Lung cancers

Question 1

Give 6 risk factors for carcinoma of the bronchus

Answer 1

Smoking
Family history
Asbestos
Pollution
Radon exposure
IPF

Question 2

What percentage of lung cancers are small cell lung cancer?

Answer 2

15%

Question 3

Give 2 types of lung cancer that tend produce central lesions

Answer 3

Small cell lung cancer

Squamous cell lung cancer

Question 4

Give 2 hormones that tend to be produced by small cell lung cancers

Answer 4

ADH

ACTH

Question 5

Give 4 paraneoplastic syndromes associated with small cell lung cancer

Answer 5

SIADH
Cushing’s syndome
Lamber-Eaton myasthenic syndrome
Paraneoplastic cerebellar ataxia

Question 6

Give 2 paraneoplastic syndromes associated with squamous cell lung cancer

Answer 6

Hypertrophic pulmonary osteoarthropathy
Malignant hyperparathyroidism (due to PTHrP)

Question 7

Give 2 paraneoplastic syndromes associated with lung adenocarcinoma

Answer 7

Hypertrophic pulmonary osteoarthropathy

Gynaecomastia

Question 8

Give 2 paraneoplastic syndromes associated with large cell lung cancer

Answer 8

Hypertrophic pulmonary osteoarthropathy

Ectopic beta-HCG secretion causing secondary hyperthyroidism

Question 9

What are the indications for an urgent 2-week referral for suspected lung cancer?

Answer 9

CXR finding suggestive or lung cancer
OR
Over 40 with unexplained haemoptysis

Question 10

What are the indications for an urgent 2-week CXR for suspected lung cancer?

Answer 10

40+ and 2 of the following OR PMH of smoking and 1 of the following:
Fatigue
Chest pain
Dyspnoea
Weight loss
Cough

Question 11

What are the indications for a CT chest/abdomen in suspected lung cancer?

Answer 11

Abnormal CXR
OR
Ongoing symptoms

Question 12

For what lung cancers should percutaneous biopsy be used?

Answer 12

Peripheral cancers with lymph nodes below 10mm

Question 13

For what lung cancers should endobronchial ultrasound biopsy be used?

Answer 13

Central cancers
OR
Peripheral cancers with lymph nodes 10mm and above

Question 14

How is mediastinal lymphadenopathy assessed?

Answer 14

Mediastinoscopy

Question 15

Pneumonectomy is contraindicated if FEV1 is below what level?

Answer 15

2 litres

Question 16

Why can a Pancoast tumour cause voice hoarseness?

Answer 16

Compression of the recurrent laryngeal nerve

Question 17

What is the management for small cell lung cancer (stage T1-T2A)?

Answer 17

Surgery

Question 18

What is the management for small cell lung cancer (stage T2B+)?

Answer 18

Chemoradiotherapy with platinum based agents

Question 19

Give 2 management options for non-small cell lung cancer (stage 3A or below)

Answer 19

Curative surgery

Curative radical radiotherapy plus adjuvant chemotherapy

Question 20

What is the management for non-small cell lung cancer (stage 3B and above)?

Answer 20

Palliative immunotherapy, chemotherapy and radiotherapy

Question 21

Give 4 presenting features of malignant mesothelioma

Answer 21

Chest pain
Weight loss
Dyspnoea
Recurrent/bloody pleural effusions

Question 22

What is the management of malignant mesothelioma?

Answer 22

Palliative chemotherapy with premetrexed and cisplatin

Question 23

Which histological features confirm asbestos exposure?

Answer 23

Pleural plaques and asbestos fibres

Question 24

What are the 2 subtypes of malignant mesothelioma?

Answer 24

Epithelioid and sarcomatoid

Question 25

What is the median survival or malignant mesothelioma?

Answer 25

10 months

Question 26

What is the main risk factor for malignant mesothelioma?

Answer 26

Asbestos exposure