Lung cancer

Question 1

Name three types of lung cancer

Answer 1

Squamous cell carcinoma
Adenocarcinoma
Small cell lung cancer
Large cell

Question 2

Name two non SCLC

Answer 2

squamous cell carcinoma SCC

adenocarcinoma

Question 3

Which lung cancer has the worst prognosis?

Answer 3

small- cell

Question 4

Which lung cancer is more common in females?

Answer 4

adeno

Question 5

One histological feature of SCC?

Answer 5

intercellular bridges and keratinisation

Question 6

One difference between SCC and adenocarcinoma?

Answer 6

SCC- central

adeno- peripheral

Question 7

One histological feature of adenocarcinoma?

Answer 7

glandular

Question 8

Three symptoms of lung cancer

Answer 8

  Cough and haemoptysis 
  Dyspnoea 
  Chest pain 
  Recurrent or slow resolving pneumonia 
  Anorexia and ↓wt. 
  Hoarseness

Question 9

Three signs of lung cancer on examination?

Answer 9

consolidation
anaemia
clubbing 
supraclavicular + axillay LNs
cachexia

Question 10

Three complications of lung cancer?

Answer 10

recurrentl laryngeal N palsy
SVC obstruction 
Horner's syndrome
Cushing's syndrome
AF
phrenic nerve palsy

Question 11

Name two palsy’s that can arise as a complication of lung cancer

Answer 11

phrenic nerve and recurrent laryngeal nerve

Question 12

Name two endocrine disorders that can stem from lung cancer

Answer 12

SIADH
Cushing’s syndrome
Hypercalcaemia

Question 13

Name one dermatological manifestation of lung cancer

Answer 13

acanthosis nigricans

Question 14

Three investigations for lung cancer

Answer 14

CXR
PET-CT
Staging CT
Bronchoscopy with endobronchial ultrasound (EBUS)
Lung function tests
Histological diagnosis- biopsy

Question 15

Two features of lung cancer on CXR

Answer 15

Hilar enlargement
Pleural effusion
Collapse, consolidation
Peripheral opacity/coin lesion

Question 16

Two differentials for coin lesion aside from neoplalsia

Answer 16

foreign body
abscess
granuloma

Question 17

Two treatment options for lung cancer

Answer 17

1. Surgical resection + adjunct chemo
2. Radiotherapy
3. Chemo + radio

Question 18

Aside from smoking, name two other risk factors for lung cancer?

Answer 18

environmental tobacco smoke, air pollution, asbestos, ionising radiation e.g. radon, HPV, fibrosing conditions of the lung, hereditary

Question 19

Name two structures close to the lung can be affected by local spread of lung cancer?

Answer 19

pleura, hilar lymph nodes, adjacent lung tissue, pericardium, mediastinum, pancoast tumour

Question 20

Name two structures of the mediastinum where lung cancer can spread to locally

Answer 20

SVC, recurrent laryngeal nerve, phrenic nerve

Question 21

What does SVC obstruction due to local cancer result in clinically?

Answer 21

raised JVP and oedema of the face, dilated veins on chest wall

Question 22

A tumour impinging on the phrenic nerve results in which clinical manifestation?

Answer 22

hemidiaphragm paralysis

Question 23

What are the features of horner’s syndrome?

Answer 23

ptsosis, miosis, anhydrosis

Question 24

Two structures can be involved in pancoast tumour?

Answer 24

apex of lung, brachial plexus, cervical sympathetic chain, brachipcephalic vein, subclavian vein

Question 25

Name two secondary organs can lung cancer spread to?

Answer 25

liver, bone, brain, adrenal glands

Question 26

What are three non-metastatic endocrine effects of lung cancer?

Answer 26

ACTH secretion- cushing’s, ADH secretion- SIADH, PTHrP secretion- hypercalcaemia

Question 27

One histological feature of small-cell lung cancer?

Answer 27

nuclear moulding, apoptopic bodies

Question 28

What is the name for the tumour that arises in the pleura?

Answer 28

mesthelioma

Question 29

What is the main cause of mesotheliomas?

Answer 29

asbestos exposure

Question 30

A 64 year old man, who is a lifelong non-smoker, is diagnosed with lung cancer. The tumour biopsy is positive for a mutation in the EGFR gene. Which type of lung cancer?

Answer 30

Lung adenocarcinomas are screened for EGFR mutations. They are also screened for mutations in ALK, PD-L1 and ROS-1

Question 31

Two contraindiactions to lung cancer surgery?

Answer 31

Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis