FN: Lung Cancer: presentation

Question 1

Classification

Answer 1

clinically, the most important distinction is between small-cell and non-small-cell

Question 2

Non-small cell types

Answer 2

Adeno
SCC
Large-cell

Question 3

SCC

Epidemiology

Answer 3

35%, M>F, smoking, Radon gas

Question 4

SCC Pathology

Answer 4

Centrally located

Histo: evidence of sqaumous differentiation - keratinisation

Question 5

SCC behaviour

Answer 5

Locally invasive
Metastasise late (via LN)
PTHrP - raised calcium

Question 6

Adeno Epi

Answer 6

25%
Females
Non-smokers
Far east

Question 7

Adeno Pathology

Answer 7

Peripherally located
Histo: Glandular differentiation
- gland formation
- Mucin production

Question 8

Adeno behaviour

Answer 8

Extrathoracic mets common and early - 80% present with mets

Question 9

large-cell epi

Answer 9

10%

Question 10

Large cell pathology

Answer 10

Peripheral or central

Histo: large, poorly differentiated cells

Question 11

Large-cell behaviour

Answer 11

Poor prognosis

Question 12

Small-cell epi

Answer 12

20%

Smoking

Question 13

Small-cell pathology

Answer 13

Central location, near bronchi

Histo: small, poorly differentiated cells

Question 14

Small-cell behaviour

Answer 14

80% present with advanced disease
V. chemosensitive but v. poor prognosis
Ectopic hormone secretion

Question 15

Other lung tumours: all rare

Answer 15

• Adenoma: 90% are carcinoid tumours
• Hamartoma
• Mesothelioma

Question 16

Epi

Answer 16

19% of all cancers

27% of cancer deaths (commonest)

Question 17

Symptoms

Answer 17

Cough and haemoptysis
Dyspnoea
Chest pain
Recurrent or slow resolving pneumonia
Anorexia and reduced weight
Hoarseness

Question 18

Signs in the chest

Answer 18

Consolidation
Collapse
Pleural effusion

Question 19

General signs

Answer 19

Cachexia
Anaemia
Clubbing an dHPOA (painful wrist swelling)
Supraclavicular and/or axillary LNs

Question 20

Metastasis signs

Answer 20

• Bone tenderness
  Hepatomegaly
  Confusion, fits, focal neuro
  Addisons

Question 21

Complications local

Answer 21

recurrent laryngeal N. palsy
Phrenic N. palsy
SVC obstruction
Horners (Pancoast tumour)
AF

Question 22

Paraneoplastic endo

Answer 22

1. ADH - SIADH (euvolaemic reduced Sodium)
2. ACTH - Cushings syndrome
3. Serotonin - carcinoid (flushings, diarrhoea)
4. PTHrP - primary HPT (raised Calcium, bone pain) - SCC

Question 23

Paraneoplastic Rheum

Answer 23

Dermatomyositits/polymyositis

Question 24

Paraneoplastic neuro

Answer 24

Purkinje Cells (CDR2) - cerebellar degeneration
- Peripheral neuropathy

Question 25

Paraneoplastic Derm

Answer 25

• Acanthosis nigricans (hyperpigmented body folds)

- Trousseau syndrome: thrombophlebitits migrans

Question 26

Metastic signs

Answer 26

• Pathological fractures
• Hepatic failure
• Confusion, fits, focal neuro
• Addisons