Malignancy

Question 1

What is the biggest risk factor for lung cancer?

Answer 1

Cigarette smoking

Question 2

Describe the different histological types of lung cancer

Answer 2

1) Non-small cell lung cancer (NSCLC)
- 80% of cases
- Further subdivided into adenocarcinoma and squamous cell carcinoma

2) Small cell lung cancer (SCLC)
- 20% of cases

Question 3

Describe the clinical features of lung cancer

Answer 3

• Cough
• Haemoptysis
• ‘Typical’ cancer symptoms: weight loss, fever/night sweats
• Lymphadenopathy (supraclavicular nodes)
• Clubbing
• Various extrapulmonary manifestations and paraneoplastic syndromes

Question 4

Describe the investigation of suspected lung cancer

Answer 4

• CXR is first line
• Staging CT (chest, abdomen, pelvis)
• Bronchoscopy
• Biopsy

Question 5

Describe the management of lung cancer

Answer 5

• Surgery, e.g. lobectomy, wedge resection
• Radiotherapy
• Chemotherapy (adjuvant vs. palliative)

Question 6

NSCLC vs. SCLC - which has the poorer prognosis?

Answer 6

Small cell lung cancer (SCLC)

Question 7

a) What is meant by a ‘paraneoplastic syndrome’?

b) Which type of lung malignancy is responsible for many paraneoplastic syndromes?

Answer 7

a) A group of signs/symptoms caused by a substance that is produced by a tumour or in response to a tumour
b) SCLC

Question 8

Give some examples of paraneoplastic syndromes caused by lung malignancy

Answer 8

• SIADH (ectopic ADH secreted by SCLC)
• Cushing’s syndrome (ectopic ACTH secreted by SCLC)
• Hypercalcaemia (ectopic PTH secreted by squamous cell carcinoma)

Question 9

What is mesothelioma?

Answer 9

Lung malignancy affecting the mesothelial cells of the pleura

Question 10

Mesothelioma is strongly linked to…

Answer 10

Asbestos inhalation

Question 11

Describe the management and prognosis of mesothelioma

Answer 11

Prognosis is poor:

• Symptomatic treatment
• Palliative care

Question 11

What are the clinical features of Horner’s syndrome?

Answer 11

Unilateral:

• Ptosis
• Miosis (pupil constriction)
• Anhidrosis (lack of sweating)

Question 12

Describe some of the extrapulmonary manifestations of lung malignancy

Answer 12

• Recurrent laryngeal nerve palsy = hoarse voice (compression of recurrent laryngeal nerve by tumour)
• Horner’s syndrome (compression of sympathetic ganglion by a tumour)

Question 13

What is the name of the lung tumour which typically causes Horner’s syndrome? Where is this tumour located?

Answer 13

Pancoast tumour (apical lung tumour)

Question 14

Which type of lung cancer is associated with gynaecomastia?

Answer 14

Adenocarcinoma (a type of NSCLC)

Question 15

What is the most common form of asbestos-related lung disease?

Is this malignant?

Answer 15

Pleural plaques

No - these are benign and do not undergo malignant transformation, therefore this does not require follow up