Lung Cancer

Question 1

Cancer Features

Answer 1

malignant growth
uncontrolled replication
local invasion
metastasis - secondary cancer 
=lymphatic spread
=blood stream
=serous cavities
non-metastatic systemic effects

Question 2

Lung cancer presentation

Answer 2

primary tumour
local invasion
metastases
non-metastatic
(paraneoplastic)

Question 3

detect cancer early

Answer 3

cough 3 weeks or more
breathless no reason
chest infection = doesn't clear up
haemoptysis
chest or shoulder pains
unexplained tiredness/ lack of energy
hoarse voice

Question 4

haemoptysis

Answer 4

fresh haemorrhage from tumour –> ulcerating through surface

direct consequence of primary tumour

Question 5

is the smaller or larger lung normally the diseased one?

Answer 5

smaller

Question 6

stridor

Answer 6

distressing symptom
difficulty breathing in
accompanied = coarse audible wheeze during inspiration

Question 7

short of breath

Answer 7

tumour blocking carina

Question 8

local invasion

Answer 8

recurrent laryngeal nerve
pericardium
oesophagus
brachial plexus
pleural cavity
superior vena cava

Question 9

hoarse voice

Answer 9

contact with vocal cord/ pharynx

Question 10

local invasion pericardium

Answer 10

breathless
atrial fibrillation
pericardial effusion

Question 11

local invasion oesophagus

Answer 11

dysphagia

Question 12

pancoast tumour can cause

Answer 12

brachial plexus invasion

Question 13

pleural effusion

Answer 13

large volume of pleural fluid accumulates

Question 14

local invasion of superior vena cave =

Answer 14

obstructs drainage of blood from arm + head

puffy eye lids + headache

Question 15

local invasion of superior vena cava symptoms palliated

Answer 15

insertion of a stent to open occluded vein

must be done before vein = permanently occluded by thrombosis

Question 16

chest wall invasion by lung cancer

Answer 16

localised chest wall pain
worse with movement
bone erosion
pain = worse at night

Question 17

result of tumour eroding artery + into major bronchus =

Answer 17

sudden death due to massive haemoptysis

Question 18

common sites for metastases

Answer 18

liver
brain
bone
adrenal
skin
lung

Question 19

cerebral metastases

Answer 19

insidious onset
weakness
visual disturbance
headaches 
-worse in morning
-not photophobic
fits

Question 20

short term cerebal metastases treatment

Answer 20

high dose corticosteroid therapy

e.g. dexamethasone = improve short term symptoms by removing oedema

Question 21

high dose corticosteroid therapy disadvantage

Answer 21

benefit = shortlived

Question 22

liver metasases

Answer 22

liver function tests = usually abnormal (particularly Alkaline phosphatase)

Question 23

bone metastases

Answer 23

localised pain worse at night

pathological fracture - bone fracture = follows mechanical stress

Question 24

non-metastatic: paaneoplastic

Answer 24

finger clubbing
hypertrophic pulmonary osteoarthropathy - HPOA
weight loss
thrombophlebitis
hypercalcaemia
hyponatraemia - SIADH
weakness - eaton lambert syndrome

Question 25

new finger clubbing

Answer 25

chest X ray = . must

Question 26

diseases causing finger clubbing

Answer 26

lung cancer
liver disease, especially chronic hepatitis C
congenital cyanotic heart disease 
bacterial endocarditis
bronchiectasis

Question 27

thrombophelbitis

Answer 27

an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs

Question 28

hypercalcaemia

Answer 28

stones (renal/biliary calculi)

bones (bone pain)

groans (abdominal pain, constipation, N +V)

thrones (polyuria)

psychiatric overtones (depression, anxiety, reduced GCS, coma)

cardiac arrhythmias

Question 29

hypercalcaemia treatment

Answer 29

initial = rehydration
calcium = very high on admission (>4)/ not correct with fluid —–> IV bisphosphonate
treat underlying cancer = usually squamous

Question 30

SIADH

syndrome of inappropriate antidiuretic hormone

Answer 30

small cell
complex
low Na concn
non specific symptoms
-nausea
-myoclonus
-lethargy/confusion
-seizures/coma

Question 31

SIADH Treatment

Answer 31

treat underlying cause
fluid restriction - 1.5L/day
sometimes = demecloycline

Question 32

lung cancer history

Answer 32

cough
haemoptysis
cigarette smoker
breathless
weight loss
chest wall pain
tiredness
recurrent infection
other smoking related disease
anything else = worried about

Question 33

chronic bronchitis

Answer 33

clear sputum every morning

Question 34

lung cancer cough

Answer 34

distortion of normal bronchial mucosa by tumour

cannot get sputum out

Question 35

breathlessness in lung cancer

Answer 35

obstruction of major branch of bronchial tree by tumour

Question 36

causes of SOB

Answer 36

pleural effusion
pulmonary emboli
pericardial invasion

Question 37

lung cancer examination

Answer 37

finger clubbing
breathless
cough
weight loss
bloated face
hoarse voice
lymphadenopathy
tracheal deviation
dull percussion
stridor
enlarged liver

Question 38

lung cancer investigations

Answer 38

full blood count
coagulation screen
Na, K, Ca, Alk Phos
spirometry FEV1
chest X ray
CT scan of thorax
PET scan
bronchoscopy
endobronchial ultrasound
NOT sputum cytology

Question 39

positron emission tomography

Answer 39

scan = assess function not structure
tissue uptake of radiolabelled glucose
tissues = high metabolic activity = light up

Question 40

lung cancer tissue diagnosis

Answer 40

bronchoscopy
CT guided biopsy
lymph node aspirate
aspiration of pleural fluid
endobronchial ultrasound
thoracoscopy

Question 41

lung cancer differential diagnosis

Answer 41

clinical picture

• smoker
• haemoptysis
• abnormal chest X-ray

Question 42

differential diagnosis possible causes

Answer 42

lung cancer
Tb
vasculitis
pulmonary embolism
secondary cancer
lymphoma
bronchiectasis