Cancer

Question 1

Describe the presentation of lung cancer

Answer 1

• Chronic cough
• Haemoptysis
• Dyspnoea
• CP
• Weight loss, anorexia, night sweats
• Complications: collapse, pneumonia, PE

Question 2

Describe the types of lung cancer and their associations (RFs, location, etc)

Answer 2

Roughly:
1/3 adenocarcinoma: peripheral, non-smokers, F
1/3 squamous: central, smoking, M. PTHrP
Small cell: smoking, paraneoplastic syndromes
Large cell: poor prognosis

Question 3

Describe the investigations for suspected lung cancer

Answer 3

• Bloods: FBC, U+Es and bone profile, LFTs
• CXR -> CT chest
• Sputum cytology
• > biospy: guided FNA, bronchoscopy, etc

Question 4

What are some complications of lung cancer?

Answer 4

Local:

• Recurrent laryngeal N palsy
• Horner’s (Pancoast tumour)
• SVC obstruction

Paraneoplastic syndromes:

• Hypercalcaemia (PTHrP- squamous cell)
• SIADH
• Lambert-Eaton myasthenic syndrome
• Cushing’s syndrome

Metastatic:

• Bone pain + fractures
• Fits, neurology

Question 5

Describe the differentials for a lesion on CXR

Answer 5

Malignancy: 1 or 2
Abscess: Staph, Klebsiella
Granuloma: TB, sarcoid, GPA

Question 6

Describe the management of lung cancer

Answer 6

Medical + surgical

Medical:

• Chemotherapy
• Radiotherapy: curative + palliative

Surgical:
-Resection eg. wedge resection/lobectomy/ pneumonectomy

Question 7

Describe the management of SVC obstruction

Answer 7

Dex
Stenting
Radiotherapy