lung cancer

Question 1

presentation of lung cancer

Answer 1

persistent cough
haemoptysis
dyspnoea
chest pain
weight loss and anorexia
hoarseness
superior vena cava syndrome
examination: fixed, monophonic wheeze, supraclavicular lymph nodes, clubbing

Question 2

paraneoplastic features of small cell

Answer 2

ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

Question 3

paraneoplastic features of squamous cell lung cancer

Answer 3

parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

Question 4

paraneoplastic features of lung adenocarcinoma

Answer 4

gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

Question 5

most common type of lung cancer

Answer 5

adenocarcinoma

Question 6

lung cancer with the worst prognosis

Answer 6

Small cell lung cancer

Question 7

investigations in lung cancer

Answer 7

chest x-ray
CT scan- investigation of choice
bronchoscopy
PET scan (typically done in non-small cell to establish eligibility for curative treatment)
bloods

Question 8

criteria for 2 week suspected cancer pathway

Answer 8

chest x-ray findings that suggest lung cancer
aged 40 and over with unexplained haemoptysis

Question 9

features specific to small cell lung cancer

Answer 9

usually central
arise from APUD cells
associated with ectopic ADH, ACTH secretion
ADH: hyponatraemia
ACTH: cushing’s syndrome

Question 10

management of small cell lung cancer

Answer 10

usually metastatic disease by time of diagnosis
patients with early stage disease considered for surgery
most patients receive combination of chemo and radiotherapy

Question 11

management of non small cell lung cancer

Answer 11

only 20% suitable for surgery
curative or palliative radiotherapy
poor response to chemotherapy