma?

Answer 13

Epithelial cells

Question 14

What do squamous cell carcinomas secrete?

Answer 14

Keratin

Question 15

What is the metatasis nature of squamous cell carcinoma?

Answer 15

Local spread is common but mets are later

Question 16

What is the most common lung cancer in none smokers?

Answer 16

Adenocarcinoma

Question 17

What is the location of adenocarcinomas?

Answer 17

Tend to be peripheral e.g bronchioles or alveoli wall

Question 18

What type of cell is effected in adenocarcinoma?

Answer 18

Glandular cells

Question 19

What are the secretions of an adenocarcinoma?

Answer 19

Mucus

Question 20

Where do adenocarcinomas metastasise to?

Answer 20

Metastasis are common and usually go to the pleura, lymph nodes, brain, bones and adrenal glands

Question 21

What cell type are involved in carcinoid tumours?

Answer 21

Neuroendocrine cells

Question 22

What is the nature of the metastasise in carcinoid tumours?

Answer 22

• Relatively low rates of invasion

Question 23

What are the most common sites of metastatic lung cancer spread?

Answer 23

• Mediastinum and hilar lymph nodes
• Liver
• Bone
• Lung pleura
• Heart
• Breasts
• Adrenal glands
• Brain

Question 24

What is more common primary or secondary lung cancer?

Answer 24

Secondary e.g breast, bowel, kidney, bladder

Question 25

What are the risk factors for lung cancer?

Answer 25

- Cigarette smoking - Occupational e.g Asbestos - Environmental e.g Ionising radiation - Host factors e.g pre-existing lunch disease

Question 26

What presenting symptoms are seen in local disease?

Answer 26

- Cough - Breathlessness - Haemoptysis - Recurrent infections

Question 27

What presenting symptoms are seen in metastatic disease?

Answer 27

- Bone pain - Headache - Seizures - Neurological deficit - Hepatic pain - Abdo pain

Question 28

What are paraneoplastic changes?

Answer 28

Conditions which occur as a side effect of the tumour and occur in 10% of patients

Question 29

What hormones can be secreted in paraneoplastic syndromes?

Answer 29

- PTH - ADH - ACTH

Question 30

What is the TNM classification?

Answer 30

- Tumour - how big it is - Nodes: how many and where they are - Metastasis (M1a = tumour on same side, M1b = tumour elsewhere)

Question 31

What do you find on a CXR in lung cancer?

Answer 31

- Appears as a round shadow - 'coin lesion' - Edge has a fluffy spiked appearance - Hilar enlargement - Consolidation - Lung collapse - Pleural effusion

Question 32

Why would you use a CT in the investigations for lung cancer?

Answer 32

To stage the tumour

Question 33

Why would you use a bronchoscopy in investigation lung cancer?

Answer 33

- To give histology and assess operability | - Tells you about infections which also appear as round spots on a CXR

Question 34

What is the treatment for NSCLC?

Answer 34

- Surgical excision - Curative radiotherapy - Chemotherapy

Question 35

What is the treatment for SCLC if the disease is limited?

Answer 35

Combined chemotherapy and radiotherapy

Question 36

What is the treatment for SCLC if the disease is extensive?

Answer 36

Chemotherapy but relapse is likely

Question 37

What palliative care is used in SCLC?

Answer 37

Radiotherapy and dexamethasone for superior vena cava obstruction

Question 38

What drugs could be used in the treatment of SCLC?

Answer 38

- Analgesia - Steroids - Antiemetics - Codeine - Bronchodilators - Antidepressents