Lung Cancer

Question 1

Which lung cancer type tends to appear in the periphery, and which as a central tumour?
A) Small Cell Lung cancer
B) Adenocarcinoma
C) Large cell carcinoma
There can be more than 1 answer.

Answer 1

Small cell lung cancer tends to be a more central tumour.

Adenocarcinoma arise from the bronchial mucosal glands and tends to occur in the periphery. Large cell carcinoma presents as a large peripheral mass on CXR.

Question 2

Fill in the blanks:
Does adenocarcinoma have an association with smoking?
Adenocarcinoma can originate in scar tissue, and carries a ___ risk of metastatic spread, often to ____ lymph nodes, and ___, producing an ____.

Answer 2

Adenocarcinoma has less association with smoking, but can originate in scar tissue and carries a high risk of metastatic spread, often to mediastinal LN and pleura, causing an effusion.

Question 3

Dysphagia is especially seen in which cancer type?
A) Adenocarcinoma
B) Large cell carcinoma
C) Small cell lung cancer

Answer 3

C. SCLC, which tends to be a more central tumour.

Question 4

Hoarse voice is a possible presenting complain. What does it suggest?

Answer 4

Hoarse voice suggests invasion of the recurrent laryngeal nerve.

Question 5

Squamous cell lung cancer is more common in smokers/non-smokers?
Adenocarcinoma is more common in smokers/non-smokers?

Answer 5

Squamous cell lung cancer is more common in smokers, Adenocarcinoma is more common in non-smokers.

Question 6

What does having a shoulder pain suggest?

Answer 6

Shoulder pain suggest diaphragm involvement or from brachial plexus involvement.

Question 7

Finger clubbing is seen especially in which lung cancer type?

Answer 7

Non-SCLC - especially in squamous cell lung cancer

Question 8

Describe Pancoast syndrome

Answer 8

Pancoast tumours are aka superior sulcus tumours.
Cause chest wall pain, Horner’s syndrome (Sympathetic nerve obstruction/interruption) and pain in the T1 dermatomal distribution

Horner’s syndrome - miosis, anhydrosis, partial ptosis, enophthalmos.

Question 9

Which type of lung cancer is the most common cause of SVC obstruction?

Answer 9

SCLC

Question 10

Having skin metastases. Which stage of lung cancer is the patient in?

Answer 10

Stage IV - 4.

Metastatic spread everywhere - Stage IV
Metastatic spread to local lymph nodes - Stage III

Question 11

Complications of lung cancer

Answer 11

1. SVC obstruction - often from SCLC
2. Pleural effusion - often by adenocarcinoma
3. Brain metastases
4. Hypercalcaemia - common in squamous cell lung cancer
5. Cushing’s disease or SIADH - common in SCLC
6. Neurological syndromes - Eg. Lambert-Eaton myasthenic syndrome

Question 12

Describe the difference between squamous cell carcinoma and large cell carcinoma in terms of spread and cancer growth rate.

Answer 12

Squamous cell carcinoma tends to grow slowly, spread locally, and disseminates late.
Large cell carcinoma tends to grow rapidly, and metastasise early. They also tend to be poorly differentiated

Question 13

Which type of lung cancer tends to cavitate?

Answer 13

Squamous cell carcinoma tends to cavitate