9 Lung Cancer

Question 1

Desribe squamous cell carcinoma of the lung

Answer 1

Arises in the metaplastic epithelium
- It is smoking-related

Presentation by cough, ulceration, and bleeding

Diagnosis by sputum cytology and biopsy

Management options determined by both tumor-related and patient-related factors

Question 2

Describe adenocarcinoma of the lung

Answer 2

NOT related to smoking

Presentation as pleural effusion

Diagnosis by image-guided biopsy

Surgery is appropriate for localized disease

Question 3

Describe the epidemiology of lung cancer

Answer 3

It is the 3rd most common cancer

• It is the most common cause of death by cancer
• More common in Males, of older age

Risk factors

• Smoking (greatest)
• Radon
• Asbestos

Question 4

List the different types of lung cancer

Answer 4

Adenocarcinoma

• 32% of all lung cancers
• Seen more in women
• Not to do with smokers

Squamous cell carcinoma

• Central
• Late metastasis
• Smoking-related

APUD cell (20%)

• central
• grows fast
• metastasize early
• can produce hormones

Question 5

List some common symptoms of lung cancer

Answer 5

• Cough
• Haemoptysis
• Shortness of breath
• Recurrent chest infections

Question 6

List some common clinical signs of lung cancer

Answer 6

• Weight loss/Cachexia
• Clubbing
• Effusion/Collapse/Consolidation
• Monophonic wheeze

Question 7

List some other presentations seen in lung cancer

Answer 7

• Hoarseness
• Horner’s syndrome (ptosis, enophthalmos, small pupil, lack of sweating on ipsilateral side of face)
• Wasted muscles of the hand

Paraneoplastic syndromes:

• SIADH (low sodium and plasma osmolality and high urine osmolality)
• Ectopic ACTH (Cushing’s syndrome)
• Hypercalcaemia (Parathoormone related peptide)
• Neurological syndromes (cerebellar degeneration, lambert Eaton myasthenic syndromes)