Lung Cancer: Overview and Practice Questions

Lung cancer is a type of cancer that forms in the tissues of the lungs that most often occurs in those who smoke tobacco-related products.

This study guide was designed to provide you with a brief overview of this topic. We included practice questions for your benefit as well. So, if you’re ready, let’s get started.

What is Lung Cancer?

Lung cancer is a major public health problem in the United States that causes approximately 25% of all cancer deaths.

Smoking tobacco consumption is the leading cause of lung cancer which has a poor prognosis because only one out of every six patients survives for more than five years after receiving their diagnosis.

Lung cancer can develop in nonsmokers, however, the overwhelming majority of cases occur in those who smoke.

Risk Factors

Some examples of the primary risk factors for lung cancer include the following:

• Occupational exposure
• Environmental exposure
• Genetic predisposition
• Dietary factors
• Chronic obstructive pulmonary disease (COPD)
• Air pollution

The diagnosis of lung cancer can be confirmed with a PET scan, or more formally known as positron emission tomography.

It’s an imaging technique that uses radioactive substances to examine the metabolic activity of the lungs.

Treatment

There are different stages of lung cancer that each may result in different signs and symptoms. The treatment method will vary from patient to patient depending on which stage they’re in as well as the signs and symptoms.

With that said, here are some of the most common treatment methods:

• Surgical resection
• Radiation therapy
• Chemotherapy
• Targeted pharmacotherapy

Again, the treatment type may vary from patient to patient depending on their current stage and condition. 

Lung Cancer Practice Questions:

1. What is lung cancer?
It is a major public health problem in the United States (and the world). In the US, approximately 28% of cancer deaths are due to lung cancer. Most of these deaths could be avoided if people did not smoke tobacco-related products.

2. Is smoking cessation important for Respiratory Therapist?
Yes, yes it is. Smoking cessation helps reduce the number of deaths that occur from lung cancer.

3. What is the leading cause of cancer-related mortality in the United States?
Bronchogenic carcinoma. Approximately 224,210 cases of were newly diagnosed in the United States in 2014, making bronchogenic carcinoma a major health hazard.

4. Approximately 85% of all cases of bronchogenic carcinoma are linked to what?
Smoking

5. What are the major histopathologic types of bronchogenic carcinoma?
Adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and large cell carcinoma.

6. What is the most common type of bronchogenic carcinoma?
Adenocarcinoma, representing more than 40% of all cases.

7. The clinical manifestations of bronchogenic carcinoma result from what?
They result from the local growth of the tumor, regional spread, metastases to extrathoracic and intrathoracic organs, and paraneoplastic syndromes.

8. The staging system most commonly used for non–small cell bronchogenic carcinoma is based on what?
The status of the primary tumor (T), local and regional lymph node involvement (N), and the presence of metastasis (M). The TNM classification groups patients in stages or categories that correlate with survival. Small cell lung cancer is classified in two stages, limited and extensive, although the TNM system can be used as well.

9. What are the most commonly used treatments for patients with non–small cell lung cancer?
Surgical resection, radiation therapy, and chemotherapy.

10. The treatment of most patients with small cell carcinoma includes what?
Chemotherapy, with radiation therapy added if a limited stage disease.

11. What is the he most effective way to prevent lung cancer?
Prevent smoking.

12. What is Adenocarcinoma?
A type of cancer characterized by glandular structures.

13. What is Bronchoalveolar Cell Carcinoma?
It is a type of lung cancer characterized by tumor occurrence at the level of the small airways, often masquerading as a pneumonia.

14. What is Large Cell Carcinoma?
A type of lung cancer characterized by large cells on microscopy.

15. What is a mass?
A body of matter without a definite shape.

16. What is a nodule?
A small rounded lump of mineral substance. (usually harder than the surrounding rock or sediment)

17. What is Non-Small Cell Carcinoma?
This cancer grows more slowly than small cell lung carcinoma, and it’s not only found in smokers. It occurs in 85-87 percent of lung cancers.

18. What should you look for in Pancoast’s Syndrome?
You should look for a supraclavicular mass→apical lung tumor involving C8 & T1-2 nerve roots causing shoulder pain with radiation in the ulnar distribution of the arm, Carcinoma in apex of lung, can compress the cervical plexus.

19. What is Paraneoplastic Syndrome?
The effect of tumors remote from the tumor site and often mediated by reactions to tumor products or immune response to the tumor.

20. What is Radiotherapy?
Treatment with radiation.

21. What is screening?
Testing objects or persons in order to identify those with particular characteristics.

22. What is Small Cell Carcinoma?
Malignant, usually bronchogenic epithelial neoplasm consisting of small tightly packed round, oval or spindle-shaped epithelial cells that stain darkly and contain neurosecretory granules and little or no cytoplasm. Many malignant tumors of the lung are of this type. also called oat cell carcinoma or small cell carcinoma.

23. What is Squamous Cell Carcinoma?
A type of lung cancer characterized by cells that appear “plate-like”.

24. What is a Staging System?
A method used in cancer registers to identify specific and separate different stages or aspects of the disease.

25. What is TNM Staging?
A staging system based on the size of the tumor (T), the presence and position of abnormal lymph nodes (N), and the presence or absence of metastasis (or spread beyond the primary tumor site).

26. What is Transbronchial Needle Aspiration?
It is a technique of sampling lung tissue through a bronchoscope which involves passing a thin needle through a bronchus.

27. What is a Transthoracic Needle Biopsy?
Technique of obtaining a biopsy of lung tissue by which a needle is passed into the chest, often guided by imaging.

28. Why is lung cancer the most common cause of cancer death?
It is found at advanced stages because there are no symptoms in the early stages, there is limited effective therapy for the advanced disease, and the absence of pop based screening.

29. What is the treatment for lung cancer?
Surgery for early stages, chemo and radiation for regional diseases, and palliative care for advanced stages.

30. What are some other environmental causes besides smoking and radon?
Indoor combustion cook stoves, air pollution, vehicle exhaust, industrial emissions, solid fuel use, asbestos, chromium, and cadmium.

31. Lung cancer staging is based on what?
Primary tumor size and invasion of surrounding structures, the involvement of draining nodes, and the presence of distant mets.

32. What are key risk factors for lung cancer?
Cigarette smoke, radon, and asbestos.

33. What is necessary for the diagnosis of cancer?
A biopsy.

34. What are two benign lesions?
(1) Granuloma and (2) Bronchial hamartoma (tissue that belongs in that region but is disorganized, lung tissue and cartilage).

35. Lung carcinoma can be divided into what?
Two types; small cell carcinoma and non-small cell carcinoma.

36. Which category of lung cancer is not amiable to surgical resection?
Small cell carcinoma cells are so small the surgeon can’t see them.

37. What are the risk factors for lung cancer?
Smoking; increases with the number of packs smoked per day and number of years spent smoking, Women are at higher risk than males, Second-hand smoke Radon, ionizing radiation (2nd leading), Occupational exposure, Cancer history (lymphomas, head, and neck cancer), Genetics, and Coexisting lung diseases.

38. Why do women have a higher risk of lung cancer than men?
Differences in nicotine metabolism; hormonal factors.

39. How can the risk of lung cancer be reduced?
It decreases after smoking cessation; measurable difference at 5 years; 80-90% reduction after 15 years. Those who smoke more than 15 cigarettes/day, cutting that amount in half reduces the risk by 25%.

40. Who is at high risk for lung cancer?
People age 55-74 and those with more than 30 pack year history smoking are at the greatest risk for lung cancer.

41. What is the screening recommendations for the high-risk population?
Baseline low-dose CT (LDCT) scan; annual LDCT at least x 2 years.

42. What is the routine screening recommendations for high and low-risk groups?
Routine screening is not recommended.

43. What is a unique symptom of lung cancer?
Nail clubbing.

44. What are the lab abnormalities of lung cancer?
Hypercalcemia, anemia, leukocytosis, and thrombocytosis.

45. What laboratory tests should be used in diagnosis?
CBC with diff, BMP, LFT’s, and albumin.

46. What tissue sampling is used in the diagnosis of lung cancer?
Tumor biopsy (gold standard), fluid cytology if pleural effusion present, sputum cytology, mutational status, pulmonary function tests (surgical eligibility), and bone marrow biopsy (neutropenic or thrombocytopenic patient).

47. What are PFT’s used for in regards to lung cancer?
They are used to determine surgical eligibility.

48. What is the most aggressive type of lung cancer?
Small cell.

49. What is the survival rate without treatment in a patient with small cell lung cancer?
2-4 months.

50. Does small cell lung cancer have a clear relationship to smoking?
Yes, yes it does.

51. What kind of staging does small cell lung cancer use?
Limited/extensive.

52. Who is adenocarcinoma most common in?
US; non-smokers; lung periphery.

53. Who is squamous cell lung cancer most common in?
It is most common in smokers; centrally located; slower growing.

54. What imaging technique is used for the diagnosis of lung cancer?
PET scan.

55. Lung cancer causes approximately what percentage of all cancer deaths?
It causes approximately 25% of all cancer deaths.

Final Thoughts

As a respiratory therapist, the topic of lung cancer is one that you are required to be familiar with. Hopefully, this study guide can help make the learning process easier for you.

We have a similar guide on lung infections that I think you find useful. Thanks for reading and, as always, breathe easy, my friend.