Resp Cancer

Question 1

Paraneoplastic syndrome of small cell cancer?

Answer 1

ADH - SIADH/hyponatraemia

ACTH - Cushing’s syndrome
(high BP, glucose - low K - alkalosis, muscle weakness)

Lambert Eaton Syndrome - anti-VGCC Ig, muscle weakness worse in legs, gets better with exercise

Question 2

Paraneoplastic syndrome of squamous cell cancer?

Answer 2

PTHrp - hypercalcaemia

Clubbing

Hypertrophic pulmonary osteoarthropathy

TSH - ectopic production - hyperthyroid

Question 3

Paraneoplastic syndrome of adenocarcinoma?

Answer 3

Gynaecomastia - produces bHCG - increases oestrogen:testosterone ratio

Hypertrophic pulmonary osteoarthropathy

(Produces mucin as well)

Question 4

What may be noted on FBC with lung cancer?

Answer 4

Thrombocytosis

Question 5

Examination findings in lung cancer?

Answer 5

Fixed, monomorphic wheeze

Supraclavicular/Cervical lymphadenopathy

Clubbing (lung cancer most common cause)

Question 6

Management principles of non-small cell lung cancer? (4)

Answer 6

• Only 20% suitable for surgery
• Mediastinoscopy always performed before surgery as CT doesn’t always show lymph nodes
• Curative/palliative radiotherapy (curative if <5cm)
• Has a poor response to chemo

Question 7

Contraindications for surgery in non-small cell lung cancer?

Answer 7

Stage IIIb or IV (mets)
FEV1 <1.5L
Malignant pleural effusion
Tumour within 2cm of hilum/carina
Vocal cord paralysis
SVC obstruction