lung cancer

Question 1

outline the aetiology for lung cancer

Answer 1

inhalation of carcinogens e.g. smoking, asbestos exposure or pollution

Question 2

what proportion of lung cancers can be linked to smoking

Answer 2

80-90%

Question 3

what are the 2 main classifications for types of lung cancer

Answer 3

small cell and non small cell

Question 4

what lung cancer has the worst prognosis

Answer 4

small cell lung cancer

Question 5

what is the most rapidly progressive lung cancer

Answer 5

small cell lung cancer

Question 6

what is the most common lung cancer in non smokers

Answer 6

adenocarcinoma

Question 7

which lung cancer is most commonly linked with asbestos exposure

Answer 7

adenocarcinoma

Question 8

what is the most common lung cancer type in smokers

Answer 8

squamous cell carcinoma

Question 9

which lung cancers have a central tumour

Answer 9

small cell lung cancer
squamous cell carcinoma

Question 10

what lung cancer types have a peripheral tumour

Answer 10

large cell carcinoma
adenocarcinoma

Question 11

large cell carcinoma has the second worst prognosis. true or false?

Answer 11

true

has early mets

Question 12

where are the most common sites of mets from a primary lung cancer

Answer 12

brain
liver
bone
adrenal glands
skin

Question 13

what are the general symptoms of a lung cancer

Answer 13

cough for 3+ weeks
dyspnoea (airway obstruction)
haemoptysis (erosion of a blood vessel by the tumour
chest or shoulder pain (initially visceral, becomes pleural if pleural invasion)
unexplained weight loss
unexplained tiredness/ lethargy

Question 14

what are the clinical signs of a lung cancer

Answer 14

stridor
clubbing
hepatomegaly
lymphadenopathy
tracheal deviation
recurrent pneumonia

if involvement of the pleura - stony dull percussion and pleural rub

Question 15

why do some lung cancers cause recurrent pneumonia

Answer 15

tumours which block the bronchi can stop the mucociliary escalator from functioning properly

secretions and bacteria are not cleared

Question 16

what are the investigations done initially in suspected lung cancer

Answer 16

bloods: FBC, coagulation screen, U+Es
CXR

Question 17

what result form U+Es can be indicative of malignancy

Answer 17

hyponatraemia
hypercalcaemia

Question 18

if a potentially malignant mass is seen on CXR, what are the further investigations that could be used?

Answer 18

biopsy
CT thorax - used to stage and see mets
PET scan - assess for mets
USS - ?pleural effusion, movement of diaphragm and subphrenic abscess

Question 19

what are the management options for lung cancer

Answer 19

palliative: chemo/radiotherapy, stenting where tumours are causing dyspnoea from airway obstruction, analgesia and antimetics

non palliative: targeted treatments - based on tumour specific markers for a patient specific regimen

Question 20

what are the symptoms of SVC mets/ obstruction

Answer 20

puffy eyelids
headache
distention of the jugular veins/ visible anastomoses of veins on the chest

Question 21

what are the symptoms associated with oesophageal mets/ obstruction

Answer 21

dysphagia

Question 22

what are the symptoms associated with recurrent laryngeal nerve compression

Answer 22

hoarseness

Question 23

what is a pancoast’s tumour

Answer 23

tumour in the lung apex that infiltrates on the brachial plexus causing Horner’s syndrome

Question 24

what is Horner’s syndrome? What can it be caused by? What are the symptoms?

Answer 24

damage of the sympathetic trunk

can be caused by a Pancoast’s tumour

symptoms:
miosis (constriction of the pupil unilaterally)
ptosis (upper eyelid droops causing a partially closed eye)
anhidrosis (decreased sweating on the affected side of the face)
enophthalmos (eyeball appears sunken)

Question 25

name 4 Paraneoplastic syndromes associated with lung cancer

Answer 25

Lambert-Eaton syndrome - disorder of neuromuscular transmission causing muscle weakness and depressed tendon reflexes etc.

thrombophlebitis: blood clot formation

anaemia

HPOA (hypertrophic pulmonary osteoarthropathy: joint stiffness, severe pain in wrists and ankles