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Lung cancer flashcards

13 high-yield MRCP Part 1 cards from the Intellect Medicos Respiratory Medicine course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. What is the most common type of lung cancer overall, and the most common in non-smokers?

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   Adenocarcinoma (for both).

   Why? Adenocarcinoma is typically peripheral and is commoner in women; it is linked with gynaecomastia and HPOA.

2. Which lung cancer is classically associated with hypercalcaemia, and by what mechanism?

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   Squamous cell carcinoma, via PTH-related peptide (PTHrP) secretion.

   Why? SCC is central, strongly smoking-related and may cavitate.

3. Name two endocrine paraneoplastic syndromes of small cell lung cancer.

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   SIADH (euvolaemic hyponatraemia) and ectopic ACTH secretion (Cushing's syndrome).

   Why? SCLC arises from neuroendocrine (APUD) cells, which can secrete hormones.

4. Which electrolyte and acid–base picture is typical of ectopic ACTH from small cell lung cancer?

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   Hypokalaemic metabolic alkalosis.

   Why? Very high cortisol saturates renal 11-beta-HSD2 and acts on mineralocorticoid receptors, causing potassium loss. Weakness is common; classic Cushingoid features may be absent.

5. Which antibodies cause Lambert–Eaton myasthenic syndrome, and how does the weakness behave with repeated effort?

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   Antibodies against presynaptic voltage-gated calcium channels; weakness IMPROVES with repeated activity.

   Why? It is associated with small cell lung cancer and causes proximal weakness, reduced reflexes and autonomic symptoms (e.g. dry mouth).

6. What is the main treatment for small cell lung cancer?

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   Platinum-based chemotherapy, with thoracic radiotherapy for limited-stage disease; surgery is rarely suitable.

   Why? SCLC grows rapidly and has usually spread at diagnosis, but it is initially chemosensitive. Prophylactic cranial irradiation is offered to fit patients who respond.

7. What targeted drug is used for advanced non-small cell lung cancer with an activating EGFR mutation?

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   An EGFR tyrosine kinase inhibitor, e.g. osimertinib.

   Why? EGFR mutations are commonest in adenocarcinoma in non-smokers and East Asian patients. Osimertinib is also recommended as adjuvant therapy (up to 3 years) after complete resection of stage IB–IIIA EGFR-mutant NSCLC.

8. How is superior vena cava obstruction from lung cancer managed?

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   Treat the cancer with chemotherapy and/or radiotherapy according to stage; consider an SVC stent for immediate relief of severe symptoms.

   Why? Stenting gives rapid relief of facial swelling, headache and breathlessness. Dexamethasone is often given in practice, but evidence for it is weak.

9. An apical lung tumour causes shoulder pain, small hand muscle wasting and a unilateral ptosis with miosis. What is the tumour called?

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   Pancoast (superior sulcus) tumour.

   Why? It invades the brachial plexus (C8/T1) and the sympathetic chain, causing Horner's syndrome.

10. After the chest X-ray, what imaging is offered to diagnose and stage suspected lung cancer (NICE)?

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    Contrast-enhanced CT of the chest, including the liver, adrenals and lower neck.

    Why? It shows the primary tumour, nodes and common metastatic sites, and guides the choice of biopsy and the next staging test.

11. Which scan should every person with lung cancer who could have treatment with curative intent be offered first (NICE)?

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    PET-CT.

    Why? PET-CT detects unsuspected nodal or distant spread, which would rule out surgery or radical radiotherapy.

12. Which two immunohistochemical markers confirm the neuroendocrine origin of small cell lung cancer?

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    Chromogranin and synaptophysin.

    Why? SCLC arises from neuroendocrine (APUD) cells. Histology shows small cells with scant cytoplasm, a high mitotic rate and nuclear moulding.

13. What is the most sensitive investigation for hypertrophic pulmonary osteoarthropathy (HPOA) in lung cancer?

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    Isotope bone scan (bone scintigraphy).

    Why? It shows increased periosteal uptake along the long bones. HPOA presents with clubbing and painful, tender wrists and ankles.