Neoplasia

Question 1

What are the causes of lung cancer?

Answer 1

Smoking (85%)
Asbestos
Environmental radon
Air pollution
Pulmonary fibrosis

Question 2

What are the types of tumours of the lungs?

Answer 2

Carcinomas
Lymphoma
Sarcoma
Metastases

Question 3

What are the 2 types of lung carcinomas?

Answer 3

Small cell lung cancer 15%
Non-small cell lung cancer 85%

Question 4

What is the distribution of SCLC?

Answer 4

Central

Question 5

What are the types of NSCLC?

Answer 5

Squamous cell (central)
Adenocarcinoma (peripheral)
Large cell carcinoma (peripheral)

Question 6

Mutations in what genes can cause adenocarcinomas?

Answer 6

EGFR
KRAS
HER2
BRAF

Question 7

What are the local symptoms of lung cancer?

Answer 7

Cough
SoB
Pneumonia
Chest infections

Question 8

What are the constitutional symptoms of lung cancer?

Answer 8

Fever
Weight loss
Fatigue
Malaise

Question 9

What are the local invasion symptoms of lung cancer?

Answer 9

Hoarse voice (recurrent laryngeal nerve)
Difficulty breathing (phrenic nerve)
Shooting arm pain (brachial plexus)
Horner’s syndrome (cervical sympathetic chain)
Facial swelling (blood vessels)

Question 10

What are the metastatic symptoms of lung cancer?

Answer 10

Brain- headaches, dizziness, vomiting
Bone- pain, fractures
Liver- abdominal pain
Adrenal gland- asymptomatic

Question 11

What are the paraneoplastic syndromes of lung cancer?

Answer 11

Caused by the tumour releasing hormones

Question 12

What are the skeletal signs of lung cancer?

Answer 12

Clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA)

Question 13

What are the endocrine signs of lung cancer?

Answer 13

Carcinoid syndrome
SiADH- excessive ADH release
PTH- parathyroid hormone
Cushing’s- high levels of cortisol

Question 14

What are the neurological signs of lung cancer?

Answer 14

Polyneuropathy
Cerebellar degeneration

Question 15

What are the cutaneous signs of lung cancer?

Answer 15

Dermatomyositis

Question 16

What are the haematological signs of lung cancer?

Answer 16

Eosinophilia
Disseminated intravascular coagulation (DIC)

Question 17

What are the cardiovascular signs of lung cancer?

Answer 17

Thrombophlebitis migraines

Question 18

What are the renal signs of lung cancer?

Answer 18

Nephrotic syndrome

Question 19

What are the immune signs of lung cancer?

Answer 19

Lambert Eaton Myasthenia syndrome

Question 20

What are the general signs of lung cancer?

Answer 20

Clubbing
Lymphadenopathy
Horner’s syndrome
Pancoast tumour
Hepatomegaly
Skin nodules
Chest signs
Svc obstruction

Question 21

What does lung cancer look like on CXR?

Answer 21

Lobar collapse
Consolidation
Hilary lymphadenopathy
Mediastinal widening
Pleural effusion
Mass or nodule

Question 22

What does lung cancer look like on CT?

Answer 22

Non calcified nodule

Question 23

What other investigations are done?

Answer 23

FBC
Renal and liver function
Calcium
Clotting screen
Spirometry

Question 24

What are the types of tissue biopsy?

Answer 24

Bronchoscopy
EBUS
Image guided biopsy
Fine needle aspiration of neck node
Bone biopsy
Mediastinoscopy
Surgical excision biopsy

Question 25

What are the treatment options for lung cancer?

Answer 25

Surgical
TKI inhibitors
Chemotherapy
Radiotherapy
Immunotherapy
Palliative management

Question 26

What are the types of surgical resection?

Answer 26

Lobectomy (FEV1>1)
Pneumonectomy (FEV1>2)
Wedge resection (FEV1>2)

Question 27

What is an example of an immunotherapy treatment?

Answer 27

Nivolumab blocks binding of PD1 and PDL1
This allows the immune system to attack the tumour