Lung cancer

Question 1

What are the 3 main types of non-small cell lung cancer?

Answer 1

Adenocarcinoma
Squamous cell lung cancer
Large cell carcinoma

Question 2

What is mesothelioma?

Answer 2

• Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura.

Question 3

What is mesothelioma strongly linked with?

Answer 3

Asbestos inhalation

Question 4

What nodes are usually first found in lung cancer?

Answer 4

Supraclavicular

Question 5

What are some symptoms of lung cancer? (7)

Answer 5

• Shortness of breath
• Cough
• Haemoptysis (coughing up blood)
• Finger clubbing
• Recurrent pneumonia
• Weight loss
• Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

Question 6

Patient with lung cancer gets hoarse voice. Why?

Answer 6

Recurrent laryngeal nerve palsy
Tumour pressing on redcurrant laryngeal nerve as it passes through the mediastinum

Question 7

What is an extra pulmonary cause of SOB in lung cancer?

Answer 7

Phrenic nerve palsy
Nerve is compressed by tumour and causes diaphragm weakness

Question 8

What is pembertons sign and when is it seen?

Answer 8

○ Pemberton’s sign is where raising the hands over the head causes facial congestion and cyanosis.

Seen in superior vena cava obstruction in lung cancer

Question 9

What does superior vena cava obstruction in lung cancer cause? (3)

Answer 9

Facial swelling
Difficulty breathing
Distended neck and upper chest veins

Question 10

What is the triad seen in horners syndrome?

Answer 10

Ptosis (drooping)
Anhidrosis (absence of sweating)
Miosis (constriction)

Question 11

What tumour is associated with Horners syndrome?
What is the mechanism that causes it?

Answer 11

Lung cancer = pancoast tumour
A tumour in the pulmonary apex pressing on the sympathetic ganglion .: interrupting supply to the face

Question 12

What type of cancer is linked with siADH?

Answer 12

Small cell lung cancer

Question 13

What does siADH in lung cancer present with?

Answer 13

Hyponatraemia

Question 14

Person with small cell lung cancer experiences hyponatraemia. What extrapulmonary manefestation would you suspect?

Answer 14

SiADH

Question 15

What lung cancer is Cushing’s syndrome associated with?

Answer 15

Small cell lung cancer
Ectopic acth secretetion

Question 16

What lung cancer is hypercalcaemia associated with?

Answer 16

Squamous cell lung cancer

Question 17

What is secreted in lung cancer to cause hypercalcameia?

Answer 17

Ectopic PTH

Question 18

What is limbic encephalitis?

Answer 18

• Limbic encephalitis is a paraneoplastic syndrome where small-cell lung cancer causes the immune system to make antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas.

Question 19

What symptoms are seen in limbic encephalitis? (4)

Answer 19

Short term memory impairment
Hallucinations
Confusion
Seizures

Question 20

What antibodies are associated with limbic encephalitis?

Answer 20

Anti-Hu antibodies

Question 21

What are anti-Hu antibodies associated with?

Answer 21

Limbic encephalitis

Question 22

How does lambert-Eaton myasthenic syndrome occur in lung cancer?

Answer 22

Autoantibodies against small cell lung cancer cells target and damage voltage gated calcium channels sited on presynaptic terminals in motor neurones

Question 23

What muscles are affected in lambert-Eaton myasthenic syndrome seen in small cell lung cancer? (4)
And what symptoms does this cause?

Answer 23

Proximal muscles - muscle weakness
Intraocular muscles - diplopia
Levator muscles in eyelid - Ptosis
Pharyngeal muscles - slurred speech and dysphagia

Question 24

What symptoms occur due to autonomic dysfunction in lambert-Eaton myasthenic syndrome? (4)

Answer 24

Dry mouth
Blurred vision
Impotence
Dizziness

Question 25

When should urgent chest X-ray be carried out in 2 weeks for suspected lung cancer?

Answer 25

Patient over 40 with:
• Clubbing
• Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
• Recurrent or persistent chest infections
• Raised platelet count (thrombocytosis)
• Chest signs of lung cancer

Question 26

What findings can be seen on a cxr suggesting lung cancer? (4)

Answer 26

• Hilar enlargement
• Peripheral opacity (a visible lesion in the lung field)
• Pleural effusion (usually unilateral in cancer)
• Collapse

Question 27

Should a staging ct scan in lung cancer use contrast or not?

Answer 27

Must be contrast enhanced

Question 28

What is the action of a pet-ct scan?

Answer 28

PET-CT (positron emission tomography) scans involve injecting a radioactive tracer (usually attached to glucose molecules) and taking images using a combination of a CT scanner and a gamma-ray detector to visualise how metabolically active various tissues are.

Question 29

What test can help visualise and take biopsies of lung cancer?

Answer 29

Bronchoscopy with endobronchial ultrasound

Question 30

What is the first line treatment of non-small cell lung cancer?

Answer 30

Surgery
Only if in isolated area

Question 31

Aside from surgery what treatment is best used in non-small cell lung cancer?

Answer 31

Radiotherapy

Question 32

What treatment is generally used in small-cell lung cancer?

Answer 32

Chemo and radiotherapy

Question 33

What are the 3 types of lung cancer surgery?

Answer 33

• Segmentectomy or wedge resection involves removing a segment or wedge of lung (a portion of one lobe)
• Lobectomy involves removing the entire lung lobe containing the tumour (the most common method) - focal absent breath sounds
• Pneumonectomy involves removing an entire lung - absent breath sounds heard

Question 34

What is the most common thoracotomy incision in lung surgery?

Answer 34

Posterolateral thoracotomy