Lung cancers

Question 1

Cancer in the pleura?

Answer 1

mesothelioma

Question 2

cancer of lung parenchyma?

Answer 2

Bronchial

Question 3

what are the 2 types of bronchial lung parenchyma cancers?

Answer 3

small cell
Non small cell

Question 4

what are the 4 types of non small cell cancers?

Answer 4

squamous
adenocarcinoma
carcinoid
large cell

Question 5

what are 1^ metastasis sites?

Answer 5

Bone, liver, adrenals (usually aSx), brain, lymph nodes

Question 6

What is mesothelioma?

Answer 6

Malignancy of lung pleura

Question 7

Mesothelioma
Cause?
When do Sx present?
Who is affected?

Answer 7

ABESTOS
typically don’t present till decades after exposure - latent period
males 40-70

Question 8

Sx of mesothelioma

Answer 8

Cancer Sx (weight loss, night pain, TATT)

Lung Sx - SOB, Persistent Cough, pleuritic chest pain

Tumour may also press on nearby structures eg. recurrent laryngeal nerve = hoarse voice

Also signs of metastasis

Question 8

Sx of mesothelioma

Answer 8

Cancer Sx (weight loss, night pain, TATT)

Lung Sx - SOB, Persistent Cough, pleuritic chest pain

Tumour may also press on nearby structures eg. recurrent laryngeal nerve = hoarse voice

Also signs of metastasis

Question 9

Dx of mesothelioma?
first line? diagnostic?

Answer 9

1st line: chest x ray + CT
CA - 125 (cancer antigen 125) high
(non specifically raised in tumours, sensitive but not specific)
Diagnostic = Biopsy

Question 10

What would be seen on a chest x ray/CT?

Answer 10

pleural thickening +/- effusion

Question 11

which is better, CT or Xray and why?

Answer 11

High resolution, more detailed than chest x ray

Question 12

Tx for mesothelioma

Answer 12

Very aggressive tumour; usually palliative
If found early, cam try surgery + chemo/radio (but generally resistant)

Question 13

Is mesothelioma likely to metastasise distantly?

Answer 13

Unlikely to distantly metastasise as affects pleura, pleura in body isn’t found everywhere

Question 14

What is a bronchial carcinoma?

Answer 14

primary malignancy of lung parenchyma
small cell
non small cell

Question 15

RF of bronchial carcinoma?

Answer 15

SMOKING
ASBESTOS
coal
ionising radiation
lung disease already present

Question 16

How many bronchial carcinomas are small cell?

Who do they affect?

Answer 16

15%
exclusively smokers

Question 17

what does small cell carcinoma cause?
examples?

Answer 17

paraneoplastic syndromes
ectopic ACTH = Cushings
ectopic ADH = SIADH
Lambert Eaton syndrome (autoimmune disorder of njm - neuro)

Question 18

small cell carcinoma
rate of growth?
metastasis?
where are the lung lesions?

Answer 18

Fast growing
early metastasis
central lung lesions

Question 19

What is BALT lymphoma?

Answer 19

non Hodgkins lymphoma in bronchi (bronchial associated tissue lymphoma)

Question 20

non small cell carcinoma affects what %?
squamous affects how many?

Answer 20

85%

25%

Question 21

Squamous - non small cell
squamous affects who mostly?
Lesions where in the lung?
what may it secrete?
Arises from?
metastasis?
spread?

Answer 21

Mostly smokers affected

Central lung, lesions with central necrosis

May secrete PTHrP –> hypercalcemia

Arise from lung epithelium

late metastasis

locally spread mostly

Question 22

What is hypertrophic pulmonary osteoarthropathy associated with?

Answer 22

NSCLC
A paraneoplastic syndrome, usually squamous cell carcinoma:
Clubbing, arthritis, periostitis

Question 23

Adenocarcinoma

What % affected?
Caused by?
which part of lung affected?
Arise from?
Mets common to?

Answer 23

Commonly abestos (+ smokes, less so than squamous)

Affects peripheral lung

Arise from Mucus secreting glandular epithelium

Mets common to bone, brain, adrenals, lymph nodes, liver

Question 24

Adenocarcinoma is the biggest cause of?
Triad of Sx?

Answer 24

2^ hypertrophic osteoarthritis

Clubbing
Arthritis
big bone swelling

Question 25

What is a adenocarcinoma in situ?

Answer 25

stage 0
Not yet spread

Question 26

Carcinoid tumour
Associated with which genes?
What is it?
Arise from?

Answer 26

Genetics; MEN1 mutation + neurofibromatosis 1

Neuroendocrine tumour (secretes serotonin)

arise in GIT (mostly) + sometimes lung

Sx only appear when liver mets present

Question 27

General Sx of bronchial carcinoma?

Answer 27

Chest pain
Cough and haemoptysis (cough up blood)
Cancer Sx
Signs of mets (eg. hoarse voice, Pemberton sign (Mediastinal mass) + Horners syndrome (pan coast))

Question 28

Dx of bronchial carcinoma?

Answer 28

1st line = Chest x ray/CT
Diagnostic (is this cancer) = bronchoscopy + biopsy
MRI - staging - TNM

Question 29

Tx for Bronchial carcinoma?
small cell and non small cell

Answer 29

Small cell - More aggressive
if early = consider chemo/radio (often unsuccessful)
Metastasised = palliative

Non small cell - less aggressive
Early = surgical excision
Metastasised = Chemo +/- radio
eg. mAb therapy cetuximab (vs epidermal growth factor)

Question 30

Are 1^ or 2^ more likely or common and why?

Answer 30

2^ tumours much more likely as lungs oxygenate 100% blood therefore all blood comes to lungs therefore higher mets risk
esp, breast, kidney, bowel, bladder cancers

Question 31

What is a Pancoast tumour?
What Sx does it cause?

Answer 31

Tumour in lung apex metastasises to neck’s sympathetic plexus
Causing HORNERS SYNDROME , ptosis (eyelid drooping), myosis (excessive pupil constriction), anhidrosis (lack of sweat)