lung cancers - bronchial carcinoma

Question 1

what is bronchial carcinoma

Answer 1

the primary malignancy of lung parenchyma

Question 2

2 types of bronchial carcinoma

Answer 2

small cell and non small cell carcinoma

Question 3

risk factors for bronchial carcinoma

Answer 3

• smoking
• asbestos
• coal
• ionising radiation
• existing lung disease

Question 4

what percentage of bronchial carcinomas are small cell

Answer 4

15%

Question 5

who does small cell carcinoma affect

Answer 5

it is exclusive to smokers

Question 6

what is small cell carcinoma

Answer 6

Malignancy affecting central respiratory system (bronchi)

appears as small cells with minimal cytoplasm on biopsy.

it is fast growing and early mets

Question 7

symptoms of small cell carcinoma

Answer 7

• cough w haemoptysis
• SOB
• recurrent chest pain
• Constitutional Sx (same in all ca)
• Compression Sx
• PARANEOPLASTIC SYNDROMES!!!!!

Question 8

what are paraneoplastic syndromes

Answer 8

1. ectopic ACTH –> cushings
2. ectopic ADH –> SIADH
3. lambert eaton syndrome

Question 9

investigations for small cell carcinoma

Answer 9

1st line = Imaging (CXR then CT)

GS = Bronchoscopy and biopsy

Staging with TNM

Question 10

treatment for small cell carcinoma

Answer 10

If very early, may try chemo/radio (usually unsuccessful).

Palliative often

Question 11

what percentage of bronchial carcinomas are non small cell

Answer 11

85%

Question 12

4 types of non small cell carcinoma

Answer 12

• squamos
• adenocarcinoma
• carcinoid tumour
• large cell

Question 13

what is squamos non small cell carcinoma

Answer 13

Bronchial carcinoma arising from lung epithelium histologically resembling squamous epithelium

• affects central lung
• lesions with central necrosis
• may secrete PTHrP –> hypercalcaemia

Question 14

who does squamos carcinoma affect

Answer 14

mainly smokers
(more than any NSCLC)

Question 15

symptoms of squamos carcinoma

Answer 15

• Lung Sx
• Constitutional Sx
• Compression Sx,
• PARANEOPLASTIC SYNDROME = PTHrP

Question 16

when does squamos carcinoma metastasize

Answer 16

Metastasises late, spreads locally in most cases

Question 17

investigations for squamos carcinoma

Answer 17

1st = Imaging (CXR then CT)

GS = Bronchoscopy + biopsy

TNM staging

Question 18

how to treat squamos carcinomas

Answer 18

Surgical excision in most cases.

If mets - chemo and/or radiotherapy

Question 19

what is adenocarcinoma

Answer 19

Bronchial carcinoma arising from mucus secreting glandular epithelium

affects peripheral lung

Question 20

what is the main risk factor for adenocarcinoma

Answer 20

ASBESTOS EXPOSURE!

Question 21

what is the most common bronchial carcinoma

Answer 21

adenocarcinoma
40-45%

Question 22

what symptoms are present in adenocarcinoma

Answer 22

• Lung Sx
• Constitutional Sx
• Compression Sx,

Question 23

what is adenocarcinoma closely related to

Answer 23

Adenocarcinoma NSCLC is also closely related to HYPERTROPHIC PULMONARY OSTEOARTHROPATHY

→ Triad of clubbing, arthritis and long bone swelling

Question 24

investigations for adenocarcinoma

Answer 24

1st = Imaging (CXR then CT)

GS = Bronchoscopy + biopsy

TNM staging

Question 25

how to treat adenocarcinoma

Answer 25

Surgical excision in some cases.

If mets (more likely) - chemo and/or radiotherapy

Question 26

common mets of adenocarcinoma

Answer 26

bone
brain
adrenals
lymph nodes
liver

Question 27

what is carcinoid tumour

Answer 27

associated with genetics
MEN1 mutation and neurofibromatosis 1

it is a neuroendocrine tumour

arises in GI tract and sometimes lungs

symptoms only appear when liver mets present

Question 28

is small cell more aggresive or non small cell

Answer 28

small cell is more aggresive

Question 29

are secondary lung tumours more common or primary

Answer 29

secondary
because lungs oxygenate 100% blood therefore all blood comes to lungs so higher mets risk

Question 30

what is pancoast tumour

Answer 30

tumour in lung apex metastasizes to necks sympathetic plexus - causing horners sydnrome