Chest malignancy Risk Factors And Complications

Question 1

What are the broad categories of lung cancer complications?

Answer 1

Mass effect of tumour

Spread of cancer

Immune response to cancer

Hormonal secretions by tumour

Question 2

What are the possible complications of the mass effect of a lung tumour?

Answer 2

1.Post-obstructive pneumonia:
MOA = Trapping infections within the bronchi - bronchi compression

2. Pancoast syndrome:
   MOA = Brachial plexus compression, and orbital sympathetic nerve compression

3. Superior vena cava syndrome
MOA = Compression of the SVC, preventing return from the face and arms
Signs:
Facial/upper limb oedema
Dyspnoea
Cough
Orthopnoea 

4. Acute or massive haemoptysis
   MOA = invasion of an airway

Question 3

When lung cancer metastasises to the brain what symptoms might we see?

Answer 3

Dizziness

Confusion

LOC

Headache

Cranial nerve palsies

Focal neurological deficits

Question 4

If a lung cancer spreads to the liver, what signs and symptoms might we see?

Answer 4

Jaundice

The lungs are close to the liver, and therefore may spread there without metastasising.

Question 5

What signs/symptoms might we see if lung cancer spreads to the adrenal glands?

Answer 5

Diabetes

Cushing’s syndrome

Addingtons disease

Hyperkalemia

Metabolic acidosis

Hyponatremia

Question 6

How does lung cancer cause pleural effusion?

Answer 6

The immune response to the lung cancer invading the pleural space is continuous and non-resolving, constantly producing exudate, this collects in the space and causes pleural effusion.

Happens commonly because the pleural space is immediately adjacent to the lung, therefore often occurs.

Tumours can also embolise and cause pulmonary embolism.

Question 7

Why in certain small cell lung cancers do the muscles display paraneoplastic signs?

Answer 7

Certain small cell cancers cause the body to produce antibodies against the cancer which cross-react with neurons.

This reduces the ability of the neurons to work,and causes:

Eaton lambert syndrome - weakness in lower limbs is main symptom
Myasthenia Gravis - weakness in eyes, eyelids and facial muscles

Question 8

Which hormone is affected by non small cell lung cancer?

Answer 8

Only PTH

This increased PTH causes more bone breakdown to increase the serum calcium (PTH increases serum calcium).

This increases chance of osteoporosis and fractures.

Also: Bones, moans, stones and groans

Question 9

Which two hormones do small cell carcinomas affect?

Answer 9

ADH - increased blood pressure and increased sodium loss (hyponatremia)

Adrenocorticotropic hormone - increased cortisol, decreased immune function and increased risk of diabetes

Question 10

What are the sources of asbestos that a patient may have had contact with?

Answer 10

1.Asbestos-containing building materials:
Roofing

Cladding

Insulation

2. Construction work
3. Demolition work
4. Refurbishment work
5. Plumbing
6. Cable laying
7. Roofing
8. Gas fitters
9. Computer installation
10. Electricians
11. Any trade basically

(Via breathing the fibre particles)

Question 11

Where does small cell lung cancer tend to metastasise to?

Answer 11

Bone

Liver

Brain