Cancer

Question 1

What are the types of lung cancer?

Answer 1

NSCLC- COMMON: SCC, Adenocarcinoma, Large cell carcinoma, Other (Carcinoid, mesothelioma)
SCLC

Question 2

What sort of hormones can SCLC’s secrete?

Answer 2

ADH = SIADH
ACTH = ↑Cortisol = Cushing’s syndrome
PTH = ↑Ca2 = Polyuria/polydipsia, N&V, Abdo pain
GFa

Question 3

What are the risk factors for lung cancer?

Answer 3

> 40yo
Smoking
Occupation (Asbestos exposture, uranium mining, ship building, petrol refining)
EFGR activation- Adenocarcinoma

Question 4

What are the initial signs of lung Ca?

Answer 4

Cough +/- haemoptysis
Dyspnoea
Chest pain
Recurrent chest infections

Question 5

What syndromal symptoms can be seen in lung Ca?

Answer 5

APICAL TUMOURS:
Horner’s syndrome = Miosis + Anhidrosis + Ptosis
Pacoast’s syndrome = pain in nerve root distribution

MEDIASTINAL TUMOURS:
SVCO
Recurrent laryngeal nerve palsy: Hoarse voice = urgent referral to ENT

Question 6

What indicates a 2w urgent CXR?

Answer 6

> 40yo + Smoker + 1 unexplained Sx
40yo + 2 unexplained Sx

Cough, SOB, Chest pain, Fatigue, Anorexia, ↓weight

Question 7

How is Lung Ca managed?

Answer 7

SCLC: Chemo +/- adjuvant RT
NSCLC: Surgical resection

Question 8

How is lung Ca investigated?

Answer 8

1) CXR: Where +/- lobar collapse
2) CT chest w/contrast = DIAGNOSTIC
3) Sputum cytology
4) Bronchoscopy: Biopsy & bronchial washings for histological diagnosis
5) PET scan: Operable disease to look for distal mets

Question 9

What are the criteria for an urgent appointment in lung clinic?

Answer 9

CXR suggestive of lung Ca

>40yo w/haemoptysis

Question 10

What is mesothelioma?

Answer 10

Aggressive, malignant Ca of mesothelium (lining of thoracic & abdominal cavity)

Question 11

What are the causes of a mesothelioma?

Answer 11

Asbestos

Question 12

How can asbestos lead to a mesothelioma?

Answer 12

Inhaled into interstitial space of lungs
Epithelial cells of visceral/parietal pleura = inflammed
Epithelial cells divide rapidly = mesothelial plaques of lungs
(produce calretinin – regulates Ca2+)
End line = Mesothelioma

Question 13

Where are mesotheliomas most commonly found?

Answer 13

Lungs
Liver
Spleen
Bowels

Question 14

What are the signs of a mesothelioma?

Answer 14

Chest pain + dyspnoea + ↓weight
Haemoptysis
U/L exudative pleural effusion
Pneumothorax
LATE: Palpable chest wall mass
Ascites (peritoneal mesothelioma)

Question 15

What are the signs of asbestosis?

Answer 15

Progressive dyspnoea
↓Exercise tolerance
Clubbing
Fine end-inspiratory crackles

Question 16

Where does asbestosis commonly affect?

Answer 16

Lower lobe = fibrosis

Question 17

How is a mesothelioma/asbestosis investigated?

Answer 17

1) CXR- suspicious → CT

2) Thoracoscopy biopsy = DIAGNOSIS from histology

Question 18

What is seen on a CXR of mesothelioma/asbestosis?

Answer 18

Pleural plaques
Mediastinal shift to I/L side
Pleural thickening
Pleural effusion- Bloody pleural fluid

Question 19

What is pneumoconiosis?

Answer 19

Inhalation of coal dust
Ingested by macrophages which then die
Release enzymes
Leads to pulmonary fibrosis

Question 20

What are the Sx of pneumoconiosis?

Answer 20

Dyspnoea on exertion
Cough +/- BLACK sputum
Resp failure

Question 21

How is pneumoconiosis investigated?

Answer 21

CXR: UPPER lobe fibrosis, Round, irregular nodules

Spirometry

Question 22

How is pneumoconiosis managed?

Answer 22

INCURABLE- manage Sx
Lifestyle: Chest physio
Prevention: Facemasks at work

Question 23

What is a complication of pneumoconiosis?

Answer 23

Caplan’s Syndrome: Pneumoconiosis with RA

Question 24

How does a lung abscess form?

Answer 24

Severe suppurative & localised infection

Leads to necrotic cavity

Question 25

What are the causes of a lung abscess?

Answer 25

Staph Aureus Klebsiella (OH- & DM) TB Fungal: Aspergillosis, Cryptococcus

Question 26

How are lung abscesses categorised?

Answer 26

``` Primary = Normal lung Secondary = Diseased lung ```

Question 27

What are the risk factors for a lung abscess?

Answer 27

``` Inhaled foreign body Penetrating trauma Untreated bacterial pneumonia Aspiration Bronchial obstruction Septic emboli ```

Question 28

How does a lung abscess present?

Answer 28

``` SWINGING FEVER Productive cough Halitosis Dyspnoea Pleuritic chest pain Empyema ```

Question 29

How is a lung abscess investigated?

Answer 29

1) CXR: Walled cavity w/air/ fluid level 2) Bloods: FBC, CRP, Cultures 3) CT

Question 30

How is a lung abscess treated?

Answer 30

1) Abx: Cephalosporin + Clindamycin 4-6w | 2) Postural drainage/aspiration

Question 31

What is bronchiectasis?

Answer 31

Permanent dilatation of airways following chronic infection or CF

Question 32

What are the causes of bronchiectasis?

Answer 32

INFECTION: Hib, Pseudomonas, Strep Pneumonia, Measles, TB, Pertussis CONGENITAL: CF, Kartagener's Malignancy

Question 33

What are the Sx of bronchiectasis?

Answer 33

``` Persistent productive cough w/purulent sputum Haemoptysis Recurrent chest infection Cor-Pulmonale Clubbing C/L Coarse inspiratory crackles Wheeze ```

Question 34

How is bronchiectasis investigated?

Answer 34

2) HRCT Chest= GOLD STANDARD shows tramline + signet ring sign, bronchial wall dilatation 1) CXR: Cystic shadows, thick bronchial walls, tramline + ring shadows 3) Sputum culture: Determine cause 4) Spirometry: Obstructive 5) Other: Sweat test- CF

Question 35

How is bronchiectasis managed?

Answer 35

1) Inspiratory muscle training 1) Postural drainage 2) Bronchodilators 3) Abx: Based on sputum culture 4) Steroids: IF co-existing asthma