Lung Tumours

Question 1

Lung carcinoma RFs

Answer 1

Smoking (90%)
Asbestos
Arsenic
Radiation

Question 2

Lung carcinoma types

Answer 2

Small cell (from endocrine Kulchitsky cells, paraneoplastic syndroms due to hormone secretion) mostly disseminated at presentation
Non-small cell (35% squamous, 27% adenocarcinoma)

Question 3

Lung carcinoma symptoms

Answer 3

Cough
Haemoptysis

Dyspnoea
Chest pain

Recurrent pneumonia

Lethargy
Anorexia
Weight loss

Question 4

Lung carcinoma signs

Answer 4

Anaemia signs
Clubbing
Supraclavicular/ axillary lymphadenopathy
Pleural effusion

Question 5

Lung carcinoma complications

Answer 5

Recurrent laryngeal/ phrenic n. palsy
SVC obstruction
AF
Mets to brain, bone, liver, adrenals

Question 6

Lung carcinoma tests

Answer 6

CXR shows peripheral nodule, hilar enlargement, consolidation and pleural effusion
PET-CT before curative intent surgery

CEA is biomarker

Cytology of sputum + pleural fluid
Fine needle aspiration/ biopsy to stage and guide bronchoscopy
Bronchoscopy for histology

Lung FTs for lobectomy suitability

Question 7

Bronchial adenoma features

Answer 7

Rare, slow-growing
90% are carcinoid
Treat with surgery

Question 8

Hamartoma features

Answer 8

Rare, benign
CT shows lobulated mass with calcification flecks
Excise to exclude malignancy

Question 9

What is malignant mesothelioma

Answer 9

Mesothelial cell tumour in pleura, rarely in peritoneum

Associated with asbestos, 45yr delay from exposure to presentation

Question 10

Malignant mesothelioma clinical features

Answer 10

Chest pain
Dyspnoea
Weight loss
Recurrent pleural effusions
Lymphadenopathy

Question 11

Malignant mesothelioma tests

Answer 11

CXR/CT shows pleural thickening/effusion
Bloody pleural fluid
Histological following thoracoscopy

Question 12

Malignant mesothelioma management

Answer 12

Pemetrexed + cisplatin chemo

Pleurodesis and indwelling intra-pleural drain helps

Question 13

Malignant mesothelioma prognosis

Answer 13

Poor (especially without pemetrexed), <2yrs

Question 14

NSCLC treatment

Answer 14

Lobectomy if medically fit, parenchymal sparing operation for borderline fitness/smaller tumours
Radical radiotherapy for stages I-III
Chemo ± radio for more advanced (platinum based with cetuximab)

Question 15

SCLC treatment

Answer 15

Surgery with limited disease
Chemo ± radio if well enough

Palliation includes radiotherapy for bronchial/SVC obstruction and mets
SVC stent + radiotherapy + dexamethasone for SVC obstruction

Pleural drain/ pleurodesis for symptomatic pleural effusions

Analgesia, steroids, anti-emetics, bronchodilators, anti-depressants

Question 16

NSCLC prognosis

Answer 16

50% 2yr survival without spread, 10% with spread

Question 17

SCLC prognosis

Answer 17

3mths if untreated, 1-1.5 if treated