Pathology of lung cancer

Question 1

What are the local signs of bronchial obstruction?

Answer 1

Collapse of lobe/segement
Mucociliary escalator damaged so secretions pool in the lung
Bronchiectasis distal to tumour
Endogenous lipid pneumonia

Question 2

What are the local signs of pleural malignancy?

Answer 2

Inflammation
Malignancy in pleura

Question 3

Where can lung cancer directly invade?

Answer 3

Chest wall
Nerves
Mediastinum
Lymph nodes

Question 4

What happens when lung cancer invades the phrenic nerve?

Answer 4

Diaphragmatic paralysis

Question 5

What happens when lung cancer invades the L recurrent laryngeal nerve?

Answer 5

Hoarse bovine cough

Question 6

What happens when lung cancer invades the brachial plexus?

Answer 6

Pancoast T1 damage
- Neurological symptoms in the hand/arm

Question 7

What happens when lung cancer invades the cervical sympathetic chain?

Answer 7

Horner’s syndrome
- Sympathetic neurological paralysis unilaterally

Question 8

What is the effect of lymph node metastasis?

Answer 8

Mass effect
Lymphangitis carcinomatosis

Question 9

Where can lung cancer effect extra thoracically?

Answer 9

Skeletal
Endocrine
Neurological
Cutaneous
Haematologic
Cardiovascular
Renal

Question 10

What are the signs in the skeleton?

Answer 10

Finger clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA)

Question 11

What are the endocrine signs?

Answer 11

ACTH
siADH
PTH
Carcinoid syndrome
Gynecomastia

Question 12

What are the neurological sings of lung cancer?

Answer 12

Polyneuropathy
Encephalopathy
Cerebellar degeneration
Myasthenia (Eaton-Lambert)

Question 13

What are the cutaneous signs of lung cancer?

Answer 13

Acanthosis nigricans
Dermatomyositis

Question 14

What are the haematologic signs of lung cancer?

Answer 14

Granulocytosis
Eosinophilia
DIC

Question 15

What are the cardiovascular signs of lung cancer?

Answer 15

Thrombophlebitis migraines

Question 16

What are the renal signs of lung cancer?

Answer 16

Nephrotic syndrome

Question 17

What are the characteristics of lung cancer?

Answer 17

Presents LATE in natural history.
Symptomatic lung cancer generally equals fatal lung cancer.
May have few signs/symptoms until disease is advanced.
SYMPTOMATIC LUNG CANCER = FATAL

Question 18

What are the 4 types of lung cancer?

Answer 18

Squamous cell
Adenocarcinoma
Large cell carcinoma
Small cell carcinoma

Question 19

What are complications of tumour invasion of the chest?

Answer 19

Recurrent chest infections

Question 20

What are complications of tumour invasion of the oesophagus?

Answer 20

Progressive dysphagia

Question 21

What are complications of tumour invasion of the pericardium?

Answer 21

Pericardial effusion
Malignant arrythmias

Question 22

What are complications of tumour invasion of the venous system?

Answer 22

Superior vena cava obstruction

Question 23

What are the effect of tumour compression of the phrenic nerve?

Answer 23

Ipsilateral diaphragmatic paralysis

Question 24

What are the effect of tumour compression of the L. recurrent laryngeal nerve?

Answer 24

Hoarse, bovine cough

Question 25

What are the effect of tumour compression of the cervical sympathetic chain?

Answer 25

Horner’s syndrome
(ptosis, miosis, anhydrosis)