Oncology - Lung Cancer

Front 1

What 2 broad categories can lung cancers be divided into?

Why is this distinction made?

Back 1

Lung cancers are divided into small cell and non-small cell cancers.

The importance of this distinction relates to the propensity of small cell carcinoma for early clinical and subclinical metastasis.

Front 2

Which type of lung cancer has the best prognosis?

Back 2

Squamous cell lung cancer has the best 5 year survival rate.

Front 3

List the 4 types of lung cancer in order from most to least common.

Back 3

1) Adenocarcinoma (38% of lung CA)
2) Squamous cell carcinoma (28%)
3) Large cell carcinoma (20%)
4) Small cell carcinoma (14%)

Front 4

"Oat cell" carcinoma is a subtype of which of the 4 types of lung cancer?

Back 4

Oat cell carcinoma is a subtype of small cell carcinoma.

Front 5

Which of the 4 types of lung cancer has the worst prognosis?

Back 5

Small cell carcinoma has the worst 5 year survival rate.

Front 6

What is the cell of origin of small cell carcinomas?

Back 6

Originally it was believed that these tumours arise from the Kulchitsky cell or K cell, a neurosecretory epithelial cell.

More recently, however, it is generally thought that ALL lung cancers have their origin from a pluripotent stem cell and that the eventual cell type depends on the pattern and degree of differentiation from this precursor cell.

Front 7

True or false: Small cell carcinomas commonly produce polypeptide hormones

Back 7

True

Front 8

What is typically the most prominent radiographic aspect of small cell carcinoma?

Back 8

Enlarged hilar and mediastinal lymph nodes

Front 9

Which is the most common type of lung cancer?

Back 9

Adenocarcinoma

Front 10

Which type of lung cancer is associated with hypercalcemia?

Back 10

Squamous cell carcinoma

Front 11

Squamous cell carcinoma is associated with which electrolyte disturbance and why?

Back 11

Hypercalcemia due to occasional secretion of a parathyroid-like hormone from the tumour cells

Front 12

What are the signs of Horner's syndrome?

How can lung cancer cause Horner's syndrome?

Back 12

The symptoms of Horner's syndrome are one-sided ptosis (drooping of the eyelind), miosis (pupil contraction), and anhidrosis (lack of sweat).

Lung cancer can cause Horner's syndrome through direct invasion or extrinsic compression of the cervical sympathetic chain.

Front 13

Explain how lung cancer can cause diaphragmatic paralysis.

Back 13

Mediastinal lymph nodes can compress the phrenic nerve, leading to diaphragmatic paralysis which presents clinically as dyspnea.

Front 14

Explain how lung cancer can cause shoulder or arm weakness/pain.

Back 14

Lung cancers can invade or externally compress the brachial plexus, resulting in shoulder or arm pain/weakness.

Front 15

What are "paraneoplastic" manifestations of malignancy?

Back 15

Paraneoplastic manifestations are those manifestations of malignancy that do not directly result from the space-occupying nature of the lesion.

They are frequently due to production of a hormone or a hormone-like substance by the tumour.

Front 16

A single nodule is found on a chest radiograph.

If the nodule is proximal, which two cancer types is it most likely to be?

If the nodule is peripheral, which two cancer types is it most likely to be?

Back 16

Central (proximal) - "bronchogenic" carcinoma--> squamous cell, small cell

Peripheral --> adenocarcinoma, large cell carcinoma

Front 17

Name 3 imaging modalities employed in the diagnosis and staging of lung cancer.

Name 2 scoping techniques also employed to visualize and aid diagnosis and staging.

Back 17

1) Chest radiograph
2) Chest CT
3) PET scan

1) Bronchoscopy
2) Mediastinoscopy

Front 18

You have a patient with suspected lung cancer. Describe the work-up required to diagnose/stage her and plan her treatment.

Back 18

1) Visualization
-Imaging (CXR, CT, PET scan)
-Scoping (bronchoscopy, mediastinoscopy)

2) Pathology (tissue diagnosis), with biopsy attained through:
-scope (bronchoscopy/mediastinoscopy)
-fine needle aspiration
-open excision

3) Functional assessment (PFTs)

Front 19

Along which three parameters is staging of non-small cell carcinomas of the lung (adenocarcinoma, squamous cell carcinoma, large cell carcinoma) based?

Back 19

1) Properties of the primary lesion
-size, location, and local complications such as obstruction

2) Hilar/mediastinal lymph node involvment

3) Presence of distant metastases

Front 20

Into what two groups are small cell carcinomas divided into for staging purposes?

Back 20

1) Limited (localized within one hemithorax)

2) Extensive (beyond the limits of one hemithrorax)

Front 21

Describe the three methods through which tissue is obtained for biopsy.

Back 21

1) From a scope (bronchoscopy/mediastinoscopy)

2) From a needle

3) Open excision

Front 22

Prognosis

What is the five year survival rate of a patient diagnosed with lung cancer?

Back 22

It depends on what cell type it is, but for all lung cancers combined the 5 year survival rate is only 14%

Front 23

Management

What is the treatment of choice for a completely localized lung cancer?

Back 23

Surgical resection

Front 24

What is the difference between excision and resection?

Back 24

Resection is the partial removal of an organ or gland.

Excision is the removal of the entire organ or gland.

Front 25

Management

What is the treatment of choice for a lung tumour that has spread to the pleura/mediastinum or metastasized to distant sites?

Back 25

Surgery not on the table. Treatment some combination of chemo and or radiotherapy.

Front 26

Surgery is almost never performed to treat small cell carcinoma. Why not?

Back 26

Small cell carcinoma is known to spread and metastasize very quickly, making it unlikely that surgery on a single lesion will solve the problem.

Front 27

Which type of lung tumour is thought to arise from the neurosecretory Kulchitky cell (K cell)?

Back 27

Bronchial carcinoid tumours

Front 28

For which type of lung tumour is smoking not a risk factor?

Back 28

Bronchial carcinoid tumours

Front 29

What is a carcinoid tumour?

Back 29

The term “carcinoid” is generally applied to well-differentiated neuroendocrine tumors originating in the digestive tract, lungs, or rare primary sites such as kidneys or ovaries.

Use of the term carcinoid implies well-differentiated (low- to intermediate-grade) histology and is not traditionally used to describe high-grade or poorly differentiated neuroendocrine tumors (which are rare).

Carcinoid tumors were so named because they seemed morphologically different and clinically less aggressive than the more common GI tract adenocarcinomas.

Front 30

What is the treatment for bronchial carcinoid tumours?

Back 30

Surgical resection if at all possible

Front 31

What is the primary risk factor for development of malignant mesothelioma?

Back 31

Asbestos exposure (disease occurs approximately 30-40 years later)

Front 32

Where does malignant mesothelioma originate?

Back 32

Malignant mesothelioma arises in the pleura and is usually associated with pleural effusion and thick, lobulated pleura.