Lung Cancer

Question 1

Types of lung cancer?

Answer 1

Small cell

Non-small cell - squamous, adeno, large cell

Question 2

What is the most common type of lung cancer?

Answer 2

Squamous currently, but adeno increasing

Question 3

Squamous cell carcinoma?

Answer 3

Epithelial cells associated with keratin production
Occasionally cavitate with central necrosis
Obstructing lesions with post-obstructive infection
Local spread, rarely metastasise

Question 4

Adenocarcinoma?

Answer 4

Originates from mucus secreting glandular cells
Most common type in non-smokers
Peripheral lesions
Mets common

Question 5

Large cell carcinoma?

Answer 5

Poorly differentiated

Mets early

Question 6

Small cell carcinoma?

Answer 6

Arises from neuroendocrine cells
Secretes hormones
Arises centrally
Metastasise early

Question 7

Presenting symptoms?

Answer 7

Cough
Breathlessness
Haemoptysis
Wheeze + stridor
Weight loss
Fever
Clubbing

Question 8

What is a pancoast tumour?

Answer 8

Apical lung tumour - often non-small cell

Question 9

How do pancoast tumours present?

Answer 9

Hoarseness
Horner’s syndrome
Thoracic outlet syndrome
Bovine cough

Question 10

What is Horner’s syndrome?

Answer 10

Damage to sympathetic trunk - mitosis, partial ptosis, anhydrosis and enophthalmos on ipsilateral side

Question 11

Mitosis? Why?

Answer 11

Constricted pupil

Loss of sympathetic drive of iris dilator muscle

Question 12

Ptosis? Why?

Answer 12

Weak, droopy eyelid

Loss of sympathetic control of Muller muscle that elevated eyelid

Question 13

Anhydrosis? Why?

Answer 13

Decreased sweating

Impingement of sweat gland fibres from cervical sympathetic ganglion

Question 14

Enophthalmos?

Answer 14

Inset eyeball

Question 15

Thoracic outlet syndrome?

Answer 15

Compression of brachial plexus - pain and weakness of muscles of the arm and hand

Question 16

Superior vena cava syndrome?

Answer 16

Small-cell lung cancer
Obstruction of SVC by tumour
Facial + upper limb oedema
Headache
Dyspnoea
Stridor
Swollen collaterals on chest wall
Pemberton's sign

Question 17

What is pemberton’s sign?

Answer 17

Demonstrate presence of latent pressure in thoracic inlet - elevate both arms to side of face - +ve sign is marked by the presence of facial congestion and cyanosis

Question 18

Other symptoms of lung cancer?

Answer 18

Pericardial effusion
Pleural effusion
Dysphagia

Question 19

Para-neoplastic syndromes?

Answer 19

Ectopic Cushing’s
SIADH
Hypercalcemia
Hypertrophic osteoarthropathy

Question 20

Ectopic Cushing’s?

Answer 20

ACTH secretion
Weight gain
Hypertension
Hypokalemia
Muscle weakness
Small cell lung cancer

Question 21

SIADH?

Answer 21

ADH secretion
Euvolmic hyponatremia
Headache, weakness, altered mental state, seizures, respiratory depression
Small cell lung cancer

Question 22

Why hypercalcemia in some lung cancers?

Answer 22

Increased PTHrP - increased bone resorption and renal calcium absorption - hypercalcemia
Squamous cell carcinoma

Question 23

Symptoms of hypercalcemia?

Answer 23

Abdominal pain
Bone pain
Confusion
Depression
Weakness
Kidney stones
Abnormal heart rhythm

Question 24

Hypertrophic osteoarthropathy?

Answer 24

Periosteal proliferation of tubular bones
Painful symmetrical arthritis of ankles, knees, wrists and elbows
Clubbing
Adenocarcinoma

Question 25

What is Lambert-Eaton myasthenic syndrome?

Answer 25

Autoantibodies against the presynaptic voltage-gated calcium channels Muscle weakness of limbs Small-cell lung cancer

Question 26

Investigations for suspected lung cancer?

Answer 26

``` Bloods CXR Contrast CT PET scan Bronchoscopy Neck ultrasound LFTs Cytology ```

Question 27

NSCLC treatment?

Answer 27

Surgery (I, II) Radiotherapy (I - III) Chemotherapy (III, IV)

Question 28

SCLC treatment?

Answer 28

Chemotherapy

Question 29

TNM staging NSCLC?

Answer 29

T1 <3cm T2 <7cm T3 >7cm with invasion T4 invasion of mediastinum, vessels, trachea N1 - ipsilateral hilar nodes N2 - ipsilateral mediastinal/subcarinal nodes N3 - contralateral nodes M1 - metastases

Question 30

Paraneoplastic features of small cell?

Answer 30

ADH ACTH Lambert-Eaton syndrome

Question 31

Paraneoplastic features squamous cell?

Answer 31

Parathyroid related protein Hyperthyroidism Hypertrophic pulmonary osteoarthropathy

Question 32

Paraneoplastic features of adenocarcinoma?

Answer 32

Gynaecomastia | Hypertrophic pulmonary osteoarthropathy

Question 33

What is Lambert-Eaton syndrome?

Answer 33

Weakness in the muscles of proximal arms and legs Legs are worse Improves with muscle use