Bronchial Carcinoma

Question 1

Presentation of lung cancer

Answer 1

Primary tumour, local invasion, metastases, non-metastatic

Question 2

Signs to detect cancer early

Answer 2

Cough for 3 weeks or more, Feeling breathless for no reason, Chest infection which doesn’t clear, coughing blood, unexpected weight loss, chest/shoulder pain, unexplained tiredness, recurrent pneumonia (on the same lung)

Question 3

Stridor

Answer 3

A symptom for lung cancer, it is a wheeze on inspiration

Question 4

Possible areas of local invasion (Symptom for lung cancer)

Answer 4

Recurrent laryngeal nerve, Pericardium, Oesophagus, Branchial pleuxs, Pleural cavity, Superior vena cava

Question 5

General features of cancer

Answer 5

Malignant growth, uncontrolled replication, local invasion, Metastasis, Non-metastatic systemic effects

Question 6

Symptoms of local invasion of the Oesophagus

Answer 6

Dysphagia - swallowing problems

Question 7

Symptoms of breathlessness and weight loss

Answer 7

when the primary tumour invades the pleural space, it generates a large volume of pleural fluid

Question 8

Local invasion of the superior vena cava

Answer 8

Obstructs drainage of blood from arms and head, patient may describe puffy eyelids and a headache

Question 9

Common sites for metastases from a primary lung cancer

Answer 9

Liver, Brain, Bone, Adrenal, Skin, Lung

Question 10

Cerebral metastases symptoms

Answer 10

Weakness (may mimic a stroke), Visual disturbance, Headaches (worse in the morning, not photophobic), Fits

Question 11

Bone metastases symptoms

Answer 11

Localised pain which is worse at night, pathological fracture. The bone may fracture following a trivial mechanical stress

Question 12

Non-metastatic: signs and symptoms of the tumour (when the tumour makes changes to the body)

Answer 12

Finger clubbing, Hypertrophic pulmonary osteoarthrophy - HPOA, Weight loss, Thrombophlebitis, Hypercalcaemia, Hyponatraemia - SIADH, Weakness - Eaton Lambert syndrome

Question 13

Hypercalcaemia definition and symptoms

Answer 13

High Calcium in the blood serum due to the tumour secretions

Symptoms: Stones, Bone pain, Abdominal pain, Constipation, Depression, Anxiety, Coma, Cardia arrhythmia

Question 14

Treatment of hypercalcaemia

Answer 14

Rehydration

If calcium is very high on admission, then IV bisphosphonate is used

Question 15

SIADH

Answer 15

Syndrome of inappropriate antidiuretic hormone
Usually small cell lung cancer
Results in low sodium concentration
Generalised non-specific symptoms (nausea, seizures etc.)

Question 16

Taking a history for Lung Cancer

Answer 16

Cough
Haemoptysis
Cigarette smoker
Breathless
Weight loss
Chest wall pain
Tiredness
Recurrent infection
Other smoking related disease
"Is there anything you are worried about?"

Question 17

Examination for Lung Cancer

Answer 17

Finger clubbing
Breathless
Cough
Weight loss
Bloated face
Hoarse voice
Lymphadenopathy
Tracheal deviation
Dull percussion
Stridor
Enlarger liver

Question 18

Investigations for Lung cancer

Answer 18

Full blood count, Coagulation screen, Spirometry and FEV1, CXR, CT scan of thorax, etc.

Question 19

What does a PET scan do?

Answer 19

Scan to asses function rather than structure, tissues with high metabolic activity “light up”

Question 20

Tests used to make a tissue diagnosis - lung cancer

Answer 20

Bronchoscopy
CT guided biopsy
Endobronchial Ultrasound

Question 21

Differential diagnosis

Answer 21

Lung cancer
TB
Vasculitis
Pulmonary embolism
Secondary cancer
Lymphoma
Bronchiectasis