Lung Cancer

Question 1

Commonest primary malignant Lung tumours

Answer 1

Non small cell lung cancer

• Squamous cell carcinoma
• Adenocarcinoma

Small cell lung cancer (survival is talked about in months not years)

Question 2

How do the three common malignant lung tumours differ

Answer 2

Presentation

Investigations

Natural History

Management

Question 3

Haemoptysis

Answer 3

Coughing out blood

Question 4

Haematesis

Answer 4

Vomiting out blood

• Diseases of GI Tract

Question 5

Dyspnoea

Answer 5

Difficulty Breathing

Question 6

What symptoms might be expected from this tumour and why

Answer 6

Erosion into vessels as it is in the hilum of the lungs - leading to bronchi and trachea causing haemoptysis

Question 7

What might this cytological analysis of sputum indicate and why

Answer 7

Seems malignant due to pleomorphisms and a high nuclear:cytoplasmic ratio

They are also squamous cells, likely in smokers

Question 8

What is the purpose of a bronchoscopy

Answer 8

Taking a sample of suspicious cells in the airways for biopsy

Question 9

Usefulness of CT scans in lung cancer investigation

Answer 9

Allows investigation of tumour size and potential analysis of lymph node involvement

Question 10

How does haemoptysis induced by lung cancer respond to radiotherapy

Answer 10

Quite well - disappears quite quickly

Question 11

DXT

Answer 11

Radiotherapy

Question 12

Where are squamous cells carcinoma more likely to arise in the lungs

Answer 12

Centrally as opposed to peripheral

**ABOUT LIKELIHOOD - NOT DEFINITIVE

Question 13

Pleural Effusion

Answer 13

Liquid collecting in the pleural cavity

Question 14

Adenocarcinoma

Answer 14

Cancer that starts in mucous-producing glandular cells of your body

Question 15

Which type of lung cancer is most common in non-smokers

Answer 15

Adenocarcinoma

Question 16

Main presentation of adenocarcinoma of the lungs

Answer 16

Pleural effusion - other more systemic symptoms like haemotysis and bleeding are not as common as it is in the periphery of the lungs

Question 17

Diagnosis of adenocarcinoma

Answer 17

Image-guided biopsy

Question 18

Most appropriate treatment for localised adenocarcinoma of the lungs

Answer 18

Surgery

Question 19

Stridor

Answer 19

Noisy breathing that occurs due to obstructed air flow through a narrowed airway

**DANGEROUS AS AIRWAY OBSTRUCTION CAN OCCUR IF SERIOUS

Question 20

What cells does a small cell carcinoma of the lungs arise from

Answer 20

Pulmonary Neuroendocrine Cells

**Smoking related

Question 21

What causes the presentations of small cell carcinoma in the lungs

Answer 21

Presentation because of local invasion of vital structures (SVC & Obstruction of bronchus)

Question 22

Why might wasted muscles of the hand or hoarseness of the voice indicate lung cancer

Answer 22

Hoarseness - Involvement of recurrent laryngeal nerve

Wasted muscles of hand - Brachial Plexus involvement

Question 23

Other less specific presentations of lung cancer

Answer 23

Cancer cachexia

Stridor

Clubbing

Hoarseness (recurrent laryngeal nerve involved)

Wasted muscles of the hand (brachial plexus involvement)

Horner’s syndrome

Question 24

Paraneoplastic Syndromes

Answer 24

Growth factors secreted by the tumour that act on organs elsewhere

Question 25

Which lung tumour type is most correlated with paraneoplastic syndromes

Answer 25

SMall cell lung cancers

Question 26

Which type of lung cancer is seen most commonly with hypercalcaemia

Answer 26

Squamous Cell Cancers

**Parathormone related

Question 27

Examples of paraneoplastic syndromes

Answer 27

SIADH - Low sodium & plasma osmolality and high urine osmolality

Ectopic ACTH (Cushing’s SYndrome)

Hypercalcaemia

Neurological Syndromes (e.g. cerebellar degeneration)

Question 28

Importance of histology and genomic analysis of lung cancers to find the specific type of mutation and not just broad type (especially for adenocarcinoma types)

Answer 28

Medications have been developed targeting specific mutations

Question 29

Are adenocarcinomas in the lungs usually primary or secondary

Answer 29

Usually secondary

Question 30

How to detect whether a lung adenocarcinoma is primary or secondary

Answer 30

Biomarkers

***** CK7+ve; CK20-ve, lung primary - opposite favours colorectal (DO NOT MEMORISE THIS JUST BE VAGUELY AWARE)