Lung Cancer

Question 1

What is lung cancer?

Answer 1

primary malignant neoplasm of the lung

Question 2

Describe the WHO classification of bronchocarcinoma

Answer 2

Small Cell Lung Cancer: 20%

Non-Small Cell Lung Cancer: 80%

Question 3

Which type of bronchocarcinoa has the worse prognosis?

Answer 3

Small cell

3 month median survival

Question 4

How do small cell and non small cell differ?

Answer 4

SC: made up of small cells that divide + spread rapidly
NSC: Divide + spread slowly

Question 5

List 4 risk factors for lung cancer

Answer 5

Smoking
Asbestos exposure
Occupational: Polycyclic hydrocarbons, nickel, radon, chromium, arsenic, iron oxides
Atmospheric pollution

Question 6

Describe the epidemiology of lung cancer

Answer 6

Most common FATAL cancer in the west (18% of cancer mortality worldwide)
M > F

Question 7

List 5 symptoms due to the primary tumour in lung cancer

Answer 7

Cough 
Haemoptysis 
Chest pain 
Dyspnoea
Recurrent pneumonia

Question 8

List 5 symptoms due to local invasion in lung cancer

Answer 8

Brachial plexus invasion: shoulder/arm pain
Left recurrent laryngeal nerve invasion: hoarse voice + bovine cough
Dysphagia
Arrhythmias
Horner’s syndrome

Question 9

List 4 symptoms due to metastatic disease or paraneoplastic phenomenon in lung cancer

Answer 9

Weight loss
Fatigue
Fractures
Bone pain

Question 10

List 7 signs of lung cancer

Answer 10

Fixed monophonic wheeze (suggests single obstruction)
Signs of lobar collapse or pleural effusion
Signs of mets (e.g. supraclavicular lymphadenopathy, hepatomegaly, bone tenderness)
Cachexia
Anaemia
Clubbing (NSCC)
Hypertrophic pulmonary osteoarthropathy

Question 11

What is the first line investigation for lung cancer? What is seen?

Answer 11

CXR 
Nodules
Hilar enlargement
Consolidation
Lung collapse
Pleural effusion 
Bony secondaries
Coin shaped lesions

Question 12

What is seen on sputum and pleural fluid cytology in lung cancer? List 3 sources of this

Answer 12

Malignant cells

Broncholavage, FNA, sputum

Question 13

List 3 investigations that may be considered in lung cancer

Answer 13

Bronchoscopy: histology
CT/US-guided percutaneous biopsy
Lymph node biopsy

Question 14

What is used for staging in lung cancer?

Answer 14

PET CT

Question 15

Describe bloods in lung cancer

Answer 15

FBC (normal/ anaemic)
Calcium (hypercalcaemia common)
ALP (raised with bone mets)

Question 16

Which form of lung cancer is almost always seen in smokers? Where is the tumour usually located?

Answer 16

Small cell carcinoma

Central

Question 17

Which form of lung cancer is common in women and non smokers? Where is the tumour usually located in the lung?

Answer 17

Adenocarcinoma

Peripheral

Question 18

Give 2 features of squamous cell carcinomas

Answer 18

PTHrp release: Hypercalcaemia

Cavitating lesion on CXR

Question 19

Which is the least common type of non small cell carcinoma?

Answer 19

Large cell carcinoma