Lung cancer

Question 1

2 histological classifications?

which is more common?

which has worse prognosis?

Answer 1

small cell (about 15%, worse prognosis)
non small cell

Question 2

types of NSCLC?

Answer 2

adenocarcinoma (mostly non-smokers)
SCC
large cell 
alveolar cell carcinoma 
bronchial adenoma (mostly carcinoid)

Question 3

commonest type of lung cancer?

Answer 3

adenocarcinoma

Question 4

T/F: alveolar cell carcinoma is often seen in heavy smokers

Answer 4

false - not related to smoking

Question 5

which lung cancer type is normally related to production of large volumes of sputum

Answer 5

alveolar cell carcinoma

Question 6

when might a lung cancer cause hoarseness

Answer 6

pancoast tumour > pressure on recurrent laryngeal nerve

Question 7

examination findings in lung cancer?

Answer 7

fixed monophonic wheeze
supraclavicular/ persistent cervical lymphadenopathy
clubbing

Question 8

thrombocyt OSIS/ OPENIA may be noted on bloods

Answer 8

thrombocytosis

Question 9

investigation of choice to investigate suspected lung cancer?

Answer 9

CT

CXR often done first, around 10% normal

Question 10

when might PET scan be indicated

Answer 10

in NSCLC to determine eligibility for curative treatment

improves diagnostic sensitivity of both local and distant mets

Question 11

SCC

1) typically CENTRAL/ PERIPHERAL
2) associated with secretion of what hormone
3) strongly associated with what finger sign
4) associated with hypertrophic ___ ___

Answer 11

1) central (SCC - Central)
2) PTHrP > hypercalcaemia
3) clubbing
4) pulmonary oestroarthropathy (🔺periositis, clubbing, painful arthralgia)

Question 12

Adenocarcinoma

1) typically CENTRAL/ PERIPHERAL
2) T/F: the majority of patients who develop lung adenocarcinoma are smokers

Answer 12

1) peripheral

2) true (although it’s the commonest type of LC in non-smokers)

Question 13

Large cell lung carcinoma

1) typically CENTRAL/ PERIPHERAL
2) T/F: poor prognosis
3) may secrete ____

Answer 13

1) peripheral
2) True - anaplastic, poorly differentiated
3) β-HCG

Question 14

T/F: most NSCLC are amenable to surgical treatment

Answer 14

false - only 20% suitable for surgery

Question 15

what procedure must be performed prior to surgery in NSCLC

Answer 15

mediastinoscopy (CT doesn’t always show mediastinal lymph node involvement)

Question 16

NSCLC has a poor response to CHEMO/ RADIO -therapy

Answer 16

chemotherapy

Question 17

contraindications to surgery in NSCLC?

Answer 17

general health 
stage IIIb or IV (i.e. mets present)
FEV1 < 1.5L
malignant pleural effusion 
vocal cord paralysis 
SVC obstruction
tumour near hilum

Question 18

paraneoplastic features of SCLC?

Answer 18

ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkolosis and muscle weakness more common than buffalo hump etc
Lambert-Eaton Syndrome

Question 19

what is Lambert-Eaton syndrome?

Answer 19

Abs against pre-synaptic voltage gated calcium channel in PNS

weakness improves after exercise (c.f. myasthenia)
limb girdle weakness (LL first)
hyporeflexia
autonomic symptoms

Question 20

paraneoplastic features of SCC?

Answer 20

PTHrP > hypercalcaemia
clubbing
HPOA
hyperthyroidism due to ectopic TSH

Question 21

paraneoplastic features of adenocarcinoma?

Answer 21

gynaecomastia

HPOA

Question 22

SCLC

1) usually CENTRAL/ PERIPHERAL
2) arise from ___ cells
3) associated with ectopic secretion of what?

Answer 22

1) central
2) APUD
3) ADH > hyponatraemia
ACTH > cushings, b/l adrenal hyperplasia, hypokalaemia alkalosis

Question 23

management of SCLC?

Answer 23

usually metastatic by time of diagnosis - most get combo of chemo and radio therapy (palliative chemo for more extensive disease)

v early stage now considered for surgery

Question 24

Refer people using a suspected cancer pathway referral (appointment within 2 weeks) if:

Answer 24

CXR findings suggestive of LC

Unexplained haemoptysis in >40

Question 25

Offer an urgent CXR (2 weeks) to assess lung cancer if >40 and 2 or more of the following unexplained symptoms (1 or more if ever smoked):

Answer 25

- cough - fatigue - SOB - chest pain - weight loss - loss of appetite

Question 26

Consider an urgent CXR (2 weeks) to assess lung cancer if >40 with any of:

Answer 26

- persistent/ recurrent chest infection - finger clubbing - supraclavicular/ persistent cervical lymphadenopathy - chest findings consistent with LC - thrombocytosis

Question 27

transudative vs exudative pleural effusion?

Answer 27

transudative: <30g/L protein exudative: >30g/L protein

Question 28

causes of transudative pleural effusion?

Answer 28

heart failure (commonest cause) hypoalbuminaemia hypothyroidism Meig's syndrome

Question 29

causes of exudative pleural effusion?

Answer 29

``` infection: pneumonia (commonest cause), TB, subphrenic abscess Connective tissue disease Neoplasia Pancreatitis PE Dressler's ```

Question 30

Mesothelioma 1) what is it 2) strongly associated with ____ exposure 3) features 4) T/F: most have pre-existing asbestosis 5) metastasises where? 6) prognosis?

Answer 30

1) cancer of the mesothelial layer of the pleural cavity 2) asbestos 3) dyspnoea, weight loss, chest wall pain, clubbing 4) false- only 20% 5) contralateral lung and peritoneum 6) poor- median survival 12months

Question 31

what CXR finding would raise suspicion of a mesothelioma? next step for investigation?

Answer 31

painless pleural effusion or pleural thickening next step: pleural CT

Question 32

Ix 1) 1st line 2) for staging? 3) for looking for mets?

Answer 32

1) CXR 2) contrast enhanced CT 3) PET-CT

Question 33

T/F: In small cell lung cancer, surgery is usually not | an option

Answer 33

true

Question 34

mainstay of treatment in SCLC?

Answer 34

chemotherapy with platinum based drugs

Question 35

symptoms of hypercalcaemia?

Answer 35

"stones, bones, abdominal moans and psychic groans" - Renal stones, and also diabetes insipidus. - Bone problems e.g. osteoporosis, pathological # - Abdominal moans (abdo pain, constipation, N&V) - Psychic: depression, anxiety, irritability, psychosis.