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iBSc: Question 3

iBSc: Question 3. By Alan McLeod Tested by Natalie Hayes. Getting the best marks. Read the whole question – a latter section may give you a clue about an earlier one.

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iBSc: Question 3

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  1. iBSc: Question 3 By Alan McLeod Tested by Natalie Hayes

  2. Getting the best marks Read the whole question – a latter section may give you a clue about an earlier one. To see how many points you need look at the marks allocated – for example a 3 point question is generally looking for 3 salient points If giving a list answer put the best answers first – examiners will not usually mark answers too far down a list Always write something – it may get you part of a mark and is anonymised so no one will think you are stupid! If you genuinely have no clue then re-write the question to see if this sparks some ideas. If not then move on and come back at the end. And remember – always write something. Good luck!

  3. Question 4 Mr Jackson, a 62 year old retired bricklayer has been experiencing haemoptysis for three weeks. Q4.1 • List 4 differentials for haemoptysis (4)

  4. Question 4 Mr Jackson has an 80 pack year smoking history. Q4.2 • What is a ‘pack year’ (2)

  5. Question 4 Cigarette smoke is a known carcinogen. Q4.3 • List two other carcinogens (1) Q4.4 • What are the three stages of carcinogenesis (3)

  6. Question 4 You suspect lung cancer. Q4.5 • What additional symptoms might you ask about to support your hypothesis (2) Q4.6 • What cancer specific tests might you order (3)

  7. Question 4 Tests reveal a squamous cell carcinoma of the lung with liver metastases. Q4.7 • Aside from SCC, list two other common types of lung cancer (2) Q4.8 • What changes occur in a cancer cell to allow metastasis? (5)

  8. Question 4 Tests reveal a squamous cell carcinoma of the lung with liver metastases. Q4.9 • Compare the characteristics of normal and neoplastic cells (4)

  9. Question 4 When you tell him the diagnosis, Mr Jackson becomes very angry - accusing you of negligence for not spotting this earlier. Q4.10 • Aside from anger, what are the stages of grief in the model proposed by Kubler-Ross (4)

  10. Question 4 You describe to Mr Jackson the probable prognosis and progression of the disease. Q4.11 • List one local and two systemic effects that cancers in general may produce (3)

  11. The Answers View these on ‘note view’ rather than on full screen – additional notes are provided for some slides

  12. Haemoptysis? Where’s that wine…

  13. Two Useful Concepts Body Mass Index (BMI) 20-25: Ideal 26-30: Overweight 31-35: Obese Pack Years > 20 = increased chance complications

  14. Carcinogens Cigarette smoke Chemicals • PAH • Aromatic amines • Nitrosamines UV Radiation Ionising radiation • Radiotherapy • Radon gas (lung) • Industry/military

  15. Carcinogens Viruses • EBV (Epstein-Barr) • HPV (Papilloma virus) • HBV (Hepatitis B virus) Stages in carcinogenesis • Initiation • Promotion • Progression

  16. Lung cancer • Male: Female 7:1 • Decreasing • Male peak in 60s • Female peak in 70s • Rare under 25 years Presenting complaints • 90% symptomatic • 40% Haemoptysis • 75% Anorexia • 75% Dyspnoea • 75% Cough • 75% Pain • Remember Weight Loss • 10% Incidental imaging

  17. Lung Cancer - Diagnosis • Imaging • Plain film • CT • MRI • Cytology • Sputum • Bronchoscopic washings Biopsy • Peripheral lesions • Percutaneous biopsy • Proximal lesions • Bronchoscopic biopsy • Pleural Effusions • Fine needle aspiration

  18. Lung Cancer Types • Small Cell (20-30%) • Non-small Cell • Large Cell (10-15%) • Adenocarcinoma (~20%) • Commonest non-smoking • Squamous cell carcinoma (40-60%) • Commonest smoking related Treatment • Small cell • Early metastasis • Chemotherapy and radiotherapy first line • Non-small cell • Surgery first line • Lobectomy • Pneumonectomy • Radio / chemo as req

  19. Invasion and Metastasis • Invasion is the spread into adjacent tissues – may occur along natural tissue planes such as along nerves • Metastasis is the spread of cells to distant parts of the body – there are several mechanisms for this

  20. To Metastasise • Changes occur in only some cells of the tumour • By random mutation • Binds to basement membr • Becomes motile • Becomes able to attach to extracellular matrix • Becomes able to degrade extracellular matrix • Must be able to survive and grow at site of implantation

  21. Fig 1 Routes of Metastasis • Vascular • Lymphatic • Coelomic

  22. Growth Characteristics

  23. Cytoplasmic Characteristics

  24. Histological Characteristics

  25. Local and systemic effects Local • Pressure • Invasion • Ulceration • Obstruction Systemic • Weight loss (cachexia) • Loss of appetite (anorexia) • Fever • Anaemia • General Malaise • Paraneoplastic

  26. The End The slides here should allow you to mark your own work – remember 1 mark per answer* up to the maximum for the question. Multiply by 3 to get percentage points. I assume a 60% pass mark. Sorry but I am unable to give further advice on answers due to time constraints.

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