Lung Cancer

Question 1

What accounts for 90% of lung cancer?

Answer 1

Cigarette smoking

Question 2

What are some risk factors for lung cancer apart from smoking?

Answer 2

Radon exposure
Asbestos
Older age
Male sex
Family history
Pre-existing lung disease
HIV infection

Question 3

What are the 4 main types of lung cancer

Answer 3

Small cell
Large cell
Squamous cell
Adenocarcinoma

Question 4

Which lung cancer is the most common among smokers?

Answer 4

Squamous cell

Question 5

How does squamous cell lung cancer spread, and where to?

Answer 5

Local spread common, metastases later
Pleura
Ribs
Lymph nodes
Oesophagus

Question 6

What conditions are associated with squamous cell lung cancer?

Answer 6

Parathyroid hormone (PTH) related protein secretion, causing hypercalcaemia
Hypertrophic pulmonary osteoarthropathy

Question 7

Where in the lung do all the types of cancer most commonly appear?

Answer 7

Squamous and small cell -central

Adenocarcinoma and large cell - periphery

Question 8

What is the most common lung cancer overall?

Answer 8

Adenocarcinoma

Question 9

Adenocarcinomas do not commonly metastasise, true or false?

Answer 9

False - metastases are common

Question 10

What is the least common lung cancer?

Answer 10

Large cell

Question 11

What may large cell lung cancer secrete?

Answer 11

Beta-hCG

Question 12

Large cell lung cancer metastasises early but has good prognosis, true or false?

Answer 12

False - metastasises early but bad prognosis

Question 13

Small cell lung cancer is rapidly progressive and metastasises early, true or false?

Answer 13

True

Question 14

What can small cell lung cancer produce, and what does this cause?

Answer 14

ACTH

• Cushing’s syndrome
• Bilateral adrenal hyperplasia
• Hypokalaemic alkalosis

Question 15

What syndrome can be caused by lung cancer, and which type causes it?

Answer 15

Lambert-Eaton syndrome

Caused by small cell

Question 16

What are the common metastases from primary lung cancer?

Answer 16

Brain
Bone
Liver
Adrenal

Question 17

What are the signs of brain metastases?

Answer 17

Weakness like a stroke
Visual disturbance
Headache due to increased cranial pressure
No photophobia
Fits

Question 18

Which cancers metastasise TO the lungs?

Answer 18

Breast
Colorectal
Renal
Prostate
Bladder
Melanoma

Question 19

What are symptoms of lung cancer?

Answer 19

Cough
Haemoptysis
Breathlessness
Chest wall pain
Recurrent infection
Weight loss
Tiredness

Question 20

What syndrome do Pancoast tumours cause?

Answer 20

Horner’s syndrome - disturbance of sympathetic chain

Question 21

What are signs of lung cancer?

Answer 21

Clubbing
Cachexia
Lymphadenopathy
Cushing's syndrome
Dull percussion

Question 22

It is common for lung cancer to be asymptomatic until late stages, true or false?

Answer 22

True

Question 23

What are some investigations that can diagnose lung cancer?

Answer 23

CXR
CT thorax
Bronchoscopy + biopsy
FNA for peripheral lesions and lymph nodes

Question 24

What is the treatment for small cell lung cancer?

Answer 24

Chemotherapy +/- radiotherapy

Rarely appropriate for surgery as it metastasises early

Question 25

What is the treatment for non-small cell lung cancer?

Answer 25

Excision in peripheral tumours with no metastases | Chemotherapy +/- radiotherapy

Question 26

What are the options for palliative care in lung cancer?

Answer 26

Palliative chemotherapy and radiotherapy Stenting of the trachea or oesophagus Analgesia Antiemetics

Question 27

What can cause hoarse voice in lung cancer?

Answer 27

Local invasion into the recurrent laryngeal nerve

Question 28

What can cause localised chest pain, worse with movement in lung cancer?

Answer 28

Chest wall invasion

Question 29

What can cause pleural effusion in lung cancer?

Answer 29

Local invasion into the pleural cavity

Question 30

What is mesothelioma?

Answer 30

Malignancy of the pleura (mesothelial cells)

Question 31

What is the chief causative agent for mesothelioma?

Answer 31

Asbestos

Question 32

What are risk factors for mesothelioma?

Answer 32

Asbestos Age 60-85 Male Radiation exposure

Question 33

Mesothelioma usually presents about 5 years after exposure to asbestos, true or false?

Answer 33

False - usually about 40 years after exposure

Question 34

What are the symptoms of mesothelioma?

Answer 34

``` Chest pain Shortness of breath Diminished breath sounds Dullness to percussion Cough Recurrent pleural effusion Non-specific features ```

Question 35

What are the investigations for mesothelioma?

Answer 35

CT (can do CXR too but CT better) Pleurocentesis Thoracoscopy and biopsy

Question 36

What are some features of mesothelioma found on imaging?

Answer 36

Pleural thickening | Pleural effusion

Question 37

What is the treatment for mesothelioma?

Answer 37

No curative options Palliative chemotherapy or radiotherapy Instillation of sclerosant substances to prevent re-accumulation of pleural effusions

Question 38

What are common metastasis sites for mesotheliomas?

Answer 38

The other pleural cavity Lung Hilar lymph nodes