Lung Cancer

Question 1

Stridor can be caused by lung cancer and is a distressing symptom of difficulty ____1_____. It is usually accompanied by a coarse audible ____2___ during inspiration. Almost all other forms of airways disease (asthma & COPD) produce an ____3____

Answer 1

1 breathing in
2 wheeze
3 expiratory wheeze and have difficulty breathing out

Question 2

Recurrent what could be a symptom of lung cancer?

Answer 2

Recurrent pneumonia

Question 3

6 common sites for lung metastases?

Answer 3

• Liver
• Brain
• Bone
• Adrenal
• Skin (less so)
• Lung

Question 4

7 para-neoplastic symptoms of lung cancer?

Answer 4

• Finger clubbing
• Hypertrophic pulmonary osteoarthropathy – HPOA (Pretty rare). The lining of the bone lifts off (periosteum), pain in legs down shins.
• Weight loss- but this happens with all cancers and for other reasons.
• Thrombophlebitis (pretty rare), superficial veins inflamed with blood clots in them.
• Hypercalcaemia- increased calcium
• Hyponatraemia – Results in low Na concentrations.
• Weakness - Eaton Lambert syndrome\

Question 5

Adenocarcinomas generally arise in the _______ of the lung from _______ tissue, they are the most common lung cancer in ____________

Answer 5

Periphery
glandular
non-smokers

Question 6

Small cell carcinomas generally arise in the _______ from ________ they are the most ______ form of lung cancer but initially responds to ___________

Answer 6

centre of the lung
immature neuroendocrine cells
aggressive
chemotherapy

Question 7

Describe large cell carcinoma

Answer 7

Consists of large malignant cells without any specific differentiation. This is therefore a diagnosis of exclusion. The tumour usually arises centrally.

Question 8

Squamous cell carcinoma generally arises in the ________ from __________ They are the most ________ type of lung cancer

Answer 8

Centre in major bronchi
dysplastic squamous epithelium following squamous metaplasia
common

Question 9

What is the best treatment option for cure of lung cancer?

Answer 9

Surgery

Question 10

When is surgery not a good treatment option for lung cancer?

Answer 10

• If spread to vocal cords
• 2cm to carina can’t do surgery as can’t tie off lungs
• Cell type- won’t do it if small type
• Won’t do if they have metastases

Question 11

What does radical therapy mean?

Answer 11

The therapy is curative

Question 12

Chemotherapy is usually used when the cancer _____1_____ and has best results in _____2____

Answer 12

has already spread

small cell

Question 13

What are potential problems with radiotherapy?

Answer 13

• Can be collateral damage from hitting tissues around the cancer
• Have to treat adjacent lung tissue too as lungs and tumour move up and down as you breathe

Question 14

What is horner’s syndrome?

Answer 14

Can be caused by lung cancer tumour and is an interruption in the sympathetic chain affecting the innervation of the face including ptosis (droopy eyelid), anhydrous (lack of sweating) and miosis (constricted pupil)
ALL ON ONE SIDE OF THE FACE

Question 15

What is a pancoast tumour and what are potential affects?

Answer 15

APICAL LUNG TUMOUR (can be any type)

• invasion of the brachial plexus causing tingling, numbness and weakness in the arm
• invasion of sympathetic chain causing Horner’s syndrome
• invasion of the SVC causing puffy face, distended EJV and formation of collateral veins to the IVC in the abdomen
• Invasion of the recurrent laryngeal nerve causing a persistently hoarse voice