Lung Cancer

Question 1

Describe common features of squamous cell carcinoma

Answer 1

Cavitating lung lesion with central necrosis
Central location
Hypercalcaemia
Causes obstructing lesions of bronchus with post-obstructive infection
Local spread is relatively common, metastasizes relatively late

Question 2

What are the four most common types of lung cancer?

Answer 2

1. Small cell 
Non-small cell:
2. Adenocarcinoma
3. Squamous cell
4. Large cell

Question 3

Describe the common features of adenocarcinoma.

Answer 3

Originates from mucus-secreting glandular cells
Most common cell type in non-smokers
Often causes peripheral lesions on CXR/CT
Metastases are common: to pleura, lymph nodes, brain, bones & adrenal glands

Question 4

Describe the common features of large cell carcinoma

Answer 4

Often poorly differentiated

Metastasize relatively early

Question 5

Describe the common features of small cell carcinoma

Answer 5

Arises from neuroendocrine cells
Often secrete polypeptide hormones
Often arise centrally and metastasize early

Question 6

Describe some symptoms of lung cancer and the cause of these symptoms

Answer 6

Cough - not sure why
Breathlessness - central tumours occlude large airways resulting in lung collapse and SOB on exertion
Haemoptysis - due to tumour bleeding into airway
Chest pain - peripheral tumours invading the chest wall
Wheeze - partial obstruction of the airway
Hoarse voice - compression of the left recurrent pharyngeal nerve
Small muscle wasting in the hand, as well as weakness and pain radiating down the arm
Recurrent infections due to tumour obstruction

Question 7

What are areas of common metastatic spread of lung cancer?

Answer 7

Liver
Bone
Adrenal glands
Brain

Question 8

Give examples of a few types of cancer which metastasize to the lungs.

Answer 8

Kidney, prostate, breast, bone, GI, cervix & ovary

Question 9

What type of tumour is a pulmonary hamartoma?

How does it appear on CXR?

Answer 9

Benign

Well defined round lesion in the periphery of the lung

Question 10

Give two cardiac manifestations of primary lung cancer

Answer 10

AF

Pericardial effusion

Question 11

How can lung cancer cause hand weakness?

Answer 11

Wasting of the small muscles in the hand is due to T1 root infiltration by a primary lung cancer in the apex of the left lung.
The tumour erodes though the ribs and in to the lower part of the brachial plexus.

Question 12

How can lung cancer cause puff eyelids, head ache and distended veins on the abdomen and thorax?

Answer 12

Local invasion of the SVC obstructs drainage of blood from the arms and head. The patient may describe puffy eyelids & head ache.
The blood flow will eventually bypass the obstructed SVC by opening op anastamoses with the IVC tributaries.

Question 13

Give some examples of symptoms and signs of paraneoplastic spread of lung cancer.

Answer 13

Finger clubbing
Hypertrophic pulmonary osteoarthropathy - finger and ankle pain
Weight loss
Thrombophlebitis
Hypercalcaemia
Hyponatraemia
Weakness - Eaton Lambert syndrome

Question 14

What protein does adenocarcinoma secrete?

Answer 14

TTF - thyroid transcription factor

Question 15

What type of carcinoma is mutation seen exclusively in?

Answer 15

Adenocarcinoma

Question 16

What are the treatment options for small cell lung cancer?

Answer 16

Surgery is usually ruled out due to metastasis from the primary site
The rapid growth of the tumour makes it more susceptible to chemotherapy, however it develops rapid resistance to this
This is often backed up with radiotherapy

Question 17

What are the common treatments for non small cell lung cancer?

Answer 17

Curative options are surgery or radical radiotherapy

Less responsive to chemotherapy