[Resp] Lung Cancer

Question 1

what are the 2 categories of lung cancer?

Answer 1

1. Non-Small Cell (NSCLC)

2. Small Cell (SCLC)

Question 2

what is NSCLC divided into?

Answer 2

1. Squamous Cell Carcinoma (SCC)

2. Adenocarcinoma

Question 3

what is the most common NSCLC and in whom?

Answer 3

adenocarcinoma, most common in non-smokers

Question 4

what is SCC strongly linked to?

Answer 4

smoking

Question 5

SCLC is fast growing. what does it often present with?

Answer 5

dissemination with many paraneoplastic syndromes associated (e.g. SIADH, Cushing’s, Lambert-Eaton syndrome)

Question 6

what are the risk factors for lung cancer?

Answer 6

• smoking
• radon / asbestos / silica
• FHx

Question 7

when do you refer pt for an urgent CXR?

Answer 7

2 or more OR smoking hx + 1 of:

• cough
• fatigue
• SOB
• chest pain
• wt loss
• appetite loss

Question 8

when do you refer pt for suspected cancer (2 week wait)?

Answer 8

• CXR suggestive of lung cancer or

- age >40 with unexplained haemoptysis

Question 9

what are the complications of lung cancer?

Answer 9

• widespread metastasis (brain, bone, liver, adrenal glands)
• SVCO (Pemberton’s sign)
• hypercalcaemia
• pathological fractures
• side effects of chemotherapy

Question 10

what is done next after a CXR suspicious for lung Ca is referred to 2˚ care?

Answer 10

CT thorax

Question 11

if the CT thorax shows suspicion of a neoplasm, what is done next?

Answer 11

biopsy

• image guided
• endobronchial US (EBUS)

Question 12

if histology shows malignancy, what is done next?

Answer 12

• staging PET CT

- lung cancer MDT

Question 13

what are the Rx options for NSCLC?

Answer 13

1. surgical resection
2. adjuvant chemotherapy
3. radical radiotherapy
4. systemic chemotherapy

Question 14

what are the Rx options for SCLC?

Answer 14

1. radical radiotherapy

2. systemic chemotherapy

Question 15

what is the classification of hypercalcaemia?

Answer 15

mild <3
moderate 3-3.5
severe >3.5 mmol/L

Question 16

what are the acute features of hypercalcaemia that can be seen on ECG?

Answer 16

• Osborn “J” wave

- short QT → VF

Question 17

what are the chronic features of hypercalcaemia?

Answer 17

"stones" - renal stones
"bones" - bone pain
"moans" - lethargy
"groans" - abdo pain
"thrones" - polyuria, constipation
psychic "overtones" - anxiety, psychosis

Question 18

how do you manage severe hypercalcaemia (oncological emergency)?

Answer 18

IV saline 0.9% (4-6 litres in 24 hours)

Question 19

in mx of severe hypercalcaemia, what do you give the pt once rehydrated?

Answer 19

IV Zolendronate 4mg (or Pamidronate)

Question 20

in mx of severe hypercalcaemia, when do you re-check serum calcium?

Answer 20

day 2 and 4

Question 21

SCLC, muscle strength improving on repetitive movement (i.e. Lambert-Eaton syndrome). antibody?

Answer 21

anti-voltage gated calcium channel

Question 22

Breast Ca or SCLC, progressive muscle stiffness (i.e. Stiff Man Syndrome). antibody?

Answer 22

anti-amphiphysin

Question 23

SCLC, cerebellar sx and sensory neuropathy. antibody?

Answer 23

anti-hu

Question 24

why does hypercalcaemia develop in SCC?

Answer 24

due to parathyroid hormone related protein release