BRONCHIAL CARCINOMA

Question 1

What is bronchial carcinoma?

Answer 1

a malignant neoplasm of the lung arising from the epithelium of the bronchus or bronchiole.

Question 2

Is it rare or common?

Answer 2

common

Question 3

What are the risk factors? (10)

Answer 3

1. cigarettes
2. asbestos
3. chromium
4. arsenic
5. iron oxide
6. radiation
7. age
8. copd
9. previous history of cancer
10. epidermal growth factor receptors (egfr)

Question 4

What are the symptoms? (7)

Answer 4

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

Question 5

What are the signs? (7)

Answer 5

1. cachexia
2. anaemia
3. clubbing
4. Hypertrophic pulmonary osteoarthropathy (HPQA)
5. supraclavicular/axillary nodes
6. chest signs
7. metastatic signs

Question 6

What chest signs may a patient with bronchial carcinoma have? (1,3)

Answer 6

1. none

or

2. consolidation
3. pleural effusion
4. collapse

Question 7

What metastatic signs may a patient with bronchial carcinoma have? (7)

Answer 7

1. bone tenderness
2. hepatomegaly
3. confusion fits
4. focal CNS signs
5. cerebellar syndrome
6. proximal myopathy
7. peripheral neuropathy

Question 8

differential diagnosis (10)

Answer 8

1. Secondary malignancy.
2. Arteriovenous malformation.
3. Pulmonary hamartoma
4. Bronchial adenoma.
5. Abscesses.
6. Granuloma - eg, tuberculosis.
7. Encysted effusion (fluid, blood, pus).
8. Cyst.
9. Foreign body.
10. Skin tumour (eg, seborrhoeic wart).

Question 9

Investigations (8)

Answer 9

1. sputum
2. pleural fluid
3. CXR
4. biopsy/fine needle aspiration
5. bronchoscopy
6. radionuclide bone scan
7. lung function tests

Question 10

What would be investigated for cytology? (2)

Answer 10

1. sputum

2. pleural fluid

Question 11

What would be sign on CXR? (6)

Answer 11

1. peripheral nodule
2. hilar enlargement
3. consolidation
4. lung collapse
5. pleural effusion
6. bony secondaries

Question 12

What would you take a biopsy of? (2)

Answer 12

1. peripheral lesions

2. superficial lymph nodes

Question 13

Why would you do a CT? (2)

Answer 13

1. to stage the tumour - PET scan

2. to guide bronchoscopy

Question 14

Why would you do a bronchoscopy? (3)

Answer 14

1. histology
2. assess operability
3. biospy

Question 15

What is a radionuclide bone scan used to assess? (1)

Answer 15

metastases

Question 16

What is the reasoning behind doing lung function tests? (1)

Answer 16

to assess suitability for a lobectomy

Question 17

What is the treatment for non-small cell tumours? (4)

Answer 17

1. excision
2. curative radiotherapy
3. chemotherapy - with/without radiotherapy
4. monoclonal antibodies

Question 18

Which one out of small cell tumours and non-small cell tumours are likely to metastasise?

Answer 18

Small cell tumours

Question 19

What is the treatment for small cell tumours?

Answer 19

1. chemotherapy +/- cisplatin, +/- radiotherapy

Question 20

What is the palliative treatment? (3)

Answer 20

1. radiotherapy
2. endobronchial therapy
3. pleural drainage

Question 21

What drug treatment is used? (6)

Answer 21

1. analgesia
2. steroids
3. antiemetics
4. cough linctus (codeine)
5. broncodilators
6. anti-depressants