Lung Cancer

Question 1

what is lung cancer

Answer 1

malignant growth, uncontrolled replication, pleural neoplasm

Question 2

what is mesothelioma

Answer 2

primary malignant neoplasm

Question 3

what are the 4 main types of lung cancer (smoking associated)

Answer 3

adenocarcinoma
squamous carcinoma (kertiinisign)
small cell
large cell

Question 4

what is the most common type of lung cancer in non-smokers and overall most common

Answer 4

adenocarcinoma

Question 5

what is adenocarcinoma lung cancer

Answer 5

cancer of mucus-secreting glands

Question 6

what is a peripheral adenocarcinoma

Answer 6

• Atypical adenomatous hyperplasia
• Neoplastic cell spread along alveolar walls (bronchioloalveolar carcinoma)
• True invasive

Question 7

in adenocarcinoma is metastases common

Answer 7

yes

to lymph nodes, pleura, brain, bones, adrenals

Question 8

what is squamous carcinoma

Answer 8

• From epithelial cells associated with keratin production

- causes obrsuting lesion s of bronchus with post-obstructive infection

Question 9

how does metastases differ in adenocarcinoma to squamous carcinoma

Answer 9

in adenocarcinoma metastases common in squamous carcinoma spread is local then metastases occurs late on

Question 10

cavities with central necrosis is an example of

Answer 10

squamous carcinoma

Question 11

what is small cell lung cancer

Answer 11

from neuroendocrine cells (APUD)

- often secrete polypeptide hormones

Question 12

a central tumour that has early metastases is likely to be what type of cancer

Answer 12

small cell

Question 13

a poorly differentiated lung cancer that metastases early is likely to be

Answer 13

large cell

Question 14

what is a neuroendocrine tumour with low grade malignancy

Answer 14

carcinoid

Question 15

what is the tumour in salivary glands

Answer 15

bronchial gland tumour

eg. adenoid cystic carcinoma, mucoepidermoid carcinoma

Question 16

2 types of large cell lung cancer

Answer 16

large cell neuroendocrine

large cell carcinoma

Question 17

what percentage of smokers die of lung cancer

Answer 17

20%

Question 18

what people are at highest risk of lung cancer

Answer 18

smokers/ex-smokers
- chronic bronchitis
passive smokers

Question 19

TB is a risk factor of lung cancer - True or False

Answer 19

FALSE

Question 20

what are the risk factors of lung cancer

Answer 20

asbestos, nickel, chromates, radiation, pollution, genetics, HIV, (interstitial) pulmonary fibrosis, bronchioalveolar adenoma, lipoid pneumonia, previous lung cancer

Question 21

what is synchronous lung cancer

Answer 21

tumours occurring at same time

Question 22

what is metachonous lung cancer

Answer 22

one tumour after another

Question 23

how does a pancoast tumour present

Answer 23

apex of lung
invades brachial plexus
C8/T1 palsy
nerve compression

Question 24

in severe cases what can a pan coast tumour cause

Answer 24

Horner’s syndrome

Question 25

what is horners syndrome and what are the features

Answer 25

compression of sympathetic chain | miosis, ptosis, anhidrosis

Question 26

muscle wasting in hand, weakness and pain down the arm can be a sign of

Answer 26

pan coast tumour

Question 27

what local invasion can occur as a result of lung cancer

Answer 27

``` recurrent laryngeal nerve pericardium brachial plexus oesophagus pleural cavity ```

Question 28

what do patients with local invasion of the pericardium present with

Answer 28

``` malignant dysrhythmia breathlessness atrial fibrillation pericardial effusion phrenic nerce damage ```

Question 29

what does invasion of recurrent laryngeal nerve cause

Answer 29

coarse voice as vocal cords paralysed

Question 30

what is the presentation of tracheal tumours

Answer 30

progressive dyspnea stridor flow volume curve: dramatic reduction in inspiratory flow

Question 31

a patent presents with wasting hand muscles and T1 root infiltration where has he tumour invaded

Answer 31

brachial plexus

Question 32

a patient presents with dysphagia, cannot swallow meat/bread and is losing weight were might have the tumour invaded

Answer 32

oesophagus

Question 33

what is the result of a tumour invading the pleural cavity

Answer 33

pleural effusion | breathlessness (obstruction) by central tumours occulting large airways

Question 34

a patient presents with puffy eyelids, distention of superficial veins over neck and chest and normal pulsation loss what has the primary tumour invaded

Answer 34

superior vena cava, obstructive drainage of blood from head and neck

Question 35

if a primary tumour obstructs the airways what disease can arise

Answer 35

pneumonia

Question 36

a patient presents with sharp pleuritic pain where has the tumour invaded

Answer 36

peripheral tumours invade wall or pleura which are well innervated

Question 37

what is the sign of large volume mediastinal node disease

Answer 37

dull central chest ache

Question 38

what does tumour invasion of the phrenic nerve cause

Answer 38

paralysis of ipsilateral hemidigphragm

Question 39

where can secondary lung cancer metastasise to

Answer 39

mediastinal, cerical, axillary, intra-abdominal nodes blood serous cavities

Question 40

what does primary lung cancer in the liver present as

Answer 40

obstructive jaundice weigh loss nausea right upper quadrant pain radiating across abdomen (liver capsular pain)

Question 41

how do cerebral metastases present

Answer 41

insidious onset - weakness (like stoke) - visual disturbance - headache (worse in morning, generalised, not photophobic, rinsed intracranial pressure) - seizures - cranial nerve defects - meningitis (uncommon)

Question 42

where does lung cancer commonly metastasise to

Answer 42

adrenals asymptomatic must be scanned

Question 43

how does cancer present in bone

Answer 43

localised pain, worse at night pathological fracture spine compressed (URGENT)

Question 44

what are the symptoms of lung cancer

Answer 44

``` haemoptysis stridor recurrent pneumonia in same part of lung long standing chest infection weight loss chest/shoulder pain fatigue horse voice >3 week cough breathlessness finger clubbing ```

Question 45

what is stridor

Answer 45

wheeze on inspiration (partial obstruction of airways by tumour) difficulty breathing in

Question 46

why do some lung cancer patients have a horse voice

Answer 46

mediastinal nodal/direct tumour invasion of mediastinum | compression of left recurrent laryngeal nerve

Question 47

what do smokers with lung cancer present with

Answer 47

no longer coughing up clear sputum distortion of normal bronchial mucosa by tumour cannot bring up sputum anymore

Question 48

what are the non-metastatic extra pulmonary manifestations of lung cancer

Answer 48

normocytic anaemia paraneoplastic features tumour cells that mimic effects of naturally occurring hormones

Question 49

what type of cancer do patients have if they present with hypercalcaemia (high calcium)

Answer 49

squamous cells cancer | tumour produces proteins miminicing effects of parathyroid hormone so parathyroid hormone switched on to produce calcium

Question 50

what do patients with hyercalcaemia present with

Answer 50

``` headache, thirst, constipation stones bones gorans thrones psychiatric overtones cardiac arrhythmias ```

Question 51

what ectopic hormone production occurs in cancer

Answer 51

PTH - squamous cell ACTH - small cell paraneoplastic syndromes caused by small cell tumours

Question 52

what is HPOA

Answer 52

hypertrophic pulmonary osteoarthropathy - bone abnormality - periosteum lifts off and enlarges - pain down legs and shins

Question 53

what is hyponatraemic - SIADH

Answer 53

``` production of a substance mimicking ADH (anti diuretic hormone) causes water retention low sodium concentration (<120) nausea myclonus lethargy seizures ```