Lung cancer

Question 1

Types of non-small-cell lung cancer

Answer 1

adenocarcinoma
squamous cell carcinoma
large cell carcinoma
other NSCLC unable to classify

Question 2

Where are squamous cell lung cancers normally located?

Answer 2

central, local nodal disease

Question 3

Where are adenocarcinoma lung cancers normally located?

Answer 3

often peripheral, can be multifocal, distant mestastases

Question 4

What mutation is present in ~10% lung cancers (particularly females and never smokers)?

Answer 4

EGFR mutation

Question 5

Lung cancer presentation

Answer 5

local symptoms = cough, SOB, stridor, phlegm change, pneumonia, haemoptysis, hoarseness, weight loss, chest pain

metastatic symptoms = bone pain, headaches, neurological findings, abdo pain, anorexia, cachexia, jaundice, weight loss

Question 6

What are the 2 main types of lung cancer?

Answer 6

small cell
non-small cell

Question 7

What can be used to help stage a lung cancer?

Answer 7

CT chest including liver and adrenal glands
PET-CT for lymph node involvement/distant metastases
MRI-CT head for cerebral metastases
bronchoscopy/mediastinoscopy
EBUS

Question 8

What staging is used for lung cancer?

Answer 8

TNM

Question 9

Small cell lung cancer treatment

Answer 9

no surgery
limited stage (inside chest) = chemoradiotherapy, or just chemotherapy +/- prophylactic cranial irradiation

extensive stage (outside chest) = just chemotherapy +/- prophylactic cranial irradiation

Question 10

Non-small-cell lung cancer treatment

Answer 10

stage 1-2:
surgery if possible
+/- adjuvant chemotherapy
unfit = stereotactic radiotherapy

stage 3 :
radical chemoradiotherapy
radical radiotherapy alone

stage 4:
- palliative intent = chemotherapy

Question 11

What should be checked in a confused patient with cancer?

Answer 11

calcium

Question 12

If a patient has hypercalcaemia and no known cancer, what should be done?

Answer 12

myeloma screen

Question 13

Malignant hypercalcaemia symptoms

Answer 13

bones, stones, groans and psychic moans

bone pain
renal stones
generalised body pain
confusion, low mood

also: constipation, polydipsia/polyuria, generalised fatigue/weakness

Question 14

Malignant hypercalcaemia management

Answer 14

rehydration - several litres of normal saline
(risk of cardiac failure - consider CVP measurements)

bisphosphonates:
- 60-90mg pamidronate IV over
- can cause renal failure so must be rehydrated first
- takes up to a week to work

systemic management of malignancy

Question 15

Superior vena cava obstruction symptoms and signs

Answer 15

symptoms = SOB, facial swelling, arm swelling, upper venous engorgement

signs = neck and upper torso venous engorgement, facial swelling

Question 16

Causes of superior vena cava obstruction

Answer 16

Intrinsic compression:
- clot (DVT)
- foreign body (eg. line)
- tumour in vessel (eg. renal cancer)

extrinsic compression:
- from mass

Question 17

Superior vena cava obstruction management

Answer 17

steroids (eg. 8mg dexamethasone BD)

chemotherapy (good response in SCLC)

radiotherapy (good response in squamous cell lung cancer)
stent - rapid symptom relief but doesn’t treat cause

caused by clot = anticoagulation