Lung Cancer Flashcards
two types of lung cancer?
which one carries a worse prognosis?
Lung cancer is initially classified into either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC)
SCLC.
Squamous cell carcinoma
- is it SCLC or NSCLC?
- occurs in smokers or non-smokers?
- affects central or peripheral lung?
- associated with increased PTH secretion causing?
- also get HPO triad - which is what?
- what do you produce which is characteristic of squamous cell carcinoma?
- NSCLC
- smokers
- central
- hypercalcaemia
- Hypertrophic osteoarthritis triad = clubbing, long bone swelling and arthritis
keratin and desmosome production
Adenocarcinoma
- is it SCLC or NSCLC?
- occurs in smokers or non-smokers?
- affects central or peripheral lung?
- also see what feature on external chest?
- also get HPO triad which is?
- what staining do you get that is characteristic of adenocarcinoma?
NSCLC
non smokers
peripheral
gynaecomastia
Hypertrophic osteoarthritis = clubbing, long bone swelling and arthritis
- mucin staining
how do you manage NSCLC like squamous cell carcinoma, large cell carcinoma and adenocarcinoma?
what are CI to surgical removal?
lobectomy if medically fit
+ radio/chemo therapy
stage 3/4
malignant pleural effusion
tumour near hilum
SVC obstruction
Large cell carcinoma
- is it NSCLC or SCLC?
- usually considered a diagnosis of exclusion
NSCLC
SCLC
- smokers or non-smokers?
- how can you differentiate SCLC from NSCLC on histology?
- paraneoplastic features - what effect does it have on ACTH, ADH?
- fast growing and get early metastases - Usually metastatic disease by time of diagnosis - what is Tx for following:
- early stage?
- late stage?
smokers only
- high nucleus:cell ratio
- ^ADH = hyponatraemia
- ^ACTH = cushings
1) Patients with early stage are considered for surgery.
2) Most receive combination of radiotherapy and chemotherapy.
3) Patients with more extensive disease are offered palliative chemotherapy.
Features of lung cancer?
Clinical signs?
cough haemoptysis dyspnoea chest pain weight loss
HPO triad bone tenderness (mets)
smoking increases risk by?
asbestos increases risk by?
combination of both?
10
5
50
first Ix for lung cancer ?
Ix of choice ?
what is done in NSCLC to identify staging?
what test assesses suitability for lobectomy?
CXR
contrast enhanced CT
PET scan
lung function test
Malignant Mesothelioma
- what % of patients report previous asbestos exposure?
specific features regarding pleural fluid?
poor prognosis without chemo - how long is survival in this case?
90%
bloody pleural fluid
2 years
A 65-year-old man is seen in the lung cancer clinic for investigation of a lung nodule in close proximity to his left main bronchus. He has also had some weight loss over the past 3 months. He has no past medical history or family history. He is on no regular medications and has no allergies. He has 65 pack year smoking history. He has no occupational exposure to asbestos.
Which of the following is the most likely histological diagnosis of this mass?
squamous cell carcinoma
mesothelioma
adenocarcinoma
large cell carcinoma
squamous cell carcinoma
Although most lung cancer is linked to smoking, squamous cell lung cancer is the most strongly linked with smoking
A 71-year-old patient with a 2-month history of a cough and associated weight loss shows a suspicious lung mass on chest X-ray. Which of the following is the most appropriate next step?
MRI US biopsy Non contrast CT Contrast enhanced CT PET scan
Contrast enhanced CT
NICE recommends that patients with known or suspected lung cancer are offered a contrast-enhanced CT scan of the chest, liver and adrenals.
A 62 year old gentleman is seen at the respiratory clinic after a mass lesion is identified by his GP on chest x-ray. He is a heavy smoker and has had a cough and weight loss for the past two months. On further questioning he admits to feeling very weak and is having difficulty getting out of a chair. On examination the consultant notices some proximal muscle wasting. Initial investigations reveal a blood pressure of 170/90mmHg and a low potassium. In addition to organising staging CT and bronchoscopy he requests a 24-hour urinary cortisol test, which is raised.
Which of the following is the most likely underlying pathology?
squamous cell bronchial carcinoma
large cell bronchial carcinoma
small cell bronchial carcinoma
bronchial adenocarcinoma
small cell bronchial carcinoma
he 24 hour urinary cortisol result here suggests a diagnosis of Cushing’s syndrome. The co-existant presentation of lung cancer points to paraneoplastic Cushing’s syndrome. The vast majority of paraneoplastic syndromes seen in lung cancer are caused by small cell bronchial carcinoma, a neuroendocrine tumour which can secrete a variety of hormones or antibodies.
A 65-year-old man with advanced lung cancer is admitted to hospital via his GP following an abnormal blood test which showed the following:
Na 118 mmol/l
Which type of lung cancer can cause this specific electrolyte disturbance?
adenocarcinoma
squamous cell carcinoma
small cell carcinoma
large cell cancer
small cell cancer
SIADH is a paraneoplastic feature of small-cell lung cancer
persistent hoarseness in voice in a smoker should raise suspicion of both?
lung and laryngeal cancer - refer to resp and ENT urgently
A 62-year-old man who is investigated for haemoptysis is found to have squamous cell lung cancer. Which one of the following is a contraindication to surgery?
continued smoking SVC obstruction haemoptysis hypercalcaemia enlarged mediastinal lymph nodes
SVC obstruction
Contraindications to lung cancer surgery include
SVC obstruction,
FEV < 1.5,
MALIGNANT pleural effusion, and vocal cord paralysis
A 62-year-old female with a 40 pack year history of smoking is investigated for a chronic cough associated with haemoptysis. Bronchoscopy reveals a 4 cm tumour confined to the right main bronchus. A biopsy taken shows small cell lung cancer (SCLC). Extensive staging investigations only show evidence of nodal involvement in the ipsilateral peribronchial nodes, giving a TNM grading of T2, N1, M0. What is the most appropriate management?
laser therapy
chemo + radiotherapy
surgery
radiotherapy
chemo + radiotherapy
Surgery plays little role in the management of small cell lung cancer, with chemotherapy being the mainstay of treatment. Adjuvant radiotherapy is also now given in patients with limited disease.
Having said that recent studies have supported a role for surgery in patients with very early stage disease (e.g. T1, N0, M0).
in small cell lung cancers = patients can get muscle weakness in arms and legs due to a paraneoplastic syndrome called?
Lambert Eaton Syndrome
