Neoplasia 3

Question 1

What is the clinical presentation of a lung tumour?

Answer 1

cough, haemoptysis, wheeze, dyspnoea, pneumonia, Pancoast’s syndrome

Question 2

What are some of the common clinical presentations of metastases?

Answer 2

lymphadenopathy, bone pain/hypercalcaemia, jaundice, seizures

Question 3

What causes weight loss and anorexia in cancer?

Answer 3

TNF-alpha and IL-1

Question 4

What are paraneoplastic effects?

Answer 4

Symptoms which aren’t related to the local presence of a tumour

Question 5

What are some common paraneoplastic effects?

Answer 5

endocrine problems, immunological problems, clubbing, hypertrophic osteoarthropathy, venous thrombosis, endocarditis

Question 6

What are some paraneoplastic endocrine effects of lung cancer?

Answer 6

hypercalcaemia, cushings, inappropriate ADH/ACTH

Question 7

What are some other paraneoplastic endocrine disorders?

Answer 7

hypoglycaemia, polycythaemia

Question 8

What blood tests might you order for a cancer patient?

Answer 8

blood picture, liver function test, tumour markers

Question 9

What are tumour markers?

Answer 9

Proteins in the blood which are useful in follow up of a tumour such as prostate specific antigen in prostate cancer, carcinoembryonic antigen, alpha fetoprotein in colon cancer

Question 10

Why is tissue sampling important?

Answer 10

To confirm malignancy and to determine features relevant to prognosis and management

Question 11

What type of stains may be done on a tissue sample?

Answer 11

H&E, stains for melanin, stains for musin, immunohistochemistry to determine cell line

Question 12

Why is cytology not as useful as a whole tissue sample?

Answer 12

Can’t see stroma and don’t see relationship of cells to each other

Question 13

What do you need to know about the tumour?

Answer 13

specific tumour type and subtype, grade, stage, presence of lymphovascular invasion

Question 14

What are the 4 main types of lung carcinomas?

Answer 14

squamous cell carcinoma, adenocarcinoma, large cell carcinoma, small cell carcinoma

Question 15

What type of lung carcinoma is the most common?

Answer 15

adenocarcinoma

Question 16

What type of lung carcinoma is the most likely if the patient is a non smoker?

Answer 16

adenocarcinoma

Question 17

What type of lung carcinoma is a result of squamous metaplasia?

Answer 17

squamous cell carcinoma

Question 18

What type of lung carcinoma is the most aggressive?

Answer 18

squamous cell carcinoma

Question 19

What are the macroscopic features of lung cancer?

Answer 19

Pale irregular mass often related to a bronchus that may be necrotic. Can lead to lung collapse or bronchiecstasis. Hilar lymph nodes often appear black.

Question 20

What type of lung carcinoma tends to be more peripheral?

Answer 20

adenocarcinomas

Question 21

What are the microscopic features of adenocarcinoma?

Answer 21

The cells show a glandular structure - they cell may try and form a lumen or there may just be an accumulation of mucous

Question 22

What are the microscopic features of squamous cell carcinoma?

Answer 22

There are rounded areas of keratin in the centre of the tumour and intracellular bridges

Question 23

What are the microscopic features of small cell carcinoma?

Answer 23

The cells are small and don’t show the typical features of malignancy

Question 24

What are the microscopic features of large cell carcinoma?

Answer 24

The cells are large and atypical and are undifferentiated

Question 25

How does immunohistochemistry work?

Answer 25

Labeled antibodies which are labeled either with fluorescence or an enzyme are used to detect the presence of particular proteins which indicate cell lineage

Question 26

What does the S100 protein indicate in immunohistochemistry?

Answer 26

That the cells are melanocytes

Question 27

What does the CAM5.2 protein indicate in immunohistochemistry?

Answer 27

That the cells are epithelium

Question 28

What does LCA protein indicate in immunohistochemistry?

Answer 28

That the cells are leukocytes

Question 29

What is the stage of a tumour?

Answer 29

Stage refers to how far advanced the tumour is - it incorporates size, how advances local spread is, if it has metastasised and if so where to

Question 30

What is the TNM system?

Answer 30

A system for staging - T is the level of the primary tumour, N is regional lymph node metastases and M is the absence or presence of distant metastases

Question 31

What is the action of traditional chemotherapy drugs?

Answer 31

Interfere with cell division

Question 32

What is the action of targeted therapies?

Answer 32

Block the growth of cancer by interfering with the function of specific molecules resulting from genetic alterations

Question 33

What specific mutation is targeted in non-small cell carcinomas?

Answer 33

EGFR tyrosine kinase

Question 34

What are the benefits of this targeted treatment?

Answer 34

superior response rate, prolonged progression-free survival, improved quality of life

Question 35

What causes death in cancer?

Answer 35

cachexia, secondary infection, damage to vital organ