Lung Carcinoma

Question 1

Which organs typically metastasise to the lungs?

Answer 1

• Kidney
• Prostate
• Breast
• Bone
• GI
• Cervix
• Ovary

Question 2

How are lung carcinomas differentiated?

Answer 2

SMALL CELL CARCINOMA (SCC) - 15%

NON-SMALL CELL CARCINOMA (NSCC) - 85%

• Squamous - 42%
• Adenocarcinoma - 40%
• Large cell - 10%

Question 3

Which lung carcinoma are non-smokers most likely to get?

Answer 3

Adenocarcinoma

Question 4

What are the risk factors of lung cancer?

Answer 4

> Smoking (MAIN)
increases risk of lung ca by a factor of 10

Other factors
>asbestos - increases risk of lung ca by a factor of 5
>arsenic
>nickel
>aromatic hydrocarbon
>cryptogenic fibrosing alveolitis

Question 5

What are the symptoms of lung cancer?

Answer 5

>Weight loss
>SOB
>Persistent Cough
>Haemoptysis
>Chest pain
>Fatigue

Question 6

Define small cell carcinoma

Answer 6

> Cancer growth rising from APUD endocrine system and secrete substances that act as hormones or neurotransmitters.

> Fast growing, highly malignant, poor prognosis

Question 7

What is a pancoast tumour?

Answer 7

Usually NSCLC in apex of lung surrounding nearby tissue

Question 8

What are common symptoms of pancoast tumour?

Answer 8

Brachial plexus Invasion

• Small muscle wasting
• Weakness in arm and hand
• Pain down arm

Sympathetic ganglion invasion (HORNER’S)

• Miosis (pupil constriction)
• Anhidrosis (Inability to sweat)
• Ptosis (drooping of eyelid)

Question 9

What are some common signs of lung cancer?

Answer 9

• Clubbing
• Supraclavicular abnormality
• Bone pain/fracture
• Seizures
• Dilated neck/chest veins

Question 10

What is meant by paraneoplastic syndrome?

Answer 10

• These are the non-metastatic distant effects of a cancer
• Due to the excretion of hormones and cytokines form a tumour
• OR the body’s own immune response to the tumour

Usually seen in SMALL CELL

Question 11

What are paraneoplastic features of small cell?

Answer 11

1. Syndrome of inappropriate antidiuretic hormone secretion (SiADH)
   - Excess ADH from posterior pituitary =
   - Hyponatraemia
   - Fluid overload
2. Inappropriate ACTH secretion
   - Leads to Cushing Syndrome features
   - Mainly HTN, hyperglycaemia, hypokalaemia, alkalosis, muscle weakness
3. Lambert-Eaton syndrome
   - Myasthenia due to antibodies affecting the NMJ causing peripheral weakness

Question 12

What are paraneoplastic features of squamous cell (NSCLC)?

Answer 12

1. Parathyroid hormone-related protein release leading to hypercalcaemia
2. Hypertrophic pulmonary osteoarthropathy
   - Clubbing
   - Wrist and ankle joint pain due to inflammation of the periosteum of long bones
3. Hyperthyroidism
   - Due to ectopic TSH

Question 13

What is the paraneoplastic feature of adenocarcinoma?

Answer 13

Gynaecomastia

Question 14

What neurological deficits can any type of lung cancer cause?

Answer 14

• Encephalopathies
• Myelopathies
• Neuropathies
• Muscular disorders - proximal myopathy

Question 15

What are the main investigations for lung cancer?

Answer 15

Bloods

• FBC = anaemia
• Other biochemistry = liver involvement, hypercalcaemia, hyponatraemia

Imaging

• CXR/CT for staging
• PET for staging/mets
• Bone scan for metastatic involvement

Scope
-Bronchoscopy and biopsy = cytology

Question 16

What are CXR features of lung cancer?

Answer 16

Central mass
Hilar lymphadenopathy
Pleural effusions
-Lung collapse
-Mediastinal/hilar fullness

Question 17

How is non-small cell lung carcinoma generally managed?

Answer 17

Surgery

• Only 20% suitable for surgery
• Mediastinoscopy performed prior to surgery as CT does not always show mediastinal lymph node involvement
• Contraindicated if stage IIIb or IV (mets present)

Radiotherapy
-curative or palliative radiotherapy

Chemotherapy
-poor response

Question 18

How is small cell lung carcinoma generally managed?

Answer 18

-Usually metastatic disease by time of diagnosis

Surgery
-Patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery.

Limited disease
-Chemotherapy and radiotherapy

Extensive disease
-Palliative chemotherapy