Resp - Lung Cancer: Presentation

Question 1

What are the 4 types of lung cancer?

Answer 1

• SCC
• Adenocarcinoma
• Large cell
• Small cell

Question 2

SCC: describe the epidemiology, pathology and behaviour of this cancer

Answer 2

• Epidemiology: 35%, M>F, Smoking, radon gas
• Pathophysiology: centrally located, will show evidence of squamous differentiation and keratinisation
• Behaviour: locally invasive, metastasises late via lymph nodes. PTHrP leads to raises Ca2+ levels

Question 3

Adenocarcinoma: describe the epidemiology, pathology and behaviour of this cancer

Answer 3

• Epidemiology: 25%, females, non smokers
• Pathophysiology: peripherally located, histological appearance (glandular differentiation with gland formation and mucin production)
• Behaviour: extrathoracic mets common and early- 80% present with mets

Question 4

Large cell carcinoma: describe the epidemiology, pathology and behaviour of this cancer

Answer 4

• Epidemiology: 10%
• Pathology: peripheral or central, histologically (large, poorly differentiated cells(
• Behaviour: poor prognosis

Question 5

Small cell carcinoma: describe the epidemiology, pathology and behaviour of this cancer

Answer 5

• Epidemiology: smoking, 20%
• Pathology: central location, near bronchi, histologically (small poorly differentiated cells)
• Behaviour: 80% present with advanced disease, V chemosensitive but V poor prognosis + ectopic hormone production

Question 6

Other tumours: 3 rare types

Answer 6

• Adenoma
• Hamartoma
• Mesothelioma

Question 7

Name 7 pre-diagnostic factors to consider in pts when suspecting lung cancer

Answer 7

• Smoking Hx
• FHx
• Age: >40
• Occupational exposure: asbestos, diesel exhaust, silica, granite
• Previous/current Ca
• Socio-economic status
• Inflammatory lung conditions: emphysema

Question 8

Name 5 red flags that are lung cancer specific

Answer 8

• New cough >3 wks with a change in nature
• Unintentional wt loss of about 10-15% of body weight
• Haemoptysis: must be mixed with phlegm to be able to specify lung origin
• Hoarse voice/Bovine cough: recurrent laryngeal nerve palsy
• Horner’s: droopy eyelid is most common complaint

Question 9

Name 6 examinations findings that would be indicative of lung Ca

Answer 9

• Pleural effusion: stoney dull, decreased chest expansion, absent breath sounds
• Lobar collapse: tracheal deviation towards collapse, decreased airway entry, significantly reduced chest expansion
• Horner’s syndrome: ipsilateral miosis, anhydrous is, and ptosis
• Paraneoplastic syndromes: cushing’s or signs of cardiomyopathy
• Lymphadenopathy in cervical chain
• Mets: bone, brain, adrenals and liver (hepatomegaly)

Question 10

Complications: local

Answer 10

• Recurrent laryngeal nerve palsy
• Phrenic nerve palsy
• SVC obstruction
• Horner’s (Pancoast tumour)
• AF

Question 11

Complications: paraneoplastic

Answer 11

• Endocrine: ADH = SIADH (euvolaemic hyponatraemia), ACTH = cushing’s syndrome, Serotonin = carcinoid (flushing, diarrhea)
• Rhematological: dermatomyositis/polymyositis
• Neurovascular: peripheral neuropathy
• Dermatological: acanthosis nigricans (hyperpigmented body folds)

Question 12

Complications: metastatic

Answer 12

• Pathological fracture
• hepatic failure
• confusion, fits
• Addison’s

Question 13

Typical paraneoplastic effects for Small cell and squamous

Answer 13

• Small cell: SIADH, ectopic ACTH, carcinoid

- Squamous: PTHrP, Horner’s + pancoast tumour