Week 9: Lung cancer

Question 1

Why is smoking highly associated with bladder cancer

Answer 1

Inhaled carcinogens are processed by liver then passed out in urine

Question 2

In a pt with lung cancer, what does a hoarse voice indicate

Answer 2

Invasion of recurrent laryngeal N

Question 3

What does Pancoast’s syndrome consist of

Answer 3

1. Horner’s syndrome
2. Chest wall pain
3. T1 dermatome pain

Question 4

What does Horner’s syndrome consist of

Answer 4

1. Miosis (pupil constriction)
2. Anhydrosis
3. Partial ptosis
4. Enophthalmos

Question 5

What is Lambert-Eaton syndrome?

• pathophysiology
• symptoms

Answer 5

Ab against presynaptic calcium channels –> damaged nerves unable to produce sufficient Ach –> Muscle weakness

Muscle weakness is improved by exercise

Question 6

Squamous cell lung cancer often invades the T1 nerve root.

How would you differentiate symptoms of this from a Median + Ulnar N palsy?

Answer 6

T1 nerve root invasion:
Sensory deficit in forearm

Median + Ulnar N palsy:
Sensory deficit in hand

Both have the same motor symptoms

Question 7

2 week wait referral criteria for lung cancer

Answer 7

1. CXR signs that suggest cancer

2. Age >40yo + unexplained haemoptysis

Question 8

Types of lung cancer

Answer 8

1. Adenocarcinoma in situ
2. Small cell
3. Squamous cell
4. Large cell
5. Mesothelioma

Question 9

Causes of Horner’s syndrome

Answer 9

1. Apical tumour
2. Aortic dissection (eg in Marfan’s)
3. Carotid body tumour

Question 10

From where does adenocarcinoma in situ arise

Answer 10

Bronchial mucosal glands

Question 11

From where does SCLC arise

Answer 11

Small cells in larger airways

Question 12

From where does squamous cell lung cancer arise

Answer 12

Epithelial cells from central bronchi to terminal alveoli (so lesion may be seen centrally or peripherally)

Question 13

From where does large cell lung cancer arise

Answer 13

Epithelial cells from central bronchi to terminal alveoli (lesion tends to be seen peripherally)

Question 14

From where does mesothelioma arise

Answer 14

Surface serosal cells of pleura, peritoneal, pericardial cavities

Question 15

CXR shows a central mass. Which lung cancers might it be?

Answer 15

Small cell

Squamous cell

Question 16

CXR shows a peripheral mass. Which lung cancers might it be?

Answer 16

Squamous cell

Large cell

Question 17

CXR shows diffuse nodules. Which lung cancers might it be?

Answer 17

Adenocarcinoma in situ

Question 18

CXR shows cavitation. Which lungs cancer might t be?

Answer 18

Squamous cell

Question 19

Most common lung cancer

Answer 19

Adenocarcinoma in situ

Question 20

Which lung cancers are more aggressive?

Answer 20

1. Small cell
2. Large cell
3. Mesothelioma

Question 21

Which lung cancers cannot be cured surgically?

Answer 21

1. Small cell

2. Mesothelioma

Question 22

Which type of lung cancer is particularly associated with clubbing

Answer 22

Squamous cell

Question 23

Which 2 types of lung cancer are more associated with skin mets

Answer 23

1. Small cell

2. Squamous cell

Question 24

Which type of lung cancer is particularly associated with hypercalcaemia?
Pathophysiology of this

Answer 24

Squamous cell.

Due to PTHrP production

Question 25

Management of hypercalcaemia

Answer 25

1. IV fluid | 2. IV bisphophonates

Question 26

Which type of lung cancer is particularly associated with SIADH

Answer 26

Small cell

Question 27

Management of SIADH

Answer 27

Fluid restriction | Democlocycline

Question 28

Which type of lung cancer is particularly associted with Cushing's? Pathophysiology of this

Answer 28

Small cell | Due to ectopic ACTH production

Question 29

Where do lung cancers tend to mets to

Answer 29

1. Liver 2. Adrenal 3. Bone 4. Brain

Question 30

Diagnostic investigation for lung cancer

Answer 30

Biopsy

Question 31

Staging investigation for lung cancer

Answer 31

PET-CT

Question 32

Describe the order in which investigations are done in lung cancer

Answer 32

1. CXR, Bloods (FBC, UnEs, LDH, serum calcium) 2. CT chest abdo pelvis 3. Biopsy 4. PET-CT 5. Investigation for mets (eg CT head, bone scan)

Question 33

What sign is pathognomic of SVCO

Answer 33

Non-pulsatile JVP

Question 34

Signs of SVCO

Answer 34

1. Facial oedema 2. Headache (due to cerebral oedema) 3. Dyspnoea, chest pain, cough (due to venous distention of chest) 4. Non-pulsatile JVP Signs worsened by bending forward

Question 35

Causes of SVCO

Answer 35

1. Compression/ invasion of the tumour | 2. Thrombosis

Question 36

CXR findings in SVCO

Answer 36

Widening of superior mediastinum | superior mediastinum starts at top of ribs and ends at T4/T5

Question 37

Acute management of SVCO

Answer 37

1. Sit upright | 2. Dexamethosone

Question 38

Permanent treatment of SVCO

Answer 38

1. Stent 2. Radiotherapy 3. Thrombolysis (if caused by thrombus)

Question 39

2 causes of hypercalcaemia in cancer

Answer 39

1. PTHrP (100x more potent than PTH) 2. Bony mets

Question 40

Which cancers (all organs) are more associated with hypercalcaemia

Answer 40

1. Squamous cell lung cancer 2. Breast cancer (due to bony mets) 3. Renal cancer 4. Head and neck, oesophageal cancer

Question 41

Signs of hypercalcaemia

Answer 41

1. Rapid onset nausea 2. Polyuria, polydipsia, dehydration 3. Cardiac arrhythmias 4. Confusion

Question 42

Definition of neutropenic sepsis

Answer 42

1. Fever >38 on single reading or >37.5 on 2 readings over 1h 2. Neutrophils <1.0 x10^9/L 3. Unexplained hypotension/ tachycardia

Question 43

Treatments which cause neutropenic sepsis

Answer 43

1. Chemotherapy (main cause) | 2. Radiotherapy

Question 44

What investigations to do in neutropenic sepsis

Answer 44

Blood cultures, swabs, MSU, CXR Note: examine all over but do NOT do PV/PR

Question 45

Empirical a/b to give in neutropenic sepsis

Answer 45

Tazocin/ gentamycin

Question 46

What level of platelets must you ensure to keep above when treating neutropenic sepsis

Answer 46

Platelets >20 x10^9/L

Question 47

What drug is preferably avoided in neutropenic sepsis

Answer 47

Paracetamol

Question 48

Most common endocrine neoplastic syndrome

Answer 48

SIADH

Question 49

Skin manifestations indicate stage what NSCLC and SCLC?

Answer 49

Stage 4

Question 50

Which cancer is associated with ectopic ACTH production? Signs of this

Answer 50

SCLC - Cushing's - Addison's