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1. In general, how are tumours classified?
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Correct answer:
- Benign.
- Malignant primary.
- Malignant secondary.
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2. For any tumour, which subheadings should you consider?
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Correct answer:
'In A Surgeon's Gown Physicians May Make Painful Progress': Incidence; Age; Sex; Geographical distribution (where relevant); Predisposing factors; Macroscopic appearances; Microscopic appearances; Pathways of spread of the tumour; Prognosis.
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3. What are the four ways in which a malignant tumour may manifest itself?
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Correct answer:
- The effects of the primary tumour itself.
- The effects produced by secondary deposits.
- The general effects of malignant disease.
- Paraneoplastic syndromes.
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4. What are paraneoplastic syndromes? Give two examples ?
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Correct answer:
These are remote effects caused by hormone or other tumour cell products, which are most common in carcinoma of the lung, particularly small-cell tumours. For example, ectopic adrenocorticotrophic hormone production may present like Cushing's syndrome, and ectopic parathyroid hormone production may present with hypercalcaemia and its symptoms.
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5. How might the primary tumour of carcinoma of the lung present?
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Correct answer:
The primary tumour may present with cough, haemoptysis, dyspnoea and pneumonia (sometimes recurrent pneumonia owing to partial bronchial obstruction).
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6. How might the secondary deposits of carcinoma of the lung present?
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Correct answer:
Secondary deposits in bone may produce pathological fracture or bone pains; cerebral metastases may produce headaches or drowsiness; liver deposits may result in jaundice.
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7. What are the general effects of carcinoma of the lung?
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Correct answer:
The patient may present with malaise, lassitude or loss of weight.
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8. What are the three paraneoplastic syndromes associated with carcinoma of the lung?
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Correct answer:
(1) Hypertrophic pulmonary osteoarthropathy and finger clubbing. (2) Myasthenia-like syndrome (Eaton–Lambert syndrome). (3) Ectopic hormone production (e.g. parathyroid hormone, adrenocorticotrophic hormone).
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10. What would you expect to find on examination of a patient with carcinoma of the lung?
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Correct answer:
The primary tumour may produce signs in the chest. Secondary deposits may produce cervical lymph node enlargement, hepatomegaly or obvious bony deposits. The general effects of malignancy may be suggested by pallor or weight loss.
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11. Which investigations would you use to investigate carcinoma of the lung?
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Correct answer:
(1) The primary tumour: chest X-ray, computed tomography, bronchoscopy, cytology of sputum and needle biopsy. (2) Secondary deposits: isotope bone scan, bone X-ray and ultrasound of the liver. (3) General manifestations of malignancy: a blood count may reveal anaemia; the erythrocyte sedimentation rate may be raised. (4) Paraneoplastic hormone production: hormone assay. This simple scheme applied to any of the principal malignant tumours will enable the student to present a very full clinical picture of the disease with little mental effort.
