Lung Cancer

Question 1

What are the 3 main risk factors for lung cancer?

Answer 1

Smoking
Asbestos inhalation
Pollution

Question 2

How are lung cancers denoted?

Answer 2

Small cell (SCLC)
Non-small cell (NSCLC)

Question 3

What paraneoplastic effects are associated with small cell lung cancer?

Answer 3

Excessive/Ectopic ACTH secretion, resulting in Cushing’s Syndrome.

Synthetic inappropriate ADH secretion (SIADH) - leads to hyponatraemia.

Question 4

Which form of lung cancer has the worst prognosis?

Answer 4

Small cell lung cancer.

This is due to rapid progression (metastasises early).

Question 5

Where are small cell lung cancers seen?

Answer 5

Centrally

Question 6

What are the forms of NSCLC?

Answer 6

Adenocarcinoma (35%)
Squamous cell carcinoma (30%)
Large cell carcinoma (10%)

Question 7

Which lung cancers are found peripherally?

Answer 7

Adenocarcinoma
Large cell carcinoma

Question 8

What type of NSCLC is linked with smoking most commonly?

Answer 8

Squamous cell carcinoma

Question 9

Which type of NSCLC is associated with parathyroid hormone related protein (PTHrP) release?

Answer 9

Squamous cell carcinoma - produces hypercalcaemia.

Question 10

What is adenocarcinoma associated with?

Answer 10

Asbestos exposure.

This form is more likely to occur in non-smokers as a result.

Question 11

What are the most common sites of lung cancer metastasis?

Answer 11

Brain
Liver
Adrenal
Bone

Question 12

What is Lambert-Eaton syndrome?

Answer 12

A disorder of neuromuscular transmission causing muscle weakness.

It may be a paraneoplastic syndrome.

Question 13

What is hypertrophic pulmonary osteoarthropathy (HPOA)?

Answer 13

A condition causing joint stiffness and severe ankle/wrist pain.

It is a paraneoplastic syndrome.

Question 14

What is a paraneoplastic syndrome

Answer 14

An immune response to a cancer - results in disease elsewhere in body.

Question 15

What is a typical presentation of lung cancer?

Answer 15

Cough lasting 3 weeks or more
Dyspnoea
Haemoptysis
Chest/Shoulder pain
Unexplained weight loss

Question 16

What is Pancoast’s tumour?

Answer 16

When a tumour in the lung apex infiltrates the brachial plexus, causing Horner’s syndrome (miosis, ptosis and anhidrosis).

A terminal diagnosis.

Question 17

Invasion of what structure causes a hoarse voice?

Answer 17

Recurrent laryngeal nerve

Question 18

What is used to diagnose a lung cancer?

Answer 18

CXR - better for central forms
CT-guided biopsy - good in peripheral disease
Aspirate analysis of pleural fluid/lymph nodes may aid diagnosis
PET scan used to investigate metastases

Question 19

How is small cell lung cancer treated?

Answer 19

Chemotherapy and/or radiotherapy.

Question 20

How are non-small cell lung cancers treated?

Answer 20

In the case of peripheral cancers (e.g. large cell and adenocarcinoma) surgery can be used to excise tumor.

In squamous cell carcinoma, chemotherapy and/or radiotherapy is indicated.