Bronchial cancer - non-small cell

Question 1

What does NSCLC stand for?

Answer 1

Non-small cell lung cancer.

Question 2

NSCLC accounts for what percentage of all lung cancers?

Answer 2

80%.

Question 3

What are the 3 main types of NSCLC?

Answer 3

1. Adenocarcinoma.
2. Squamous cell carcinoma.
3. Large call carcinoma.

Question 4

Which type of NSCLC is the most common?

Answer 4

Adenocarcinoma.

Question 5

What is the epidemiology?

Answer 5

· More common in males.

· Incidence and mortality correlates with tobacco use.

Question 6

What is the pathophysiology?

Answer 6

· Squamous cell carcinoma:

• 25-30%.
• Located more centrally.

· Adenocarcinoma:

• 45%.
• Located more peripherally.

· Large cell carcinoma:

• 10%.
• Located more centrally.

Question 7

What is the aetiology?

Answer 7

· Cigarette smoking - 90% of cases:

• Multiple carcinogens.
• Hydrocarbons.
• Nitrosamines.

· Radon gas.

Question 8

List the common risk factors.

Answer 8

· Cigarette smoking. 
· Environmental tobacco exposure. 
· COPD. 
· FH. 
· Radon gas exposure. 
· Older age.

Question 9

List the common signs and symptoms.

Answer 9

· Cough.
· Dyspnoea. 
· Haemoptysis. 
· Chest pain. 
· Weight loss. 
· Fatigue. 
· Wheeze, rales, decreased breath sounds and dullness to percussion.

Question 10

What investigations would you request if you suspected a patient had NSCLC?

Answer 10

· CXR
· CT scan of lower neck, thorax and upper abdomen.
· Sputum cytology.
· Bronchoscopy.
· Diagnostic thoracentesis and/or pleural biopsy.
· VATS.
· Bloods.

Question 11

What would you look for on a CXR?

Answer 11

· Single or multiple pulmonary nodules.
· Mass.
· Pleural effusion.
· Lung collapse.

Question 12

Differentials?

Answer 12

· Small cell lung cancer - NSCLC may not show massive hilar lymphadenopathy like SCLC. 
· Metastatic cancer. 
· Pneumonia/Bronchitis. 
· TB. 
· Sarcoidosis. 
· Infectious granuloma. 
· Amyloidosis.
· RA. 
· Lymphoma.

Question 13

What are the current treatment options?

Answer 13

· Surgery.
· Pre-op chemo or chemoradiation.
· Post-op chemo or radiotherapy. 
· Chemotherapy.
· Radiotherapy. 
· Palliative radiotherapy. 
· Palliative care.

Question 14

What complications may arise?

Answer 14

· Post-obstructive pneumonia/hypoxia.
· SVC syndrome.
· Paraneoplastic syndromes.