Malignancy (cancer)

Question 1

Non-small-cell lung cancer includes what?

Answer 1

1. Adenocarcinoma
2. Squamous cell carcinoma
3. Large cell carcinoma

Question 2

Explain adenocarcinoma

Answer 2

35%
Found in non-smokers

Type most closely linked with asbestos

Peripheral Tumour- atypical, spread of neoplastic cells along alveolar walls (bronchioalveolar carcinoma)

Side effect - Gynaecomastia

Question 3

Explain squamous cell carcinoma

Answer 3

30%
The most common type in smokers

Central tumour- mainly in the lung
- Local spread common

Ectopic PTHrPrelease → hypercalcaemia

Initial treatment is rehydration + if high then IV bisphosphonate

Question 4

Explain Large cell carcinoma

Answer 4

10%
Second-worst survival prognosis - early metastases

Peripheral tumour

Question 5

What is staging?

Answer 5

T - Tumour
N - Nodes
M - Metastases

Question 6

What indicates malignancy in bloods?

Answer 6

↓ Na+, ↑Ca2+

Question 7

What imaging do you use for peripheral tumours?

Answer 7

CT guided biopsy

Question 8

Most common cause of Mesothelioma

Answer 8

Asbestos

Question 9

Most common lung cancer

Answer 9

Adenocarcinoma - most likely to cause pleural effusions

Question 10

Management of Non-small cell lung cancer

Answer 10

First-line: lobectomy

Curative radiotherapy can also be offered to patients with stage I, II and III disease

Chemotherapy should be offered to patients with stage III and IV disease to control the disease and improve quality of life

Question 11

Management of Small cell lung cancer

Answer 11

Generally palliative chemotherapy, as tumours are disseminated on presentation

Question 12

A 58-year-old male presents to the Emergency Department reporting a one-week history of worsening shortness of breath and headache, both of which are worse on leaning forwards. He also reports swelling of his face and arms which is most noticeable in the mornings. He has a background of small cell lung cancer and chronic obstructive pulmonary disorder. On examination his temperature is 37.2 degrees, respiratory rate is 24 bpm, and oxygen saturation 93% on room air. There is evidence of peri-orbital oedema and distended neck veins but no lower limb swelling or calf tenderness. Pemberton’s sign is positive. Chest X-ray shows a right hilar mass which has increased in size compared to the previous chest X-ray.

What is this describing and what is the correct medication to prescribe?

Answer 12

superior vena cava obstruction

= Intravenous dexamethasone

Question 13

Managment for a lung nodule

Answer 13

Patients should have a CT scan and have follow-up imaging guided by the Fleischner guidelines

Most lung nodules will just require interval surveillance scans to check the appearance are static

Question 14

A 56-year-old female patient with a 40-pack-year smoking history presents with their GP with weight loss and a persistent cough. The GP suspects lung cancer and wants to refer this patient on to the specialist Respiratory clinic for further assessment.

What sort of referral should the GP make for this patient to the Respiratory clinic?

Answer 14

2 week referral

Question 15

An 85 year old man with a history of lung cancer presents to A&E with a three-day history of cough with which he brings up foul-smelling purulent sputum, fevers and increased shortness of breath. He has never smoked.

Chest x-ray reveals a cavitating lesion on the left side with an air-fluid level. Bloods also reveal raised inflammatory markers.

Given the likely diagnosis, what would be the most appropriate management option?

Answer 15

IV antibiotics

Question 16

A 56-year-old gentleman presents to his GP with a 3 month history of fatigue and weight loss. He is especially anxious today as he coughed up a large amount of blood on waking. He has a 30 pack year smoking history. On examination, the patient appears cachectic with a slightly droopy right eye lid when compared to the left. His right pupil appears smaller than the left. The GP suspects cancer.

What is the most likely location of the tumour? and why?

Answer 16

Right lung apex
= cardinal signs of lung cancer and also has Horner’s syndrome (partial ptosis and miosis) of the right eye. This indicates that the sympathetic chain on the right is being compressed, most likely by an apical lung tumour on that side

Question 17

When would you advise immediate review in the Emergency Department instead of the 2 week referral?

Answer 17

patient had stridor on examination, signs of sepsis or symptoms of superior vena cava obstruction, such as dyspnoea, facial swelling and upper limb oedema

Question 18

A 47 year old male patient presents to the Emergency Department with significant shortness of breath and a cough with some witnessed haemoptysis. He is cachectic. The team have a discussion and name both Tuberculosis (TB) and lung cancer as important diagnoses to consider.

Which single additional feature in the history most points towards TB as the diagnosis?

Answer 18

The patient is homeless

Question 19

is family history significant for lung cancer?

Answer 19

nope

Question 20

Lung cancer most commonly metastasises to where?

Answer 20

brain, bone, liver and adrenals

Question 21

A 60 year old male demolition worker presents to his GP with a new, persistent cough and is referred via the 2 week wait pathway to see a Respiratory specialist. They send him for a CXR and subsequent CT chest as part of his work up and a diagnosis of mesothelioma is made.

What would be the characteristic imaging finding in this condition?

Answer 21

Pleural thickening with some distinct plaques

Question 22

A 72-year-old woman presents to the two-week wait clinic with an 8-week history of a dry cough, weight loss, fatigue, and painful wrist swelling. There is no past medical history or family history of note and she has never smoked.

Her chest X-ray reveals a peripherally located nodule in keeping with the most likely diagnosis of adenocarcinoma of the lung. What is the best investigation?

Answer 22

CT chest abdomen pelvis

Question 23

Whats a recognised complication of pneumonia?

Answer 23

Lung absess

Question 24

An 84-year-old man is admitted to the hospital with haemoptysis and recent weight loss. CT chest shows a 90 mm round cavitating mass in the right lower lobe of the lung.

He also complains of a one week history of constipation and abdominal pain. Blood results reveal a raised serum calcium.

What best describes the histological diagnosis of the malignancy?

Answer 24

Squamous cell carcinoma

Question 25

A 64-year-old male with a 35-year-pack history presents to his GP surgery with a 4 month history of feeling tired and not eating properly. On examination, the patient’s observations are normal and his chest is clear. He reports that he has had recurrent chest infections and unintentional weight loss over the past few months. What would be the next most appropriate investigation for the GP to perform?

Answer 25

Chest X-ray within 2 weeks

Question 26

A 67-year-old male smoker presents to the emergency department with haemoptysis.

What disease is the most likely cause of haemoptysis in this patient?

Answer 26

Lung cancer