Clinical Aspects of Lung Cancer

Question 1

give 5 general features of cancer

Answer 1

malignant growth
uncontrolled replication
local invasion
metastasis
non-metastatic systemic effect

Question 2

d: paraneoplastic features

Answer 2

is the consequence of cancer in the body but that, unlike mass effect, is not due to the local presence of cancer cells

Question 3

why is the prevalence of Lung cancer low/

Answer 3

patients do not live for long

Question 4

what is one reason for poor prognosis of lung cancer?

Answer 4

lung cancer tends not to cause any symptoms until the disease has become too advanced for any hope of cure

Question 5

give some common symptoms of a common potential cancer

Answer 5

cough of 3 weeks or more
feeling breathless for no reason
a chest infection that doesn't clear up
coughing blood
unexplained weight loss
chest/shoulder pains
unexpected tiredness or lack of energy
a prevalent hoarse voice

Question 6

d: haemoptysis

Answer 6

coughing up blood

Question 7

what is haemoptysis a direct consequence of?

Answer 7

primary tumour

Question 8

which lung is normally the diseased lung in an X ray?

Answer 8

the smaller one

Question 9

what may recurrent pneumonia be a sign of?

Answer 9

primary lung cancer

causing a partial obstruction of the upper lobe bronchus

Question 10

What is a shrinking lung explained by?

Answer 10

a shrinking lung is explained by the obstruction of proximal divisions of the bronchial tree. When a lobe becomes obstructed, all of the air beyond the obstruction is absorbed and the lung tissue shrinks down to a much smaller size. The net effect is a reduction in size.

Question 11

d: stridor

Answer 11

distressing symptom of breathing in; a coarse audible wheeze during inspiration

Question 12

why may a patient with lung cancer be SOB?

Answer 12

tumour may block bronchioles narrowing airway

Question 13

why might someone have a hoarse voice?

Answer 13

paralysis of the left vocal cord and a tumour at the origin of the left upper lobe. The primary tumour had invaded the recurrent laryngeal nerve

Question 14

medical term for hoarse voice

Answer 14

recurrent laryngeal nerve palsy

Question 15

d: atrial fibrillation

Answer 15

irregular and rapid heart beat
the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart

Question 16

d: pericardial effusion

Answer 16

fluid around the heart

Question 17

d: dysphagia

Answer 17

pain whilst swallowing

Question 18

what symptom may indicate a tumour in the oesophagus?

Answer 18

dysphagia for solids eg bread

Question 19

d: Pancoast tumour

Answer 19

tumour in the pulmonary apex

Question 20

why may a man who had hand pain have a lung tumour?

Answer 20

The wasting of the small muscles of the hand is due to T1 root infiltration by a primary lung cancer in the apex of the left lung. The tumour has eroded through the ribs and into the lower part of the brachial plexus
the tumour destroys the bone

Question 21

d: pleural effusion

Answer 21

in cancer, condition in which a tumour invades plural space it often generates a large volume of pleural fluid

Question 22

why may a patient have a distended external jugular vein?

Answer 22

a local invasion of the superior vena cava obstructs drainage of the blood from the arms and head

Question 23

if the patient describes localised chest wall pain which is worse with movement and the pain is worse at night, what may have happened?

Answer 23

primary tumour has grown through the intercostal spaces and we can see the mass lying deep to the pectoralis muscle
if bone has be eroded, there has been destruction of part of the adjacent ribs

Question 24

name the 6 common sites for metastases

Answer 24

liver
brain
bone
adrenal
skin
lung

Question 25

why may a patient with cerebral metastasis experience an epileptic fit?

Answer 25

metastasis involves the cortex

Question 26

what does a cerebral metastasis look like on a CT scan?

Answer 26

ring surrounds | dark halo of swollen brain

Question 27

name 7 non-metastatic(paraneoplastic) features

Answer 27

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

Question 28

what does HPOA stand for and what does it show? what are the symptoms?

Answer 28

Hypertrophic pulmonary osteoarthropathy - bone scan Symptoms of pain and tenderness of the long bones near the adjacent joints are due to elevation of the periosteum away from the bone surface

Question 29

why do patients with a tumour experience unexplained weight loss?

Answer 29

tumour requires energy using up stores

Question 30

d: hypercalcaemia

Answer 30

abnormally high level of calcium in the blood

Question 31

name the effects of hypercalcaemia

Answer 31

``` stones bones groans thrones pscychiatric overtones ```

Question 32

treatments of hypercalcaemia

Answer 32

initial is rehydration then IV Bisphosphate treat underlying cancer- usually squamous epithelium

Question 33

d: SIADH

Answer 33

– Syndrome of inappropriate antidiuretic hormone

Question 34

d:diuresis

Answer 34

excessive urine production

Question 35

what are the generalized symtoms of SIADH and what is it normally caused by?

Answer 35

``` Nausea/vomiting Myoclonus Lethargy/confusion Seizures/coma usually small lung cancer results in low sodium concentration ```

Question 36

treatment of SIADH

Answer 36

teat the cancer fluid restriction drugs- demeclocycline

Question 37

what colour is the sputum that smokers normally cough up?

Answer 37

clear

Question 38

if the patient tells you that they try to cough something up but cant, what is this a sign of?

Answer 38

In lung cancer, the sensation which triggers a desire to cough is distortion of the normal bronchial mucosa by the tumour

Question 39

name some lung cancer tests

Answer 39

``` FBC Coagulation screen Na K Ca Alk Phos spirometry, FEV1 Chest X ray CT scan of the Thorax PET scan Bronchoscopy Endobronchial US ```

Question 40

what does PET scan assess?

Answer 40

function over structure analysis of tissue uptake of radiolabelled glucose tissues with high metabolic activity light up

Question 41

what bits always shine bright on PET? Why?

Answer 41

brain urine tumours glucose content

Question 42

name some ways we can make a tissue diagnosis

Answer 42

``` Bronchoscopy CT guided biopsy Lymph node aspirate Aspiration of pleural fluid Endobronchial Ultrasound Thoracoscopy ```

Question 43

describe how the endobronchial US works

Answer 43

Bronchoscope with ultrasound tip Enables visualisation of hilar and mediastinal structures Target and sample lymph nodes