Lung Cancer in MRCP

Lung cancer in MRCP

Lung cancer ( bronchial carcinoma) is a very popular topic in MRCP exam. The reason is quite simple, lung cancer is always among the top three cancer killer in males throughout the world. Cigarette is thought to be the major cause of lung cancer. There are a few important facts about lung cancer you must know,


1) There are 5 major subtypes of lung cancer

OSLAA- Oat cell ( small cell), squamous cell, Large cell , adenocarcinoma and alveolar cell carcinoma.
Small cell lung cancer is usually the commonest type you will see in your clinical practice. Other subtypes can be put under as non-small cell lung carcinoma.

2) There are three main complications of lung cancer

The complications can be either it is due to local spread of the disease, distant metastasis or paraneoplastic syndrome. Remember that Para-neoplasic complication is frequently asked in MRCP! The most popular question asked is about Eaton-Lambert syndrome!

3) Absolute contraindications for surgical intervention are presence of distant metastasis, malignant pleural effusion, FEV1<0.8ll,other>

Clinical presentations

Classical symptoms include loss of weight, loss of appetite, cough, haemoptysis or symptoms due to underlying Para- neoplastic syndromes.

Physical signs

The physical signs can be divided according to type of complication as mentioned above.

Local spread of disease- pleural effusion, recurrent laryngeal nerve palsy ( hoarseness of voice) , superior vena cava obstruction

Distant metastasis- bony tenderness, hepatosplenomegaly

Paraneoplastic syndrome- Cushing’s syndrome, clubbing+/- hypertrophic pulmonary osteoarthropathy. (HPA)

Paraneoplastic syndrome

There are a few main presentations that you must always remember,

a) Endocrine

SIADH, Ectopic ACTH ( especially in small cell)
Hypercalcaemia- ( in squamous cell)
Carcinoid-like syndrome…… etc, etc ( Make sure your remember these four!)

b) Neurology
Remember Eaton- Lambert(EL) and how to differentiate from Myasthenia gravis.
Remember that in EL syndrome,
- usually affect proximal limbs and trunks, ocular and bulbar rarely affected
- hyporeflexia
- repeated muscle contraction may lead to increased muscle strength
( Source: Oxford Handbook of clinical medicine)

c) others- HPA, clubbing, some very rare skin lesions ( occasionally asked in MRCP PART 1 such as Erythema gyratum repens, dermatomyositis, acanthosis nigricans)

Investigations
The most important investigation- CXR but definite diagnosis may only be made after bronchoscopy, lymph node biopsy or even CT-guided biopsy.

Treatment

Small cell is usually not operable on presentation, chemotherapy may be useful
For non- small cell cancer, surgical resection if possible