Lung cancer

Question 1

What percentage of lung tumours are carcinoid?

Answer 1

1%

Question 2

What were carcinoid lung tumours previously known as?

Answer 2

Brionchial adenoma

Question 3

Where in the lung do carcinoid tumours arise from?

Answer 3

Amine precursor uptake
and decarboxylation (APUD)

**i.e. same place as small cell tumours

Question 4

Typical age of presentation with carcinoid lung tumour

Answer 4

40-50 years

Question 5

Smoking is a risk factor for carcinoid tumours. TRUE/FALSE

Answer 5

FALSE

Question 6

How do carcinoid tumours usually present?

Answer 6

slow growing
=> long history of cough
recurrent haemoptysis

Question 7

Do carcinoid tumours present centrally or peripherally in the lung?

Answer 7

Centrally
=> often not seen on CXR

Question 8

Sign on bronchoscopy

Answer 8

‘cherry red ball’

Question 9

What metastases are common if a patient has developed carcinoid syndrome?

Answer 9

Liver

Question 10

Management of carcinoid tumour

Answer 10

surgical resection

Question 11

5 year prognosis in carcinoid tumour

Answer 11

if no metastases then 90% survival at 5 years

Question 12

Investigations for lung cancer

Answer 12

CXR
CT
Bronchoscopy
PET
Bloods

Question 13

Management options for non-small cell lung cancer

Answer 13

• surgery (only 20% are suitable)
• Radiotherapy curative/palliative
• chemotherapy (poor response)

Question 14

Give examples of some contraindications to surgery to manage non-small cell lung cancer

Answer 14

Stage IIIb or IV (i.e. metastases)
FEV1 < 1.5L
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction

Question 15

Paraneoplastic syndromes associated with small cell lung ca

Answer 15

ADH (hyponatraemia)
ACTH (Cushing’s syndrome)
Lambert-Eaton Myasthenic Syndrome

Question 16

Paraneoplastic syndromes associated with squamous cell lung ca

Answer 16

Parathyroid hormone-related protein (PTH-rp) secretion
=> hypercalcaemia

Hypertrophic pulmonary osteoarthropathy (HPOA)

Ectopic TSH => Hyperthyroidism

Question 17

Paraneoplastic syndromes associated with adenocarcinoma of the lung

Answer 17

gynaecomastia

hypertrophic pulmonary osteoarthropathy (HPOA)

Question 18

What is Hypertrophic pulmonary osteoarthropathy?

Answer 18

• proliferative periostisis
• typically involves the long bones
• painful.

Question 19

What symptoms would prompt you to refer a patient >40years for urgent suspicion of lung cancer?

Answer 19

• unexplained haemaoptysis
• recurrent chest infection
• finger clubbing
• supraclavicular lymphadenopathy
• thrombocytosis

Question 20

by how much does smoking increase the risk of lung cancer?

Answer 20

By a factor of 10

Question 21

Risk factors for lung cancer (excluding smoking)

Answer 21

asbestos
arsenic
radon
nickel
chromate
aromatic hydrocarbon
cryptogenic fibrosing alveolitis

Question 22

Smoking and asbestos exposure are synergistic in terms of lung cancer risk. What does this mean?

Answer 22

Smoking = 10 fold risk
Asbestos = 5 fold risk

i.e. a smoker with asbestos exposure has a 10 * 5 = 50 times increased risk

Question 23

Are small cell lung cancers usually central or peripheral?

Answer 23

Central

Question 24

What cells do small cell lung cancers arise from?

Answer 24

Amine precursor uptake and decarboxylation (APUD)

Question 25

Management of small cell lung cancer

Answer 25

• early stage disease (T1-2a, N0, M0) are now considered for surgery
• Most patients get chemotherapy and radiotherapy
• palliative chemotherapy for extensive disease

Question 26

Small cell lung cancer is usually metastatic disease by time of diagnosis. TRUE/FALSE

Answer 26

TRUE