Lung cancer

Question 1

%wise how many lung cancers are caused by smoking?

Answer 1

90%

Question 2

what are the two categories of lung cancers,

and their commonness as a &.

Answer 2

Small cell lung cancer 15%

Non-small cell lung cancer 85%

Question 3

of the two categories of lung cancer which is more aggressive with a worse prognosis?

Answer 3

Small cell lung cancer

Question 4

of the two categories of lung cancer, which will rarely every have surgery done.

and why?

Answer 4

Small cell lung cancer

mets because it divides rapidly.

Question 5

SCLC is derived from which neuroendocrine cell?

Answer 5

Kulchitsky cells

Question 6

is smoking a RF for SCLC?

Answer 6

yes

Question 7

why is called small cell lung cancer?

Answer 7

because cells are small

Question 8

generally is prognosis good or bad for lung cancer?

Answer 8

bad

Question 9

what are the three most common types of NSCLC?

and their commonness %wise?

Answer 9

Adenocarcinoma (40%)

Squamous-cell (25-30%)

Large-cell (10-15%)

Question 10

which non-small cell lung cancer has a weak link to smoking?

Answer 10

Adenocarcinoma

Question 11

Adenocarcinoma is derived from what type of tissue?

Answer 11

glands

Question 12

which non-small cell lung cancer are peripheral lesions?

- 2

Answer 12

Adenocarcinoma

Large-cell

Question 13

which non-small cell lung cancer is a central lesion?

Answer 13

Squamous-cell

Question 14

Cushing’s syndrome is associated with what type of lung cancer.

Answer 14

small cell lung cancer

Question 15

how does ADH affect Na+ levels.

which category of lung cancer is associated with increased ADH?

Answer 15

lowers [Na+]

small cell lung cancer

Question 16

Hypertrophic pulmonary osteoarthropathy is associated with which category of lung cancer?

Answer 16

non - small cell lung cancer

Question 17

increased β-HCG is associated with which type of cancer?

Answer 17

Large-cell

Question 18

hypercalcaemia is associated with which type of cancer?

Answer 18

Squamous-cell

Question 19

lung cancer pt has hoarseness of voice,

why is he/she having this symptom?

Answer 19

lung mass pressing on left recurrent laryngeal nerve

Question 20

lung cancer pt has raised hemidiaphragm on CXR,

why is he/she having this symptom?

Answer 20

phrenic nerve pressed on by mass

Question 21

lung cancer pt has dyspnoea + wheezing.

why is he/she having this symptom?

Answer 21

mass pushing on airways

Question 22

lung cancer pt has:
dyspnoea
pulseless jugular venous distension
swelling of the face, neck and arms

diagnosis?

Answer 22

svc obstruction

Question 23

pt has lung cancer,

you are suspicious of bone mets.

what scan do you do to confirm?

Answer 23

bone scan.

Question 24

how many lung cancer pts will have cervical lymphadenopathy % wiise?

Answer 24

30%

Question 25

why is there haemoptysis with lung cancer? | - 2 reasons

Answer 25

neovascularisation from tumour | airways erode causing bleeding

Question 26

symptoms of lung cancer? - 8 in total (remember the standard cancer symptoms)

Answer 26

``` Cough Haemoptysis SOB Pleuritic chest pain Fever, weight loss, lethargy, night sweats ```

Question 27

sign of lung cancer when auscultating?

Answer 27

wheeze

Question 28

sign of lung cancer when percussing? explain the cause of this sign.

Answer 28

Stony dull percussion | pleural effusion

Question 29

sign of lung cancer around the fingers?

Answer 29

clubbing

Question 30

sign of lung cancer around the neck on palpating?

Answer 30

lymphadenopathy

Question 31

which type of lung cancer is particularly associated with lung cancer?

Answer 31

squamous

Question 32

pt suspected of lung cancer based on history. CXR done. what features will come on CXR for a lung cancer pt? - 4 things

Answer 32

big hilars, pleural effusion, consolidation, opacities

Question 33

pt suspected of lung cancer. what bloods do you do and why? - 3

Answer 33

FBC – anaemia of chronic disease & thrombocytosis Na+ - low=ADH secretion Ca2+ - high=bone mets

Question 34

CXR shows features of lung cancer. what is the next IX to confirm this which is also the gold. S IX?

Answer 34

CT chest with contrast

Question 35

which scan is used for staging after the CT? | - the scan is used more so for NSLC.

Answer 35

PET scan

Question 36

which radionuclide is used in PET scanning?

Answer 36

18-fluorodeoxygenase

Question 37

what method is used for biopsy of central lesion and peripheral lesion lung cancer? if pt is not suitable for standard biopsy method in regards to central lesion, what is the next method??

Answer 37

Peripheral lesions – percutaneously Central lesions – bronchoscopy sputum cytology if bronchoscopy not tolerated.

Question 38

how many CXR are negative with lung cancer pts (% wise)?

Answer 38

10%

Question 39

usual Mx for SCLC?

Answer 39

chemoradiotherapy

Question 40

of SCLC and NSCLC, which is surgery more viable on? and why?

Answer 40

NSCLC SCLC very aggressive, so mets

Question 41

before doing lung cancer surgery, a mediastinoscopy needs to be done. why so?

Answer 41

check for lymphadenopathy (that can be missed n CT)

Question 42

CI for lung cancer surgery? | - 4

Answer 42

cancer has metastasised, tumour near hilum, malignant pleural effusion, vocal cord paralysis

Question 43

of SCLC and NSCLC which has a poor response to chemo?

Answer 43

NSCLC

Question 44

define lobectomy

Answer 44

remove lobe

Question 45

define pneumonectomy

Answer 45

remove lung

Question 46

1st lifestyle MX for lung cancer?

Answer 46

quit smoking

Question 47

Ix to check Mets?

Answer 47

PET scanning

Question 48

which Ix do you do before surgery? why?

Answer 48

mediastinoscopy shows mediastinal lymph node involvement if any

Question 49

most people’s Mx if the have lung cancer? | after lifestyle factor changes

Answer 49

chemo + radiotherapy

Question 50

clubbing is a sign of what particular lung cancer?

Answer 50

squamous cancer

Question 51

stony dull percussion is a sign of what on percussion?

Answer 51

pleural effusion

Question 52

Hoarseness of voice comes what from tumour, i.e. give the name of the tumour? what is happening to cause this hoarseness of voice?

Answer 52

Pancoast tumour presses on recurrent laryngeal nerve

Question 53

for lung cancer CXR is normal in how many pts? | - % wise

Answer 53

10%

Question 54

Horner’s syndrome is caused by what exactly? what will be the classic symptoms?

Answer 54

something pressing on sympathetic trunk miosis, ptosis, anhidrosis (all on one side)

Question 55

Ix of choice for lung cancer?

Answer 55

CT

Question 56

Ix to get histological diagnosis of lung cancer?

Answer 56

bronchoscopy + biopsy

Question 57

which lung cancer secretes beta-hCG and is on periphery?

Answer 57

Large Cell cancer

Question 58

which lung cancer causes ↑PTH? the ↑PTH will cause a rise in what mineral in the blood?

Answer 58

Squamous ↑Ca2+