tumours

Question 1

what is main cause of lung cancer

Answer 1

smoking

Question 2

other causes of lung cancer

Answer 2

• radon exposure
• asbestos
• ionising radiation
• arsenic
• chromium
• nickel
• pulmonary fibrosis
• HIV
• genetics

Question 3

what are the 2 types

Answer 3

• small cell

- non-small cell

Question 4

examples of non-small cell

Answer 4

• adenocarcinoma
• squamous cell
• large cell

Question 5

what is a mutation

Answer 5

in the epidermal growth factor (EGFR)

Question 6

what do squamous cell carcinoma arise from

Answer 6

epithelial cells associated with production of keratin

Question 7

what is most common type in non-smokers

Answer 7

adenocarcinoma

Question 8

where do small cell arise from

Answer 8

neuroendocrine cells (APUD cells)

Question 9

what do small cell often secrete

Answer 9

polypeptide hormones

Question 10

where are small cell most common

Answer 10

centrally

Question 11

symptoms

Answer 11

• cough
• chest pain
• haemoptysis
• chest infection
• malaise
• breathlessness
• wheeze
• recurrent infection
• invasion of phrenic nerve

Question 12

what is most common symptom

Answer 12

cough

Question 13

why do patients get breathless

Answer 13

tumour occludes large airways can cause lung collapse

Question 14

what is a co-existing disease

Answer 14

COPD

Question 15

why does patient get hoarse voice

Answer 15

compression of left recurrent laryngeal

Question 16

where can it metastases

Answer 16

• liver
• bone
• adrenal gland
• brain
• malignant pleural effusion

Question 17

extra pulmonary manifestations

Answer 17

• anaemia
• finger clubbing
• hypertrophic pulmonary osteoarthropathy
• weight loss
• anorexia
• gynaecomastia

lots more

Question 18

aims of investigations

Answer 18

• stage
• differentiate
• assess fitness to undergo treatment

Question 19

what investigations are done

Answer 19

• chest x-ray
• CT
• ultrasound
• biopsy

Question 20

what does CT indicate

Answer 20

extent of disease

Question 21

what is used for staging

Answer 21

TNM

Question 22

what does T stand for in TNM

Answer 22

tumour size

Question 23

what does N stand for in TNM

Answer 23

nodal involvement

Question 24

what does M stand for in TNM

Answer 24

metastases

Question 25

TX means

Answer 25

- primary tumour cannot be assessed | - or tumour present in sputum but cannot be found

Question 26

T0 means

Answer 26

no evidence of primary tumour

Question 27

Tis means

Answer 27

carcinoma in situ

Question 28

T1 means

Answer 28

tumour <3cm

Question 29

T2 means

Answer 29

tumour >3cm but less than 7cm - involves main bronchus - invades visceral pleura

Question 30

T3 means

Answer 30

tumour >7cm - directly invades chest wall, diaphragm, phrenic nerve, pleura

Question 31

T4 means

Answer 31

tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, carina

Question 32

NX means

Answer 32

regional lymph nodes cannot assessed

Question 33

N0 means

Answer 33

no regional lymph node metastases

Question 34

N1 means

Answer 34

metastasis in ipsilateral peribronchial hilar lymph nodes

Question 35

N2 means

Answer 35

metastasis in ipsilateral mediastinal and/or subcranial lymph nodes

Question 36

N3 means

Answer 36

metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene nodes

Question 37

M0 means

Answer 37

no distant metastasis

Question 38

M1 means

Answer 38

distant metastasis

Question 39

when are lymph nodes classed as being enlarged

Answer 39

>1cm

Question 40

what is test for assessing extent of lymph node involvement

Answer 40

PET

Question 41

is MRI useful

Answer 41

no

Question 42

when is MRI useful

Answer 42

pancoast tumour

Question 43

what is bronchoscopy used for

Answer 43

biopsy

Question 44

when is tumour inoperable

Answer 44

if carcinoma involved first 2cm of either main bronchus

Question 45

what is most common complication of biopsy

Answer 45

pneumothorax

Question 46

are most patients curable or incurable

Answer 46

incurable

Question 47

when is surgery done

Answer 47

non small cell

Question 48

what is treatment of choice when surgery not available

Answer 48

radiation therapy

Question 49

what is given at end of chemotherapy

Answer 49

radiotherapy to consolidate treatment in small cell lung cancer

Question 50

what is used in palliation

Answer 50

laser therapy

Question 51

who are all involved in treatment

Answer 51

MDT

Question 52

how do metastases of lung present

Answer 52

as round shadows

Question 53

where do secondary lung tumours come from

Answer 53

- kidney - prostrate - breast - bone - GI tract

Question 54

differential diagnosis

Answer 54

- primary bronchial carcinoma - tuberculoma - benign tumour of lung - hydatid cyst

Question 55

BENIGN TUMOURS

Answer 55

BENIGN TUMOURS

Question 56

what is most common benign tumour

Answer 56

pulmonary hamartoma

Question 57

how is pulmonary hamartoma detected on CXR

Answer 57

well-defined round lesion 1-2cm

Question 58

what do bronchial carcinoids produce

Answer 58

adrenocorticotrophic hormone (ACTH)

Question 59

what does small cell release

Answer 59

ACTH

Question 60

what does ACTH cause

Answer 60

cushing syndrome

Question 61

what does squamous cell carcinoma release

Answer 61

PTH

Question 62

what does PTH cause

Answer 62

hypercalaemia

Question 63

what are the signs of cushing syndrome

Answer 63

- central obesity - 'buffalo hump' - striae - proximal muscle weakness

Question 64

what is most common in non-smokers

Answer 64

adenocarcinoma

Question 65

metastases from primary lung cancer

Answer 65

BLAB - brain - liver - adrenal - bone

Question 66

where is pancoast tumour

Answer 66

apex of lung

Question 67

where do pancoast tumour invade

Answer 67

the brachial plexus

Question 68

what is pancoast tumour associated with when it compresses the sympathetic chain

Answer 68

Horner syndrome

Question 69

features of Horner syndrome

Answer 69

- miosis - ptosis - anhidrosis

Question 70

what can pancoast tumour compress

Answer 70

sympathetic chain

Question 71

what do squamous cell carcinoma produce

Answer 71

keratin