Lung Cancer

Question 1

Types of lung carcinoma

Answer 1

Non small cell lung carcinoma

Small cell lung carcinoma

Question 2

What is carcinoma

Answer 2

malignancy that starts at layer surrounding internal organs

Question 3

Types of non small cell lung carcinoma

Answer 3

Adenocarcinoma
Squamous cell
Large cell

Question 4

What is the most common type of lung cancer

Answer 4

Adenocarcinoma

Question 5

Why is the prognosis of small cell lung cancer often poor

Answer 5

When discovered, already at late stage, may have metastasized already
More aggressive

Question 6

Symptoms

Answer 6

Haemoptysis 
Hoarseness 
Unintentional weight loss 
Cough > 3 weeks 
Dyspnea 
chest pain
malaise
chest infection that doesn't go away

Question 7

Where is adenocarcinoma often found

Answer 7

outer region of lungs

Question 8

What is adenocarcinoma

Answer 8

Cancer of mucus secreting cells

Question 9

What is squamous cell carcinoma

Answer 9

Cancer of squamous cell

Question 10

Why may there be recurrent chest infections

Answer 10

Tumour blocking the airways may prevent clearance of mucus

Question 11

Why may there be hoarseness of voice

Answer 11

Tumuor pressing against recurrent laryngeal nerve

Question 12

Why may there by haemoptysis

Answer 12

Tumour needs good blood supply so angiogenesis occurs. Angiogenesis produces blood vessels with weak walls so can easily rupture

Question 13

What other things can cause haemoptysis except from cancer

Answer 13

pneumonia / TB (cavitating granulomata) / coughing too hard

Question 14

What is stridor

Answer 14

Wheeze on inspiration due to obstruction of airway

Question 14

Why may there be stridor

Answer 14

Tumour blocking the airway

Question 15

Clinical features / signs of local invasion

Answer 15

Stridor 
lymphadenopathy 
pleural effusion
AF / pericardial effusion 
finger clubbing 
superior vena cava obstruction
dysphagia

Question 16

Cancer spreading to lymph nodes causes

Answer 16

lymphadenopathy

Question 17

Cancer spreading to pleural cavity causes

Answer 17

pleural effusion

Question 18

Cancer spreading to pericardium causes

Answer 18

AF / pericardial effusion

Question 19

Cancer spreading to oesophagus causes

Answer 19

dysphagia

Question 20

Signs of superior vena cava obstruction

Answer 20

Enlarged vessels at neck and face

Question 21

TNM staging - T

Answer 21

T0 - tumour not visible but found in sputum culture / bronchial fluids
T1 - 3cm or less
T2 - 3 < x

Question 22

TNM staging - N

Answer 22

N0 - no lymph node metastases
N1 - ipsilateral hilar lymph node
N2 - ipsilateral mediastinal or subcarinal lymph nodes
N3 - contralateral mediastinal or hilar lymph nodes

Question 23

TNM staging - M

Answer 23

M0 - no distant metastases

M1 - distant metastases

Question 24

Paraneoplastic syndromes

Answer 24

``` Hypertrophic pulmonary osteopathy SIADH (hyponatraemia) Hypercalcaemia Cushing's Syndrome Eaton Lambert's Syndrome ```

Question 25

What is HPOA

Answer 25

periostitis - inflammation in periosteum layer of bone

Question 26

most common paraneoplastic syndromes of squamous cell carcinoma

Answer 26

HPOA | Hypercalcaemia

Question 27

What does HPOA cause

Answer 27

finger clubbing | pain during movement

Question 28

What causes hypercalcaemia

Answer 28

Due to bony metastases and secretion of PTHrP

Question 29

What does hypercalcaemia cause

Answer 29

Stones - renal / biliary calculi Bones - bone pain Groans - abdominal pain Thornes - polyuria (excess urination)

Question 30

Most common paraneoplastic syndromes of SCLC

Answer 30

SIADH Cushing's Eaton Lambert's

Question 31

What is SIADH

Answer 31

Excess secretion of ADH

Question 32

What does SIADH cause

Answer 32

Too much retention of water in kidneys, causing dilutional hyponatraemia Also decreases excretion of Na+ in urine = hyponatraemia

Question 33

What is Cushing's Syndrome

Answer 33

Excessive release of ACTH hormone so makes too much glucocorticoids

Question 34

What does Cushing's Syndrome cause

Answer 34

``` Glucocorticoids are responsible for regulating blood sugar and blood pressure so Hyperglycaemia Hypertension Hypokalaemia Alkalosis ```

Question 35

What tests to do for suspected lung cancer

Answer 35

Blood tests LFTs Scans Biopsies

Question 36

What should blood tests for lung cancer measure

Answer 36

U&Es (urea and electrolytes) | FBC

Question 37

What scans are used

Answer 37

CXR - first thing to do CT scan - usually definitive PET scan - identifies metastases

Question 38

How does PET scan work

Answer 38

Tumour will be bright and light up in PET scan because it has high metabolic rate

Question 39

What to do to confirm diagnosis

Answer 39

Biopsies

Question 40

How to take biopsies

Answer 40

``` Bronchoscopy Endobronchial ultrasound Medical thoracoscopy Aspiration of pleural fluid Aspiration of lymph nodes ```

Question 41

What does medical thoracoscopy do

Answer 41

Make an incision at 5/6/7th intercostal space to view the pleura for lesions and take biopsies

Question 42

Surgery

Answer 42

Curative intention | Not suitable for patients with metastases