Lung Cancer

Question 1

What type of tumour is one likely to be if it is a central (tubal) lung tumour?

Answer 1

Squamous cell

Question 2

What type of tumour is one likely to be if it is a peripheral lung tumour?

Answer 2

Adenocarcinoma

Question 3

Histologically what might inform you that a tumour is a squamous cell tumour?

Answer 3

If there are clear borders between the cells

Question 4

Histologically what might inform you that a tumour is an adenocarcinoma?

Answer 4

It will likely try to disguise itself as glandular tissue

Question 5

Histologically what might inform you that a tumour is a small cell tumour?

Answer 5

Cells will be virtually all nucleus with little cytoplasm and nuclear moulding

Question 6

What are 3 possible signs of a Pancoast tumour?

Answer 6

Ptosis
Shoulder pain (due to rib destruction)
Atrophy in hand and arm (C8, T1 distribution)

Question 7

If you see a whiteout on one side of a radiograph what is that likely to mean?

Answer 7

A collapsed lung

Question 8

With a collapsed lung is the trachea often pulled towards or pushed away from the affected side?

Answer 8

Pulled towards

Question 9

In a tension pneumothorax is the trachea often pulled towards or pushed away from the affected side?

Answer 9

Pushed away

Question 10

with pleural effusion is the trachea often pulled towards or pushed away from the affected side?

Answer 10

Pushed away

Question 11

What types of cancer commonly metastasise to lung in men in particular and why?

Answer 11

Abdominal cancers and testicular cancers as they drain to para-aortic lymph nodes and into the cisterna chyli through the oesophageal hiatus.

Question 12

Where do small cell carcinomas commonly metastasize to?

Answer 12

Adrenals and liver

Question 13

If a consequence of lung cancer is hypercalcaemia what type of tumour is it most likely ot be?

Answer 13

Squamous cell

Question 14

Name 3 broad types of complication caused by lung cancers

Answer 14

Hormonal (hyercalcaemia (PTH-like), hyponatraemia)
Neuromuscular (Lambert-Eaton Myasthenia Syndrome)
Hypertrophic pulmonary arthropathies (hands, wrists, knees)

Question 15

A man with suspected lung cancer (mass found on CXR and correlating signs and sympts) walks with a wide gait, struggles to get out of chairs and has difficulty walking for long periods of time. What is the likely tumour type and why?

Answer 15

Small Cell Lung Cancer - often presents with Lambert-Eaton Syndrome (L-E S often presents before the cancer does) which causes proximal muscle weakness among other muscle weaknesses

Question 16

What is the most common form of treatment for non-small cell lung cancer (NSCLC)?

Answer 16

Palliative - rarely curable

Question 17

If a patient being treated with radiotherapy for a central lung tumour c/o a sensation of swallowing razor blades what is likely to have occurred?

Answer 17

Rupture of the oesophagus

Question 18

List some side effects of Erlotinib (antineoplastic drug - chemo) - similar to many over chemo drugs

Answer 18

Acneform rash; Chronic itchy dry skin; Conjunctivitis; Diarrhoea; Fatigue; Pneumonitis; Bowel perforation
All affect growth of blood vessel so reduce healing ability

Question 19

Where are the most likely sites of spread from lung cancers?

Answer 19

Liver; Brain; Bones; Adrenal glands; Skin (mets via blood - haematogenous)

Question 20

What are the likely signs in a patient with SVC obstruction?

Answer 20

Swelling in face, neck and arms; headache (worse on bending); dilated veins