Lung Cancer

Question 1

Why does lung cancer sometimes cause hoarseness?

Answer 1

Invasion of the left recurrent laryngeal nerve

Tumour likely in the mediastinum

Question 2

What is stridor and how does lung cancer cause it?

Answer 2

Wheeze on inspiration
Tumour obstructing the carina
(if within 2cm of carina, surgery not possible)

Question 3

What happens if the tumour obstructs the SVC?

Answer 3

Obstructs drainage of blood from arms and head:

• puffy eyelids
• headache
• distended veins
• anastomoses may develop
• malar flush

Question 4

What type of tumour can effect the brachial plexus?

Answer 4

Pancoast tumour (apex)

Question 5

What is Horner’s syndrome and how can it occur in lung cancer?

Answer 5

Pancoast tumour (in lung apex)

• Miosis
• Ptosis
• Anhydrosis

Question 6

Which two electrolyte imbalances are seen in lung cancer and why do they present?

Answer 6

Hypercalcaemia –> Squamous cell cancer produces substance which mimics effect of parathyroid hormone
Hyponatraemia –> small cell cancer produces substance which mimics ADH (plasma sodium <120)

Question 7

What are the symptoms of hypercalcaemia?

Answer 7

headaches
confusion
thirst
constipation

Question 8

What are the symptoms of hyponatraemia?

Answer 8

confusion
nausea and vomiting
headache

Question 9

What is Eaton Lambert syndrome?

Answer 9

mimics myasthenia gravis –> muscles become weak

Question 10

What is hypertrophic pulmonary osteoarthropathy?

Answer 10

Expansion of the top layer of bone

Pain and tenderness of long bones

Question 11

What are common sites for lung cancer to metastasise to?

Answer 11

Liver
Bone
Brain
Adrenal gland
Skin
Lung

Question 12

What are the 4 different types of lung cancer?

Answer 12

Adenocarcinoma (35%)
Squamous cell carcinoma (30%)
Small cell lung cancer (25%) *worst prognosis
Large cell lung cancer (10%)

Question 13

What are the features of adenocarcinoma?

• where are the tumours?
• who does it affect?
• what is the immunohistology?

Answer 13

Peripheral lung tumours
Non-smokers
Expresses TTF (thyroid transcription factor) 1

Question 14

What are the features of squamous cell carcinoma?

Answer 14

Cavitating
Central
HyperCalcaemia (PTH secretion)

Expresses nuclear antigen p63 and keratin pearls

Question 15

Which type of cancer is neuroendocrine and in what way?

Answer 15

Small cell tumours

• produces ACTH –> cushings
• produces ADH –> SIADH

Question 16

Which type of lung cancer responds best to chemotherapy?

Answer 16

Small cell lung cancer

Question 17

Which structures should be included in CT to stage disease?

Answer 17

CT chest including liver, adrenals and lower neck

Question 18

What are the features of mesothelioma on CXR?

Answer 18

Pleural plaques

Honeycombing

Question 19

What are the side effects of chemotherapy?

Answer 19

Nausea
Bone marrow suppression (infections/anaemia)
Hair loss
Pulmonary fibrosis

Question 20

What are the side effects of radiotherapy for lung cancer?

Answer 20

Temporary oesophagitis

Fibrosis of normal lung tissue

Question 21

Which nerves are implicated in Horner’s syndrome?

Answer 21

Sympathetic trunk/chain