Lung

Question 1

What is the most common type of lung cancer?

Answer 1

non-small cell lung cancer - adenocarcinoma

Question 2

PC - central, PTHrP and hypercalcaemia associated, finger clubbing, central cavitating lesions

Answer 2

Squamous cell cancer

Question 3

PC - peripheral, anaplastic, poorly differentiated with poor prognosis, B-hCG + gynaecomastia

Answer 3

large cell

Question 3

PC - peripheral, most common type among non-smokers, majority of those who develop this are smokers
female
endocarditis association

Answer 3

Adenocarcinoma

Question 4

PC - rapidly growing, central, SIADH, cushings, lambert-eaton, subacute cerebellar degeneration
*poor prognosis

Answer 4

Small cell lung cancer

Question 4

What is lambert Eaton syndrome ?

Answer 4

antibodies against presynaptic calcium channels of NMJ presenting as proximal muscle weakness

*calcium channels present on small cell LC cells also present at NMJ hence confused as those and attacked by immune system

Question 5

PC - hx of asbestos exposure, pleural plaque thickening and effusion on imaging

Answer 5

mesothelioma

Question 5

What are some risk factors for developing lung cancer?

Answer 5

• smoking
• asbestos exposure
• air pollution
• radon gas exposure
• ionising radiation exposure

Question 6

How might lung cancer present?

Answer 6

70% dyspnoea
cough
chest or shoulder pain
weight loss, anoresia
haemoptysis
lethargy

Question 7

In what specific ways might local invasion of lung cancer present?

Answer 7

horners - sympathetic invasion or pancoast compression
SVCO - compression or thrombosis
dysphagia, hoarse coice
C8-T1 pain
tachyarrhythmias
raised hemidiaphragm

Question 8

How might metastatic disease present?

Answer 8

• lymph nodes - compression, lymphangitis, carcinomatosa
• brain - seizures, N+V, focal neurology, personality change
• further lung nodules or effusions
• adrenal glands - asymptomatic, electrolyte imbalance, pain
• bone pain, #, hypercalcaemia, MSCC
• liver - jaundice, liver capsule pain, itch

Question 9

When might you refer a patient on the 2ww pathway?

Answer 9

CXR suggestive of cancer
>40 with unexplained haemoptysis

Question 10

What investigations might you carry out for suspected lung cancer?

Answer 10

bloods - FBC, U&E, LFT, CRP, bone profile
imaging - CXR, CT CAP, PET
histology - sputum, bronchoscopy, percutaneous needle biopsy

Question 11

how do you stage lung cancers?

Answer 11

TNM staging

Question 12

What are the management options for non-small cell lung cancers?

Answer 12

20% suitable for surgery - mediastinoscopy pre surgery
curative or palliative radiotherapy
poor response to chemo

Question 13

What are some contraindications for surgery?

Answer 13

assess general health
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction

Question 14

What are the management options for small cell lung cancers?

Answer 14

*usually metastatic at diagnosis
- T1-2s, N0, M0 considered for surgery
- combo chemo and radio
- palliative chemo

*prophylactic radiotherapy to brain for SCLC

Question 15

What types of surgeries are available in lung cancers?

Answer 15

lobectomy, pneumonectomy
wedge resection - part of one lobe
sleeve resection - one lobe and part of bronchi

Question 16

What is the 5 year survival for lung cancers?

Answer 16

• stage 1 - 55%
• stage 2 - 35%
• stage 3 - 15%
• stage - 5%

Question 17

What are the paraneoplastic features of small cell LC?

Answer 17

ADH
ACTH
Lambert-eaton

Question 18

What are the paraneoplastic features of squamous cell?

Answer 18

PTHrP
clubbing
hypertrophic pulmonary osteroarthropathy
ectopic TSH

Question 19

What are the paraneoplastic features of adenocarcinoma?

Answer 19

gynaecomastia
hypertrophic pulmonary osteoarthropathy