Primary Lung cancers

Question 1

What is a cancer of the pleura called?

Answer 1

Mesothelioma

Question 2

What are the different types of cancer of the lung parenchyma?

Answer 2

Small cell lung cancer and non-small cell lung cancer

Question 3

Name some types of non-small cell lung parenchyma cancer

Answer 3

Squamous
Adenocarcinoma
Carcinoid
Large cell

Question 4

What are common sites of metastasis for lung cancer to spread to?

Answer 4

Bone
Liver
Adrenals
Brain
Lymph nodes

Question 5

What causes a mesothelioma?

Answer 5

Asbestos
(typically doesn’t present until decades after exposure

Question 6

Who is most at risk of mesotheliomas?

Answer 6

males aged 40-70

Question 7

What are symptoms of mesothelioma?

Answer 7

Weight loss
Tired all the time
Night pain
SOB
Persistent cough
pleuritic chest pain
Hoarse voice
Bone pain if metastasised

Question 8

Why may a patient with mesothelioma present with a hoarse voice?

Answer 8

Tumour may press on nearby structures including the recurrent laryngeal nerve

Question 9

How do you diagnose mesothelioma?

Answer 9

1st line = Chest x-ray and/or CT showing pleural thickening

Cancer antigen 125 raised in many tumours (sensitive but not specific)

Biopsy

Question 10

Is a CT or a chest x-ray higher resolution and more detailed?

Answer 10

CT

Question 11

How is mesothelioma cancer treated?

Answer 11

Very aggressive, so normally palliative care
If found early, surgery and chemo/radiotherapy howevere generally resistant

Question 12

Is a mesothelioma likely to metastasise distally?

Answer 12

No, pleura isn’t found everywhere in the body

Question 13

What is a primary malignancy of lung parenchyma called?

Answer 13

bronchial carcinoma

Question 14

What percentage of bronchial carcinomas are small cell?

Answer 14

15%

Question 15

What are risk factors for bronchial carcinomas?

Answer 15

Smoking
Asbestos
Coal
Ionising radiation
Lung disease already present

Question 16

Who gets small cell bronchial carcinoma?

Answer 16

Exclusively smokers

Question 17

What does small cell lung cancer cause?

Answer 17

Paraneoplastic syndromes

Ectopic ACTH causes Cushing’s
Ectopic ADH causes SIADH
Lambert Eaton Syndrome (disorder of NMJ)

Question 18

Does small cell lung cancer grow quickly or slowly and metastasis or not?

Answer 18

Grows quickly, early metastases

Question 19

What percentage of bronchial carcinomas are non-small cell?

Answer 19

85%

(consists of adenocarcinoma, squamous, carcinoid tumour and large cell)

Question 20

What group of people make up the majority of squamous cell lung carcinoma?

Answer 20

Smokers

Question 21

Describe what the squamous cell lung carcinoma affects

Answer 21

Arises from lung epithelium
Affects central lung
lesions with central necrosis
may secrete PTHrP (related protein) causing hypercalcaemia

Question 22

When do squamous cell lung carcinoma mets appear?

Answer 22

Late
Mostly spread locally

Question 23

What condition is heavily associated with non-small cell lung carcinoma, particularly squamous cell carcinoma?

Answer 23

Hypertrophic pulmonary osteoarthropathy

Question 24

Hypertrophic pulmonary osteoarthropathy (associated with non-small cell lung carcinomas) consists of what 3 things?

Answer 24

Clubbing
Arthritis
Periostosis (swelling of tissue around joints and subperiosteal new bone formation)

Question 25

What is the periosteum?

Answer 25

The membrane of nerves and blood vessels that wraps around most bones, key role in growing and repairing bones particularly after a fracture

Question 26

What is an adenocarcinoma?

Answer 26

A malignant tumour of glandular structures in epithelial tissue

Question 27

What are common causes of a lung adenocarcinoma?

Answer 27

Asbestos and smoking

Question 28

Where does a lung adenocarcinoma form?

Answer 28

Affects the peripheral lung and arises from mucous secreting glandular epithelium

Question 29

Where does a lung adenocarcinoma commonly metastasise to?

Answer 29

Bone Brain Adrenals Lymph nodes Liver

Question 30

What does adenocarcinoma in situ mean?

Answer 30

Stage 0, tumour has not yet spread

Question 31

What causes a carcinoid tumour?

Answer 31

Associated with genetics, MEN1 mutation and Neurofibromatosis 1 (a multisystem disorder)

Question 32

Where do carcinoid tumour commonly arise?

Answer 32

in the GIT and sometimes the lungs

Question 33

Carcinoid tumours and n______ tumours that secrete s_____

Answer 33

neuroendocrine serotonin

Question 34

When do symptoms of carcinoid tumour appear?

Answer 34

When it metastasises to the liver

Question 35

What are general symptoms of a bronchial carcinoma?

Answer 35

Chest pain Cough Haemoptysis (coughing up blood) Weight loss Night sweats Feeling tired all the time Hoarse voice Pemberton sign Horner's syndrome

Question 36

What is Pemberton's sign?

Answer 36

Lift arms up so forearms touch the sides of face. Positive sign shows facial congestion and cyanosis and respiratory distress after 1 minute

Question 37

How do you diagnose a bronchial carcinoma?

Answer 37

1st line = imaging with Chest X-ray or CT Bronchoscopy and biopsy MRI for staging TNM

Question 38

How do you treat small cell carcinoma of lungs?

Answer 38

If early consider chem/radiotherapy but often resistant If metastasised, then palliative

Question 39

How do you treat non-small cell carcinoma?

Answer 39

If early, surgical excision If metastasised, chemo/radiotherapy

Question 40

What chemotherapy may be used for non-small cell adenomas?

Answer 40

mAb therapy cetuximab against epidermal growth factor

Question 41

What is a Pancoast tumour?

Answer 41

Tumour in lung apex that metastasis to neck's sympathetic plexus causing Horner's syndrome

Question 42

What is the triad of symptoms for Horner's syndrome?

Answer 42

Ptosis Myosis (excessive pupil constriction) Anhidrosis

Question 43

True or false: primary lung tumours are much more common than secondary lung tumours

Answer 43

False The lungs oxygenate all the blood so all the blood comes to the lungs therefore there is a higher risk of metasises

Question 44

Which cancers commonly metastasise to the lung?

Answer 44

Breast Kidney Bowel Bladder