Investigating Cancer

Question 1

why are investigations necessary?

Answer 1

to stage the extent of the disease

to make a tissue diagnosis (differentiate small cell from non-small cell cancer

to assess fitness to undergo surgery

Question 2

what investigations can be done?

Answer 2

• imaging
• blood tests
• bronchoscopy
• spirometry, FEV1
• CT guided biopsy
• endobronchial ultrasound
• NOT sputum cytology
• liver function tests

Question 3

why may a CXR initially be normal?

Answer 3

due to small lesion/confined to central structures

Question 4

what are common presentations of imaging?

Answer 4

mass lesions, pleural effusion (large, unilateral), mediastinal widening or hilar adenopathy, slow resolving consolidation, collapse, reticular shadowing

Question 5

what does a CT tell you

Answer 5

CT indicates extent of disease. Includes liver, adrenal glands. TNM staging can be done

Question 6

what does a PET tell you?

Answer 6

PET characterises extent of mediastinal nodal involvement or distant metastases (2nd line to CT) PET + CT for best correlation

this is a test to assess function rather than structure

Question 7

what is looked for in the blood tests?

Answer 7

Full blood count
Coagulation screen
Na, K, Ca, Alk phos

Question 8

For which patients is a bronchoscopy useless?

Answer 8

useless for investigating possible tumours in the periphery of the lungs because you cannot inspect the smaller bronchioles

Question 9

which test is useful for peripheral tumours?

Answer 9

CT guided biopsy

Question 10

what is a risk of CT GB?

Answer 10

there is a risk of pneumothorax. Most resolve spontaneously and others may need a chest drain.

Question 11

which patients never have a CT GB?

Answer 11

if the patient has a poor FEV1 - never do this procedure as they are unlikely to survive if there is a complication like a pneumothorax

Question 12

what does an endobronchial ultrasound permit?

Answer 12

enables the visualisation of hilar and mediastinal structures

target and sample lymph nodes - via the needle

Question 13

why are liver tests done?

Answer 13

the tests are abnormal if the liver metastases

Question 14

which marker is particularly useful if there is metastases in the liver?

Answer 14

alkaline phosphatase

Question 15

what are the common ways to make a tissue diagnosis

Answer 15

bronchoscopy

CT guided biopsy

lymph node aspirate

aspiration of pleural fluid

Question 16

what would the diff. diagnosis be if the clinical picture is:

• smoker
• haemoptysis
• abnormal CXR

Answer 16

• lung cancer
• TB
  vasculitis
  PE
  secondary cancer
  lymphoma
  bronchiectasis