Bronchial carcinoma

Question 1

General features of cancer

Answer 1

1. malignant tumour
2. uncontrolled replication
3. local invasion
4. metastases (lymphatic spread, blood stream, serous cavity)

Question 2

risk factors

Answer 2

1. smoking
2. asbestos
3. radiation

Question 3

symptoms

Answer 3

1. cough
2. haemoptysis
3. dyspnoea
4. chest pain
5. recurrent/ slowly resolving pneumonia
6. lethargy
7. weight loss

Question 4

signs

Answer 4

1. cachexia
2. anaemia
3. clubbing
4. supraclavicular nodes

Question 5

features of small cell

Answer 5

1. rapidly progressive disease
2. early metastases
3. rarely suitable for surgery
4. good initial response to chemo

Question 6

non-small cell

Answer 6

1. includes squamous + adenocarcinomas
2. surgery or radical radiotherapy
3. less response to chemo

Question 7

Metastases places

Answer 7

1. liver
2. brain
3. bone
4. adrenal
5. skin

Question 8

complications

Answer 8

Local:

1. recurrent laryngeal nerve palsy
2. phrenic nerve palsy
3. rib erosion
4. pericarditis

Question 9

CXR

Answer 9

peripheral nodule, consolidation, lung collapse, pleural effusion

Question 10

CT and PET scan

Answer 10

stage tumour

Question 11

bronchoscopy

Answer 11

give histology and assess operability

Question 12

other tests

Answer 12

FBC, spirometry. endobronchial ultrasound (EBUS)

Question 13

Radiotherapy

Answer 13

small cell - used for bronchial obstruction, SVC obstruction, haemoptysis, bone pain and cerebral metastases

Question 14

endobronchial therapy

Answer 14

small cell - stent insertion for stridor, photodynamic therapy, laser

Question 15

pleural drainage

Answer 15

small cell - pleural effusions

Question 16

surgery

Answer 16

non small cell

Question 17

curative radiotherapy

Answer 17

non small cell

Question 18

chemo and/or radiotherapy

Answer 18

non small cell

Question 19

contraindications of surgery

Answer 19

1. SVC obstruction

2. FEV