Lung Cancer

Aetiology

100

What is the biggest risk factor for lung cancer

SMOKING!

200

What is the primary cause of mesothelioma?

Asbestos Exposure

300

A 70-year-old man, a non-smoker, has experienced haemoptysis for 2 weeks. On physical examination there are no abnormal findings. A chest CT scan shows a 6 cm left perihilar cavitary mass. Sputum cytologic examination reveals atypical cells present consistent with squamous cell carcinoma. A mediastinoscopy is performed, and the mass appears to extend into the the mediastinum, but not to the opposite lung. Sampling of enlarged hilar and scalene lymph nodes reveals metastatic squamous cell carcinoma. Which of the following is the most appropriate conclusion from these findings?

A He has a resectable lesion

B The stage of his neoplasm is T1

C His 5 year survival is 80%

D There is a history of radon gas exposure

E His antinuclear antibody test is positive

(D) CORRECT. This is a large, unresectable cancer with a poor prognosis because distant nodes are involved. The second most common cause for lung cancer is probably radon gas (if passive smoking is included with smoking as a risk).

Pathogenesis

100

What type of cells do squamous cell carcinomas effect ?

squamous cells which line the inside of the airway

200

Where does SCLC usually begin?

bronchi

300

A patient presents with a hoarse voice and difficulty speaking. Imaging shows a mass in the mediastinum, and it is suspected that the mass is affecting the nerve that controls the vocal cords. Which of the following nerves is most likely involved in this condition?

A. Vagus nerve
B. Phrenic nerve
C. Recurrent laryngeal nerve
D. Glossopharyngeal nerve

C. Recurrent laryngeal nerve

"•Recurrent laryngeal nerve palsy presents with a hoarse voice. It is caused by a tumour pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum."

Types

100

What are the two main divisions of lung cancer?

SCLC

NSCLC

200

Name the most common subtype of non-small cell lung carcinoma (NSCLC).

Adenocarcinoma

300

What clinical features would help you distinguish a patient with adenocarcinoma from a patient with squamous cell carcinoma of the lung?

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  • Adenocarcinoma often occurs in non-smokers and peripheral lung areas, while squamous cell carcinoma is more common in smokers and typically found centrally in the lungs, often associated with cough and hemoptysis.

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Clinical and Pathological Features

100

Name 3 symptoms of lung cancer.

Coughing,

Shortness of breath,

Chest pain,

Haemoptysis.

200

List three paraneoplastic syndromes commonly associated with small cell lung carcinoma.

- Syndrome of inappropriate ADH (SIADH). It presents with hyponatraemia.

- Cushing’s syndrome can be caused by ectopic ACTH secretion by a small cell lung cancer.

- Hypercalcaemia can be caused by ectopic parathyroid hormone secreted by a squamous cell carcinoma.

300

A 44-year-old woman, a non-smoker, has had a fever and cough for the past 4 days. She does not have haemoptysis. She has not experienced weight loss, malaise, nausea, or vomiting. On physical examination her temperature is 37.7 C. There are decreased breath sounds over the right upper lung. A chest radiograph reveals a 6 cm area of infiltrates in the right upper lobe. She is given a course of antibiotic therapy, but her cough persists. A month later her chest x-ray now reveals a 3 cm peripheral mass in the right upper lobe. Which of the following neoplasms is most likely to be present in this woman?

A  Squamous cell carcinoma

B  Small cell anaplastic carcinoma

C  Adenocarcinoma

D  Mesothelioma

E  Carcinoid tumor

Peripheral lung cancers (adenocarcinoma and large cell carcinoma) show less of an association with smoking than central cancers (small cell and squamous cell carcinoma).