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Hypercalcaemia of malignancy — MCCQE Part 1 MCQ

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HardFatigueHypercalcaemia of malignancyMCCQE Part 1

A 58-year-old smoker has progressive facial swelling, distended chest-wall veins, and dyspnoea when bending forward. He is haemodynamically stable, has no stridor, and has no confusion or focal neurologic deficit. Chest radiography shows a right hilar mass. What is the most appropriate next management step?

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Correct answer: B — Obtain contrast chest imaging and an urgent tissue diagnosis

Facial swelling, venous collaterals, positional dyspnoea, and a hilar mass indicate superior vena cava syndrome. Because he has no airway compromise, cerebral oedema, or haemodynamic collapse, contrast-enhanced chest imaging should define the obstruction and guide the safest urgent biopsy. Histology matters because small-cell lung cancer, non-small-cell cancer, lymphoma, thrombosis, and benign causes require different treatments. Empiric radiotherapy can obscure tissue diagnosis and is not routinely necessary in a stable patient. Thrombolysis is reserved for selected acute thrombotic disease, and neither delayed review nor an invasive airway procedure is appropriate. Severe stridor, laryngeal oedema, or neurologic deterioration would require immediate multidisciplinary intervention.

Reference: National Cancer Institute PDQ, Cardiopulmonary syndromes: https://www.cancer.gov/about-cancer/treatment/side-effects/cardiopulmonary-pdq