12. Lung Cancer

Question 1

Is lung cancer common

Answer 1

Yes, most common male cancer and highest cancer-related deaths worldwide

Question 2

What are the main risk factors for lung cancer

Answer 2

1. Smoking
2. Low socio-economic class
3. Age: 60-80
4. Asbestos, radon, other occupational carcinogens

Question 3

What are the main types of cancer

Answer 3

1. Non-small cell lung carcinoma
   - squamous cell carcinoma (40%)
   - adenocarcinoma (35%) - likely in non-smokers
   - large cell carcinoma (5%)
2. Small cell lung carcinoma (12%) - grows and metastasises much faster

Question 4

Where are lung cancers likely to metastasise

Answer 4

• other lung
• adrenal glands
• bones
• brain
• liver

Question 5

Suggest 3 types of endocrine neoplastic syndromes that can be caused by small cell lung carcinomas

Answer 5

1. Hypercalcaemia - ectopic PTHrP secretion
2. SIADH - ectopic ADH secretion
3. Cushing’s syndrome - ectopic ACTH secretion

Question 6

What is the 5 yr survival rate for stage 1 and stage 4 lung cancer

Answer 6

• stage 1 = 50%

- stage 4 = 2%

Question 7

What are the possible symptoms caused by primary lung tumours

Answer 7

• cough
• dyspnoea
• haemoptysis
• asymmetric wheezing
• lung infections

Question 8

What might lung cancer CXR show

Answer 8

• coin lesions

In some cases

• lobar collapse
• pleural effusion

Question 9

How is tissue obtained for diagnostic purposes

Answer 9

• bronchoscopy with needle biopsy of lung or pleura

- affected lymph node fine needle aspiration can also be performed first as allows staging

Question 10

What treatments are possible for lung cancer

Answer 10

Stage 1-2: surgery (lobectomy, mostly for non-small cell) +/- (neo)adjuvant chemo-/radiotherapy
Combination chemo potentially curative in minority of small cell

Stage 3: non-operable, combination chemotherapy, radiotherapy

Stage 3-4: palliative treatment

+/- biological targeted therapy based on mutational analysis