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 ```