Lung Cancer

Question 1

Types of Lung Cancer

Answer 1

Non-small cell carcinoma

• SCC (35%)
• Adenocarcinoma (25%)

SCLC (20%)

• Contain neurosecretory granules can release neuroendocrine hormones
• Responsible paraneoplastic syndromes

Question 2

Signs and Symptoms (7)

Answer 2

Shortness of breath
Cough
Haemoptysis (coughing up blood)
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

Question 3

Invetigations for Lung Ca

Answer 3

CXR (first line)
Contrast CT - staging, lymph node involvement and mets
PET-CT
Bronchoscopy with (EBUS)
Histological diagnosis

Question 4

What findings on Xray suggest Lung Ca?

Answer 4

Hilar enlargement
Peripheral Opacity
Pleural effusion
Collapse

Question 5

Treatment options for Non-small cell lung Ca

Answer 5

Surgery - offered first line in non-small cell lung cancer to patients that have disease isolated to a single area (Lobectomy)

Radiotherapy - can be curative in NSCLC if found early enough

Chemotherapy - can be offered in addition to surgery or radiotherapy to improve outcomes or palliatively

Endobronchial treatment with stents or debulking

Question 6

Treatment for SCLC

Answer 6

Usually CHEMO and RADIOTHERAPY

Prognosis generally worse from small cell lung cancer than non-small cell lung cancer

Question 7

Extrapulmonary manifestations in Lung Ca (9)

Answer 7

Recurrent laryngeal nerve palsy
Phrenic nerve palsy
Superior vena cava obstruction
Horner’s syndrome
Syndrome of inappropriate ADH (SIADH)
Cushing’s syndrome
Hypercalcaemia
Limbic encephalitis
Lambert-Eaton myasthenic syndrome

Question 8

How does Superior vena cava obstruction present?

Answer 8

Facial swelling
Difficulty breathing
Distended veins in the neck and upper chest

(Pemberton’s sign)

Question 9

What can Horner’s syndrome be caused by in Lung Ca?

Answer 9

Compression of sympathethic ganglion by a pancoasts tumour

Question 10

How can SCLC present?

Answer 10

SIADH - ectopic ADH hyopnatremia

Cushings - ectopic ACTH

Hypercalceamia - ectopic PTH

Question 11

What is Limbic encephalitis?

Answer 11

SCLC causes the immune system to make antibodies to tissues in the brain, specifically the limbic system

Short term memory impairment,
Hallucinations
Confusion
Seizures
Associated with anti-Hu antibodies

Question 12

What is Lambert-Eaton myasthenic syndrome?

Answer 12

Result of antibodies produced by the immune system against SCLC cells
Antibodies also target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones

Question 13

Symptoms of Lambert-Eaton myasthenic syndrome?

Answer 13

Weakness, particularly in the proximal muscles
Can also affect:
Intraocular muscles causing diplopia (double vision)
Levator muscles in the eyelid causing ptosis
Pharyngeal muscles causing slurred speech and dysphagia (difficulty swallowing).
Weakness gets worse with prolonged used of the muscles

Question 14

What is mesothelioma?

Answer 14

Lung malignancy affecting the mesothelial cells of the pleura
Strongly linked to asbestos inhalation
Huge latent period (up to 45 years)
Prognosis very poor