Clinical Aspects of Lung Cancer

Question 1

What are the 4 presentations of lung cancer?

Answer 1

Primary tumour
Local Invasion
Metastases/non-metastases
Paraneoplastic
Slide 7

Question 2

What are presentations of a primary lung tumour?

Answer 2

Haemoptysis
Recurrent pneumonia
Stridor
Short of breath

Question 3

What are examples of places a lung tumour can invade on locally?

Answer 3

Recurrent laryngeal nerve
Pericardoim
Oesophagus 
Brachial Plexus
Pleural Cavity
Superior Vena Cava. Slide 15

Question 4

What would happen if the tumour invaded towards the recurrent laryngeal nerve?

Answer 4

If the tumour invaded towards the recurrent laryngeal nerve it would cause the left vocal cord to be paralysed presenting as a hoarse voice. Slide 16

Question 5

What would happen is the tumour invades the pericardium or oesophagus?

Answer 5

Pericardium would cause breathlessness, AF and pericardial effusion.
Oesophagus would cause dysphagia, not being able to swallow. Slide 17

Question 6

What would happen is the tumour invades the brachial plexus?

Answer 6

The nerve would be dampened and would cause weakness of the left hand and wasting. Slide 18

Question 7

What would happen is the tumour invades the pleural cavity?

Answer 7

The tumour would generate large volumes of pleural fluid which accumulates and causes a pleural effusion. Slide 20

Question 8

What would happen is the tumour invades the superior vena cava?

Answer 8

Causes obstruction of blood draining from the arms and head. Blood tries to find another route through the jugular vein causing it to be dilated. Patients present with feelings of a bursting head and distension of superficial veins. Slide 21

Question 9

What are the most common sites of a lung tumour to metastases?

Answer 9

Liver
Brain
Bone
Adrenal
Skin
Lung. Slide 25

Question 10

If a patient comes in with weakness, visual disturbance and headaches but are not sensitive to light, what can this be symptoms of?

Answer 10

Cerebral metastases. Slide 26

Question 11

What are paraneoplastic features?

Answer 11

Result from biochemically active products from the primary tumour and are not indicative of a metastatic disease. Slide 32

Question 12

What are some paraneoplastic features?

Answer 12

Finger clubbing
HPOA
Weight loss
Hypercalcaemia
SIADH
Hyperotrophic pulmonary 
Thombophlebitis. Slide 32

Question 13

What is HPOA?

Answer 13

Hypertrophic Pulmonary Osteoarthropathy which is when the periosteum elevates away from the bone and causes pain and tenderness. Slide 34

Question 14

What is thrombophlebitis?

Answer 14

A common occurrence from cancers and is due to increased coagulability of blood in cancer patients so it causes a blood clot to form. Slide 35

Question 15

What is hypercalcaemia?

Answer 15

Too much calcium and causes stones, bone pain, groans around abdominal region, thones (polyuria) and psychiatric overtones. Slide 39

Question 16

What is SIADH?

Answer 16

Syndrome of Inappropriate Antidiuretic Hormone.

Results in low Na conc. and has very generalised symptoms e.g. nausea and lethargy. Slide 41

Question 17

When examining a patient for lung cancer what would you look for?

Answer 17

Finger clubbing
Breathlessness
Weight loss
Bloated face
Enlarged liver
Tracheal Deviation
Hoarse voice
Slide 44

Question 18

What scans and procedures would you do on investigating lung cancer?

Answer 18

Chest X-ray
CT scan of thorax
PET scan
Bronchoscopy
Full blood count
EBUS. Slide 45

Question 19

What does EBUS stand for and what is it used for?

Answer 19

Endobronchial Ultrasound

Targets and samples lymph nodes. Slide 52

Question 20

What are other causes for the same symptoms of lung cancer?

Answer 20

TB
Vasculitis
PE
Lymphoma
Secondary cancer. Slide 56