Clinical Aspects of Bronchial Carcinoma (DISEASE MECHANISMS)

Question 1

What are the general features of cancer? (5)

Answer 1

Uncontrolled replication
Malignant growth
Local invasion
Metastasis
Non-metastatic systemic effects?

Question 2

What aspect of cancer causes non-metastatic systemic effects?

Answer 2

Biologically active cells released from tumour cells

Question 3

What are para-neoplastic symptoms?

Answer 3

Symptoms that come up because of chemicals or hormones that the malignant tissue produce

Question 4

What are the early symptoms of lung cancer? (8)

Answer 4

Cough for > 3 weeks 
Breathlessness without reason
Persistent chest infection
Haemoptosis 
Unexplained weight loss
Chest/Shoulder pains
Unexplained fatigue/lethargy
Hoarse voice

Question 5

What lines the bronchial mucosa?

Answer 5

Ciliated epithelium

Question 6

What tool is used to take a sample during bronchoscopy?

Answer 6

Cytology Brush

Question 7

What can be the underlying cause of recurrent pneumonia?

Answer 7

Underlying primary tumour

Question 8

What is stridor?

Answer 8

Distressing symptom of difficulty breathing in

Question 9

What sound is stridor typically associated with?

Answer 9

Coarse audible wheeze dring inspiration

Question 10

What are the 6 common sites of local invasion of lung tumours?

Answer 10

Recurrent laryngeal nerve
Pericardium
Oesophagus
Brachial plexus
Pleural cavity
Superior vena cava

Question 11

How would a local invasion of the recurrent laryngeal nerve present?

Answer 11

Hoarse voice / Inability to speak

Question 12

How would a local invasion of the pericardium present?

Answer 12

Breathless
Atrial fibrillation
Pericardial effusion

Question 13

How would a local invasion of the oesophagus present

Answer 13

Dysphagia

Question 14

What is dysphagia?

Answer 14

Difficulty/Inability swallowing

Question 15

What is pericardial effusion?

Answer 15

Fluid build-up in the pericardium

Question 16

What can pericardial effusion lead to?

Answer 16

Tamponade
Tachycardia
Fibrillations

Question 17

What is a pan coast tumour?

Answer 17

Tumour in the apex of the lung

Question 18

What can brachial plexus invasion of a tumour cause?

Answer 18

Wasting of muscles in the upper limb/pectoral girdle?

Question 19

What does the brachial plexus supply?

Answer 19

Upper limbs and pectoral girdle

Question 20

What can a tumour invading the pleural cavity cause?

Answer 20

Pleural effusion

Question 21

What does local invasion of the SVC cause?

Answer 21

Obstruction of blood drainage from the arms and head

Question 22

How do patients with a SVC obstruction present?

Answer 22

Puffy eyelids
Headache
Distension of superficial veins

Question 23

Blood bypasses obstructed SVC by opening _______ with __ tributaries

Answer 23

Anastomoses

IVC

Question 24

How does a patient with chest wall invasion by lung cancer present?

Answer 24

Localised chest wall pain - worse with movement

If there is bone erosion, often worse pain at night

Question 25

How do patients with a pulmonary artery obstruction present?

Answer 25

Breathless

Question 26

What is the danger of a tumour eroding the pulmonary artery and major bronchus?

Answer 26

Sudden death due to massive haemoptysis

Question 27

What are the common sites for metastases of primary lung cancer? (6)

Answer 27

``` Liver Brain Bone Adrenal Skin Lung ```

Question 28

How would a patient with cerebral metastases present?

Answer 28

``` Insidious onset of: Weakness Visual disturbance Headaches Fits/Seizures ```

Question 29

What distinguishes headaches caused by cerebral metastases?

Answer 29

Worse in the morning Not photophobic Worse when leaning forward

Question 30

Why do cerebral metastases cause headaches?

Answer 30

Raised intracranial pressure

Question 31

If cerebral metastases involve the cortex, the patient may present with ______

Answer 31

Epileptic fits

Question 32

Cerebral metastases can displace vessels in the brain causing ______

Answer 32

Oedema

Question 33

Oedematous brain can be treated with _____

Answer 33

Corticosteroid therapy

Question 34

Which corticosteroid could be used to treat oedematous brain?

Answer 34

Dexamethasone

Question 35

How would a patient with liver metastases adjacent to the liver capsule present?

Answer 35

Abdominal pain

Question 36

How would a patient with liver metastases obstructing the biliary drainage present?

Answer 36

Obstructive jaundice

Question 37

How can liver metastases often be identified?

Answer 37

Felt upon palpation - liver can become enormous

Question 38

How do patients with bone metastases commonly present?

Answer 38

Localised pain, usually mid-shaft that is worse at night

Question 39

What is the issue with adrenal metastases?

Answer 39

Often don't show many symptoms

Question 40

What are the most common neoplasms in the adrenal?

Answer 40

Adenomas

Question 41

What are the common paraneoplastic symptoms of lung cancer?

Answer 41

``` Finger clubbing Hypertrophic pulmonary osteoarthropathy (HPOA) Weight loss Thrombophlebitis Hypercalcaemia Hyponatraemia (SIADH) Weakness - Eaton Lambert syndrome ```

Question 42

How can tumours cause hypercalcaemia?

Answer 42

By producing a substance that mimics th effects of the parathyroid hormone

Question 43

What are common features of hypercalcaemia?

Answer 43

Headaches, confusion, thirst and constipation

Question 44

How can tumours cause hyponatraemia?

Answer 44

Production of a substance which mimics anti-diuretic hormone

Question 45

What is the main symptom of hyponatraemia?

Answer 45

Confusion

Question 46

What characterises Eaton-Lamber syndrome

Answer 46

Muscle weakness of the limbs

Question 47

How would you identify hypertrophic pulmonary osteoarthropathy on an X-ray?

Answer 47

Fuzzy appearance around the outer layer of the bone

Question 48

Where are common sites for hypertrophic pulmonary osteoarthropathy?

Answer 48

Hands, legs, and lower legs

Question 49

What is Thrombophlebitis?

Answer 49

Inflammation of the wall of a vein associated with thrombosis

Question 50

How do patients with thrombophelibits present?

Answer 50

Painful red tracking up the veins that doesn't settle down very easily

Question 51

What important things should you ask for in a history in regards to lung cancer?

Answer 51

``` Cough Haemoptysis Cigarette smoker Breathless Weight loss Chest Wall pain Tiredness Recurrent infection Other smoking-related disease ```

Question 52

Why do lung cancer patients present with a cough?

Answer 52

Distortion of normal bronchial mucosa stimulates signal to cough

Question 53

How can tumours cause haemoptysis?

Answer 53

Ulcerate through mucosa - prone to bleeding

Question 54

Almost all smokers cough up ___ sputum in the morning

Answer 54

clear

Question 55

Why do patients with lung cancer often get recurrent lung infections?

Answer 55

Due to partial obstruction of a bronchial division by a tumour

Question 56

Why do many lung cancer patients present breathless?

Answer 56

Obstruction of airways

Question 57

What things should be watched out for in terms of signs of lung cancer during examination?

Answer 57

``` Finger clubbing Breathless Cough Weight loss Bloated face Hoarse voice Lymphadenopathy Tracheal deviation Dull percussion Stridor Enlarged liver ```

Question 58

What are the possible investigation at clinic?

Answer 58

``` Full blood count Coagulation screen Na, K, Ca, Alk Phos Spirometry, FEV1 Chest X-ray CT scan of thorax PET scan Bronchoscopy Endobronchial Ultrasound (EBUS) ```

Question 59

How does a PET scan work?

Answer 59

Analysis of tissue uptake of radio labelled glucose - tissues with high metabolic activity "light up"

Question 60

Why does the bladder always light up during a PET scan?

Answer 60

Because the bladder is where contrast is excreted

Question 61

Why does the brain always light up during a PET scan?

Answer 61

Because it is highly metabolically active

Question 62

How can a tissue diagnosis of lung cancer be made?

Answer 62

``` Bronchoscopy CT guided biopsy Lymph node aspirate Aspiration of pleural fluid Endobronchial ultrasound Throacoscopy ```

Question 63

Why is video-bronchoscopy more suitable for central disease?

Answer 63

Can't reach too far