Lung Neoplasms (Step-Up 2 Med)

Question 1

Lung cancer is divided into what 2 types? How is this differentiation made?

Answer 1

• Small cell lung cancer (25%)
• Non-SCLC (75%)
• Diff must be made via tissue biopsy

Question 2

Which lung cancer has lowest association w/ smoking?

Answer 2

Adenocarcinoma

Question 3

Local manifestations of lung cancer?

Answer 3

• Airway involvement can lead to Cough, Hemoptysis, Obstruction, Wheezing, Dyspnea
• Recurrent pneumonia (postobstructive)

Question 4

Which lung cancer is most commonly ass’d w/ local manifestations/symptoms?

Answer 4

Squamous cell carcinoma

cough, hemoptysis, obstruction, wheezing, dyspnea, recurrent pneumonia

Question 5

Superior Vena Cava Syndrome – which Lung Cancer is most often ass’d & what are the findings?

Answer 5

SCLC

Findings:

• Facial fullness
• Facial & arm edema
• Dilated veins over anterior chest, arms, & face
• JVD

**Occurs in ~5% of patients w/ lung cancer

Question 6

Phrenic Nerve palsy – findings?

Answer 6

Hemidiaphragmatic paralysis
– Phrenic nerve courses through mediastinum to innervate the diaphragm (nerve destroyed by tumor)

**Occurs in ~1% of patients w/ lung cancer

Question 7

Recurrent Laryngeal Nerve palsy – findings?

Answer 7

Voice hoarseness

**Occurs in ~3% of patients w/ lung cancer

Question 8

Local invasion symptoms of lung cancer?

Answer 8

• Malignant Pleural Effusion (10-15%)
• SVC syndrome (5%)
• Phrenic nerve palsy (1%)
• Recurrent Laryngeal Nerve palsy (3%)
• Horner’s Syndrome
• Pancoast’s tumor

Question 9

Most common local invasion symptom in lung cancer?

Answer 9

Malignant Pleural Effusion – occurs in 10-15% of patients w/ lung cancer
– Prognosis is very poor – equivalent to distant metastases

Question 10

Pancoast’s Tumor – what is it? Which lung cancer is it ass’d w/?

Answer 10

Superior Sulcus Tumor – an apical tumor involving C8 & T1-T2 nerve roots, causing shoulder pain radiating down the arm

– Usually Squamous cell cancers

Question 11

Pancoast’s Tumor – Sx?

Answer 11

• Pain
• UE weakness 2/2 brachial plexus invasion
• Ass’d w/ Horner’s Syndrome ~60% of the time

Question 12

SCLC – paraneoplastic syndromes ass’d?

Answer 12

• SIADH (10% SCLC patients)
• Ectopic ACTH secretion
• Eaton-Lambert Syndrome (proximal muscle weakness/fatigability, diminished DTRs, paresthesias – usually in LEs)

Question 13

Squamous Cell Carcinoma – paraneoplastic syndromes ass’d?

Answer 13

• PTH-like hormone secretion

- Hypertrophic Pulmonary Osteoarthropathy (also Adenocarcinoma)

Question 14

Hypertrophic Pulmonary Osteoarthropathy – Sx & cancers it is ass’d w/?

Answer 14

• Severe long bone pain

- Squamous cell carcinoma & Adenocarcinoma

Question 15

SCLC – prognosis?

Answer 15

Limited disease: 5-year survival = 10-13%

Extensive disease: 5-year survival = 1-2%

**85% of patients have extensive disease @ time of diagnosis