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Common Lung cancer exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

What are the main types of lung cancer?

  • Non-Small cell lung cancer (NSCLC)
    • Approximately 75-80% of all lung malignancy
    • Squamous cell carcinoma
      • Commonest primary lung malignancy
      • Associated with hypercalcaemia
      • Usually presents as a mass on CXR
    • Adenocarcinoma
      • Not necessarily associated with smoking
    • Alveolar cell carcinoma
  • Small cell lung cancer (SCLC)
    • Approximately 20-25%
    • Most aggressive but chemo and radiosensitive
    • Associated with syndrome of inappropriate ADH (SIADH)

 

Question 2.

What are some other types of lung cancer?

  • Carcinoid
    • 1% all tumours – 60% visible from bronchial tree
    • Vascular, tend to bleed
    • Originate from APUD
    • Only a small number lead to carcinoid syndrome
    • 5 year survival 90% with surgery
  • Mesothelioma
    • Causes – Asbestos
    • M>F
    • Presentation – Pleuritic chest pain, Pleural effusion, Anorexia, night sweats
    • Treatment – Chemo/RT, treatment of pleural effusions

 

Question 3.

What is a Pancoast’s tumour?

  • An apical tumour
  • Can cause Horner’s Syndrome (meisosis, ptosis, enopthalmos and anhidrosis) and weakness of small muscles of the hand (C5/6 and T1 motor loss).

 

Question 4.

What is lymphangitis carcinomatosis?

  • Infiltration of pulmonary lymphatics by tumour. Causes cough and shortness of breath.
  • CXR shows fine linear shadowing throughout both lung fields.
  • Treatment with steroids.
  • Poor prognosis.

 

Question 5.

What are the complications of lung cancer?

  • Tumour-related
    • Local
      • Recurrent laryngeal nerve palsy
      • Phrenic nerve palsy
      • Brachial plexus invasion
      • Horner’s syndrome
    • Distant
      • Mets
      • Brain, bone, liver
      • Adrenal symptoms (Addisons)
  • Endocrine
    • SIADH – small cell
      • Concentrated urine (Na >20mmol; osm > 500)
      • No hypovolaemia, oedema or diuretics
    • ACTH (Cushings) – small cell
    • PTH – squamous cell
      • Actually PTHRP
      • Can lead to hypercalcameia
  • Neurological
    • LEMS (pre-synampic calcium channel Abs)
    • Neuropathy (anti-Hu)
    • Cerebellar degeneration (anti-Yo or Purkinje)
  •  Muscular
    • Polymyositis
    • Proximal myopathy
    • HPOA