Session 10: Group Work

Question 1

Best treatment option for primary lung adenocarcinoma with no evidence of metastases.

Answer 1

Surgical resection

Question 2

What is the most likely explanation for the weakness and wasting of the right hand in a pancoast tumour?

Answer 2

Tumour compressing the brachial plexus (C8,T1)

Question 3

Given the findings in the right hand, where would you expect sensory loss in the right upper limb?

Answer 3

Two ulnar digits and ulnar half of forearm
Ulnar arm
Some of posterior arm.

Question 4

How could the diagnosis of bronchial carcinoma be established?

Answer 4

Imaging CT and biopsy

Question 5

Following investigations squamous cell carcinoma of the lung is diagnosed. The blood test reveal hypercalcaemia. What are the possible causes for hypercalcaemia in this patient?

Answer 5

PTHrP producing tumour

Bone metastases

Question 6

What investigations could help diagnosis?

Answer 6

PTH to see if it is low (should be low in this case)
ALP to check if there is bone turnover
Phosphate
Vitamin D

Question 7

What investigations would be helpful to establish the cause of hoarseness of voice?

Answer 7

Laryngoscope

Laryngeal cancer vs RLN injury where the vocal cords would be in the paramedian position.

Question 8

State two important differences between SCLC and NSCLC?

Answer 8

SCLC are aggressive and metastasise quickly

SCLC is neuroendocrine of bronchi whereas NSCLC is epithelial cells of the lung. SCLC are also smaller tumours.

Question 9

How do these differences influence the treatment of SCLC?

Answer 9

SCLC is treated with chemoradiation instead.

Question 10

SCLC can produce paraneoplastic syndromes.

If Serum sodium is 120 mmol/L, which paraneoplastic syndrome is this associated with?

Answer 10

SIADH

Question 11

SCLC can produce paraneoplastic syndromes.

If the patient has moon face, buffalo hump, hirsutism and hyperpigmentation, which paraneoplastic syndrome is this associated with?

Answer 11

ACTH producing

Cushing’s syndrome

Question 12

SCLC is also the most common lung cancer subtype to produce SVC obstruction.
What clinical features are likely to arise from SVC obstruction?

Answer 12

Raised JVP
Headaches
Oedema
Redness
Distended neck veins

The patient will look angry

Question 13

What consequences of bronchial carcinoma could cause breathlessness?

Answer 13

Can block lymphatic drainage and therefore cause a pleural effusion.

The bronchial carcinoma can also cause increased capillary permeability.

Question 14

On examination there was stony dullness to percussion in the right lower zone with associated reduction in breath sounds.
What do these signs indicate?

Answer 14

Consolidation in the right lower zone

Probably a pleural effusion.