Lung Cancer

Question 1

What are some common presentations of lung cancer?

Answer 1

SOB
Haemoptysis
Weight loss
Hoarse voice
Horners syndrome
Paraneoplastic syndrome
Wheeze
Infection

Question 2

What type of wheeze do you get with lung cancer?

Answer 2

Monophonic wheeze

Question 3

What type of wheeze do you get with lung cancer?

Answer 3

Monophonic wheeze

Question 4

What type of wheeze do you get with COPD and asthma?

Answer 4

Polyphonic wheeze

Question 5

Why do you get a polyphonic wheeze with asthma and COPD?

Answer 5

Varying degrees of inflammation and narrowing all around the lungs

Question 6

What are some extrapulmonary symptoms/signs of lung cancer?

Answer 6

Hoarseness of voice
SVC obstruction symptoms
Dysphagia
Shoulder/inner arm pain
Chest pain
Facial/upper body swelling
Arrhythmia
Horners syndrome

Question 7

What are some signs of SVC obstruction which can be caused by a lung cancer?

Answer 7

Breathlessness
Faint
Headaches
Facial / upper body swelling

Question 8

How can you clinically test for SVC obstruction?

What is the name of the sign?

Answer 8

Get patients to raise arms above head, will make have a headache or make headache worse

Pembertons sign

Question 9

What is Horner’s syndrome?

What typically causes it?

Answer 9

Triad of:
-partial Ptosis
-miosis
-anhydrosis

Pancoast Tumor (apical lung Tumor) compresses sympathetic chain

Question 10

Why does Horners syndrome cause partial Ptosis not full Ptosis?

Answer 10

Sympathetic chain is damaged

Sympathetics supply the smooth muscle part of levator palpebrae superioris, whereas the majority of levator palpebrae superioris is skeletal muscle supplied by the Occulomotor nerve

Majority of LPS still has innervation so not full Ptosis

Question 11

What are some extrathoracic symptoms/signs of lung cancer?

Answer 11

Poor appetite
Cachexia
Weight loss
Pain
Neurological issues
Skin nodes and lymph nodes
Palpable liver
Clubbing

Question 12

What are essential parts/questions in a Hx where you think it might be lung cancer?

Answer 12

Do you smoke?
Have you ever smoked?
How much for how long?
Do you smoke anything else?

What occupation do you do?
Any exposures to toxins?
Nature of exposure?
How long exposed for?
Who was you employer?
What protective gear was provided?

Question 13

What scoring system is used to assess patients with potential lung cancer to aid in management decisions?

Answer 13

Performance status

Question 14

What is performance status scored between?

Answer 14

0-4

Question 15

What is a 0 performance status score?

Answer 15

Asymptomatic

Question 16

What is a 1 performance status score?

Answer 16

Symptomatic but completely ambulatory

Question 17

What is a 2 performance status score?

Answer 17

Symptomatic but less than 50% of time in bed during the day

Question 18

What is a 3 performance status score?

Answer 18

Symptomatic but over 50% of time spent in bed but NOT BED BOUND

Question 19

What is a 4 performance status score?

Answer 19

BED BOUND

Question 20

What investigations are done for a potential lung cancer?

Answer 20

U+Es
LFTs
Ca2+
FBC
Clotting
Spirometry + transfer factor

Question 21

What imaging techniques would you do for a potential lung cancer?

Answer 21

CXR (first line)
Staging CT CAP
Biopsy if possible
PET CT after biopsy if possible
Echo if CVS issues

Question 22

What techniques can be used to biopsy a ?lung cancer?

Answer 22

Bronchoscopy
Endobronchial US guided transbroncial fine needle lymph node aspiration

Question 23

What are the 2 categories of lung cancer?

Answer 23

Small cell lung cancer

Non small cell lung cancer

Question 24

What are the 3 types of Non small cell lung cancer?

Answer 24

Squamous cell carcinoma
Adenocarcinoma
Large cell

Question 25

What gene does squamous cell carcinoma often have?

Answer 25

PDL1

Question 26

What genes do adenocarinomas often have?

Answer 26

PDL1 EGFRr ALK ROS1

Question 27

What is the treatment pathway if a GP suspects lung cancer? What does this mean?

Answer 27

2 week urgent referral Time from GP referral to first hospital admission should be done in 2weeks

Question 28

Why can you get voice hoarseness with lung cancer?

Answer 28

Lung cancer can compress teh recurrent laryngeal nerve

Question 29

What type of lung cancer typically has paraneoplastic syndromes?

Answer 29

Small cell lung cancer

Question 30

What are some syndromes that can be cause by a small cell lung cancer secreting hormones or substances?

Answer 30

SIADH Cushings

Question 31

What does the small cell carcinoma produce leading to Cushing’s syndrome?

Answer 31

ACTH

Question 32

What electrolyte imbalance is caused by a small cell lung cancer secreting ADH leading to SIADH?

Answer 32

Hyponatraemia

Question 33

What type of lung cancer can cause Hypercalcaemia? Why can this happen?

Answer 33

Squamous cell carcinoma Ectopic PTH secretion by the. Tumour

Question 34

What syndrome can rarely be caused by a small cell lung cancer which can lead to damage to Autonomics, vision, voice and swallowing?

Answer 34

Lambert Eaton myasthenic syndrome

Question 35

What is the pathophysiology of lambert Eaton myasthenic syndrome?

Answer 35

Antibodies set up against cancer damage voltage gated calcium channels at presynaptic membrane of motor neurones

Question 36

What is the treatment options for lung cancer?

Answer 36

Surgical resection/ablation Radiotherapy (radical or palliative) Systemic anti cancer therapy (chemo + immunotherapy)

Question 37

What is a bright area called on a CT image? What is a dark area called on a CT image?

Answer 37

Bright = highly attenuated Dark = low attenuation

Question 38

What are bright areas on a PET scan called? What are dark areas on a PET scan called?

Answer 38

Bright = has high FDG Avidity (highly avid) Dark = low avidity

Question 39

What are fluffy opacities on a CXR. Called?

Answer 39

Alveolar shadowing

Question 40

What are dots and lines called on a CXR?

Answer 40

Nodular or reticular shadowing

Question 41

What are the bright areas called on an MRI? What are the dark areas called on an MRI?

Answer 41

Bright = hyper intense Dark = hypointense

Question 42

What is the NICE. Guidelines criteria for referral for an urgent 2 week CXR with ?lung cancer?

Answer 42

Patients over 40 with: -clubbing -lymphadenopathy -persistence / recurrent chest infections -raised platelets (Thrombocytosis) -chets signs of lung cancer