Lung Cancer

Question 1

2 Main subtypes of lung cancer

Answer 1

Non small cell lung cancer (80%) and Small cell lung cancer (20%)

Question 2

Subtypes of NSCLC

Answer 2

Adenocardinomas (40%), squamous cell carcinoma (20%), large cell carcinoma (10%), other types (10%)

Question 3

What do small cell lung cancers contain

Answer 3

Neurosecretory granules which can release neuroendocrine hormones

Question 4

What can small cell lung cancers cause

Answer 4

Paraneoplastic syndromes

Question 5

Signs and symptoms of lung cancer

Answer 5

SOB, cough, haemoptysis, finger clubbing, recurrent pneumonia, weight loss, lymphadenopathy

Question 6

Findings in CXR suggestive of lung cancer

Answer 6

Hilar enlargement, peripheral opacity, pleural effusion, collapse

Question 7

Investigations into lung cancer

Answer 7

CXR, Staging CT scan, PET-CT, bronchoscopy with endobronchial US, histological diagnosis with biopsy

Question 8

First line treatment in non-small cell lung cancer

Answer 8

If isolated to single area then surgery - lobesctomy, segmentectomy or wedge resection

Question 9

Prognosis of SCLC

Answer 9

Worse than NSCLC

Question 10

What does endobronchial treatment involve

Answer 10

Stents or debulking can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer

Question 11

Extrapulmonary manifestations

Answer 11

REcurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, Horner’s syndrome, SIADH, Cushing’s. hypercalcaemia, limbic encephalitis, LEMS

Question 12

Symptoms of recurrent layngeal nerve palsy

Answer 12

Hoarse voice from cancer pressing on or affecting nerve as it passes through mediastinum

Question 13

Symptoms of phrenic nerve palsy

Answer 13

Nerve compression causes diaphragm weakness and presents as SOB

Question 14

Symptoms of SVC obstruction

Answer 14

Caused by direct compression of tumour presenting with facial swelling, difficulty breathing, distended veins in neck and upper chest and Pemberton’s sign

Question 15

What is Pemberton’s sign

Answer 15

Raising hands over the head causes facial congestion and cyanosis

Question 16

Symptoms of Horner’s syndrome

Answer 16

Triad of partial ptosis, anhidrosis and miosis caused by Pancoast tumours pressing on sympathetic ganglion

Question 17

Where is a pancoast tumour

Answer 17

Pulmonary apex

Question 18

Cause of Cushing’s

Answer 18

Ectopic ACTH secretion by small cell LC

Question 19

Causes of hypercalcaemia

Answer 19

Ectopic parathyroid hormone secreted by squamous cell carcinoma

Question 20

Symptoms of limbic encephalitis

Answer 20

short term memory impairment, hallucinations, confusion and seizures

Question 21

Cause of limbic encephalitis

Answer 21

Small cell lung cancer causes Immune system to make antibodies to tissues in brain, specifically the limbic system.

Question 22

Cause of lambert eaton myasthenic syndrome

Answer 22

Antibodies produced by immune system against small cell lung cancer cells, which also target voltage gated calcium channels on motor neurons

Question 23

Symptoms of lambert eaton myasthenic syndrome

Answer 23

Weakness in proximal muscles, intraocular and levator muscle weakness (diplopia, ptosis), phayngeal muscle causing slurred speech and dysphagia, dry mouth, blurred vision, impotence and dizziness

Question 24

Notable finding of patient with LEMS

Answer 24

Reduced tenson reflexes, which become temporarily normal for short period after strong muscle contraction

Question 25

Links to mesothelioma

Answer 25

Asbetstos inhalation