Classification
• ~15% of lung cancers
• Central, rapidly growing, early metastases (brain, liver, bone, adrenals)
• Almost always linked to smoking
• Squamous cell carcinoma
o Central location
o Cavitating masses
o Associated with hypercalcaemia (PTHrP production)
o Strong smoking link
• Adenocarcinoma
o Peripheral
o Most common lung cancer in non-smokers and women
o Can present as solitary pulmonary nodule
• Large cell carcinoma
o Peripheral or central
o Poorly differentiated, aggressive
• SCLC:
o SIADH → hyponatraemia (euvolaemic)
o Ectopic ACTH → Cushing’s syndrome
o Lambert–Eaton myasthenic syndrome (LEMS)
• Squamous cell carcinoma:
o Hypercalcaemia (PTHrP)
• Others:
o Hypertrophic pulmonary osteoarthropathy (HPOA) → clubbing, periostitis
o Dermatomyositis/polymyositis
Diagnosis and Staging
• Initial: CXR (non-specific; mass, collapse, effusion)
• CT thorax: detailed assessment of primary tumour and nodes
• PET-CT: distant metastases (staging)
• Tissue diagnosis:
o Central tumours → bronchoscopy ± endobronchial biopsy
o Peripheral tumours → CT-guided biopsy
Management
• SCLC: chemotherapy ± radiotherapy; surgery rarely used due to early spread
• NSCLC:
o Early-stage → surgery ± adjuvant therapy
o Advanced → chemotherapy, targeted therapy (EGFR inhibitors if EGFR+, ALK inhibitors)
Features
• Malignant tumour of pleura, almost always linked to asbestos exposure
• Long latency (decades after exposure)
Clinical
• Dyspnoea, pleuritic chest pain
• Recurrent unilateral effusion
• Weight loss
Imaging
• CXR: unilateral effusion, diffuse pleural thickening
• CT: pleural thickening, nodularity
Diagnosis
• Pleural biopsy (thoracoscopy)
Prognosis
• Very poor; median survival ~1 year
Management
• Palliative: pleurodesis, analgesia
• Chemotherapy: pemetrexed + cisplatin
• Thymoma:
o Associated with myasthenia gravis
o Also red cell aplasia, hypogammaglobulinaemia
• Teratoma/germ cell tumours
• Thyroid goitre
• Terrible lymphoma
• Lymphadenopathy (sarcoidosis, lymphoma, metastases)
• Bronchogenic cysts
• Neurogenic tumours (schwannomas, neurofibromas)
• Oesophageal lesions
Extra Revision Pearls
• SCLC → central, "smoking, SIADH, Small cell, Speedy spread"
• Adenocarcinoma → peripheral, non-smokers
• Squamous → central, cavitating, calcium
• Mesothelioma → pleural plaques clue, long latency
• Thymoma → strongly think myasthenia gravis if mediastinal mass + weakness
• Hypertrophic pulmonary osteoarthropathy → clubbing + periostitis = lung cancer clue
• Pancoast tumour (superior sulcus): shoulder pain, Horner’s syndrome, brachial plexopathy
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
