neoplastic pulmonary disease

Question 1

What is the most common type of primary lung cancer + RF

Answer 1

bronchial carincomas (95%)

RF: Active/passive smoking, age, occupation exposure (asbestos, silica, welding fumes, coal), COPD, prev Ca

Question 2

Types of bronchial carincomas + what type is common in non-smokers?

Answer 2

(1. ) SCLCs
- rapid growing and highly malignant, inoperable.
- arises from endocrine cells resulting in paraneoplastic syndromes.
- associated with ectopic ADH, ACTH, secretion.

(2. ) NSCLCs
(a. ) Squamous: PTH-related protein -> hypercalcemia , associated with clubbing + HPOA

(b. ) Adenocarcinoma: associated with asbestos, more common in non-smokers.
(c. ) Large cell
(d. ) Carcinoid tumour
(e. ) Bronchoalveolar

Question 3

Presentation + (7) paraneoplastic syndrome features for bronchial carincomas

Answer 3

Presentation

• Cough
• Dyspnoea
• CP
• Haemoptysis
• Hoarseness
• Wt loss, fever, N+V

Extrapulmonary manifestations + paraneoplastic syndrome

(1. ) Recurrent laryngeal nerve palsy: hoarseness
(2. ) Phrenic nerve palsy: diaphragm weakness and sob

(3. ) Superior vena cava obstruction:
- facial swelling, distended veins + upper chest.
- “Pemberton’s sign” - raising hands over head causes facial congestion + cyanosis.
- This is a medical emergency.

(4. ) Horner’s syndrome: ptosis, anhidrosis, miosis
- Pancost tumour (pulmonary apex tumour) pressing on sympathetic ganglion

(5. ) SIADH or Cushing
- SIADH caused by SCLC secreting ectopic ADH. Presents with hyponatremia
- Cushing caused by SCLC secreting ectopic ACTH.

(6. ) Hypercalcemia
- ectopic PTH secreted by a squamous cell carcinoma.

(7. ) Lambert-Eaton myasthenic syndrome
- syx: proximal weakness, diplopia, ptsosis, dysphagia, slurred speech

Question 4

2ww referral criteria for lung ca

Answer 4

(1. ) 2ww referral
- CXR findings suggest lung ca
- >40y with unexplained haemoptysis

(2.) 2ww urgent CXR: >40y with

(a. ) >2 syx OR smoker with 1 syx of following:
- Cough, fatigue, sob, CP, wt loss, appetite loss
- Syx are unexplained

(b. ) Any of:
- Persistent chest infection
- clubbing
- lymphadenopathy
- chest signs of lung ca
- thrombocytosis

Question 5

Mx for lung Ca

Answer 5

Mx
Involves MDT

NSCLC

(1. ) Surgery: lobectomy 1st line.
- CI = mets present, FEV1 <1.5, pleural effusion, SVC obstruction, Vocal cord paralysis
(2. ) Mediastinoscopy
(3. ) Curative or palliative radiotherapy
(4. ) Chemotherapy

SCLC

(1. ) Chemo and radio
(2. ) Palliative

Question 6

Where do common lung mets arise from?

Answer 6

breast 
colon
renal cell
bladder
prostate

Question 7

Carcinoid tumours - what are they? RF? Syx? Ix? Mx?

Answer 7

• Slow growing neuroendocrine tumours – releases hormones including serotonin
• Common sites: GI tract and lungs
• RF: age, female, MEN1

Syx
- CP, wheeze, sob, diarrhoea, N+V, flushing, wt gain

Ix

• FBC, UE, LFT, TFT, PTH, Ca, prolactin, hormones, CgA
• 24hr urinary 5-HIAA (breakdown of serotonin)
• Imaging: CXR, CT, PET
• Biopsy

Mx

• Surgery
• Somatostain analogue

Question 8

Pulmonary nodule - what is it? types? Ix?

Answer 8

Small round or oval shaped growth in lung ‘coin lesion’.
RF: smoking, inc age, FH/Hx of Ca

Types:

(1. ) Benign
- Infectious: TB, fungal infections
- Non-infectious inflammation: RA, sarcoidosis
- Non-cancerous tumours: fibroma

(2.) Malignant

Ix

• Bloods
• Blood cultures
• Auto-antibodies
• Imaging: CXT, CT/MRI +/-biopsy