Lung cancer

Question 1

What are the main types of non-small cell lung cancer?

Answer 1

squamous cell carcinoma

adenocarcinoma

Question 2

Describe small cell lung cancer

Answer 2

Small cell lung cancer cells contain neurosecretory granules that can release neuroendocrine hormones. Responsible for multiple paraneoplastic syndromes

Question 3

What are the signs and symptoms of lung cancer?

Answer 3

Shortness of breath 
cough
haemoptysis
finger clubbing
recurrent pneumonia 
weight loss
lymphadenopathy

Question 4

What are the main investigations for lung cancer?

Answer 4

Chest Xray
Staging CT scan
PET=CT
Bronchoscopy with EBUS
Histological diagnosis

Question 5

What are the findings on an X-ray which may suggest lung cancer?

Answer 5

Hilar enlargement
Peripheral opacity
Pleural effusion (usually unilateral)
Collapse

Question 6

Describe recurrent laryngeal nerve palsy in lung cancer

Answer 6

presents with a hoarse voice

Cancer presses on nerve as it passes through the mediastinum

Question 7

Describe phrenic nerve palsy in lung cancer

Answer 7

Due to nerve compression

causes diaphragm weakness and presents as shortness of breath

Question 8

Describe superior vena cava obstruction in lung cancer

Answer 8

caused by direct compression of the tumour

presents with facial swelling, difficulty breathing and distended veins in the neck and upper chest

Question 9

Describe Pemberton’s sign

Answer 9

Vena cava obstruction

where raising the hands over the head causes facial congestion and cyanosis. Medical emergency

Question 10

Describe Horner’s syndrome

Answer 10

A triad of partial ptosis, anhidrosis ans moisis

Caused by a pancoast tumour pressing on the sympathetic ganglion

Question 11

Describe SIADH in lung cancer

Answer 11

Caused by ectopic ADH secretion by small cell lung cancer and presents with hyponatraemia

Question 12

Describe Cushing’s syndrome in lung cancer

Answer 12

Can be caused by ectopic ACTH secretion by a small cell lung cancer

Question 13

Descrive hypercalcaemia in lung cancer

Answer 13

caused by ectopic ACTH secretion by squamous cell lung cancer

Question 14

Describe limbic encephalitis in lung cancer

Answer 14

Paraneoplastic syndrome were the small cell lung cancer causes the immune system to make antibodies to tissue in the brain, specifically in the limbic system causing inflammation
Causes short term memory impairment, hallucinations, confusion and seizures
Associated with anti-Hu antibodies

Question 15

Describe what causes Lambert-Eaton Myasthenic syndrome

Answer 15

A result of antibodies produced by the immune system against small cell lung cancer cells. These antibodies also target and damage voltage-gated calcium channels sited of the presynaptic terminals in motor neurones

Question 16

What are the effects of Lambert-Eaton syndrome?

Answer 16

Weakness, particularly in the proximal muscles but can also affect the intraocular muscles causing diploma, ptosis and slurred speech and dysphagia

Question 17

Describe mesothelioma

Answer 17

Affects the mesothelial cells of the pleura. It is strongly linked to asbestos inhalation. There is a huge latent period of up to 45 years. The prognosis is very poor. Palliative chemo is usually the only option