Clinical features and Investigation of lung cancers

Question 1

What are risk factors for lung cancer ?

Answer 1

Smoking 
Asbestos 
Radon 
Air pollution 
Diesel exhaust

Question 2

What are the clinical symptoms of lung cancer ?

Answer 2

Chronic coughing >3 weeks
Haemoptysis 
Wheezing 
Chest and bone pains 
Chest infections
Difficulty swallowing
Hoarse voice
SOB
Unexplained weight loss

Question 3

What are the metastatic effects of lung cancer ?

Answer 3

Bone pain
Spinal cord compression:
    - limb weakness
    - paraesthesia 
    - bladder/ bowel dysfunction
Cerebral metastases:
    - headache
    - vomiting
     - dizziness
    - ataxia
    - focal weakness
Thrombosis

Question 4

What are the paraneoplastic effects of lung cancer?

Answer 4

Hyponatraemia:
    - SIADH
Anaemia
Hypercalcaemia:
    - parathyroid hormone related protein
    - bone metastases
Dermatomyositis/ polymyositis:
    - proximal muscle weakness
Cerebellar ataxia
sensorimotor neuropathy

Question 5

What are the clinical signs of lung cancer ?

Answer 5

Chest signs 
Nail clubbing
Lymphodenopathy
Horner's syndrome
Pancoast tumour
SVC obstruction
Hepatomegaly
Skin nodules (metastasis)

Question 6

What are the initial investigations for lung cancer ?

Answer 6

CXR
FBC
Renal, liver functions and calcium
Clotting screen
Spirometry

Question 7

What investigations are used for staging ?

Answer 7

CT thorax and abdomen

Question 8

What are the tissue diagnosis tissue investigations ?

Answer 8

Bronchoscopy (most common)
EBUS
Image guided lung biopsy
Image guided liver biopsy 
FNA of neck node or skin metastasis
Excision of cerebral metastasis
Bone biopsy
Mediastinoscopy/otomy
Surgical excision biopsy

Question 9

Which types of lung cancer have high associations with smoking ?

Answer 9

Squamous cell and small cell carcinoma

Question 10

What does prognosis depend on ?

Answer 10

Staging and cell type

Question 11

What is prognosis like for small cell carcinoma and adenocarcinoma?

Answer 11

Small cell = bad

Adenocarcinoma = good

Question 12

What is the point in a PET scan ?

Answer 12

To determine micrometastasis in all parts of the body

Question 13

What are the considerations for treatment decision ?

Answer 13

Performance status:
- measure of how fit a patient is and will give an idea of how well they will respond to
treatment
Patient wishes
Histological type and stage
MD team
Aims of treatment e.g. Radical or palliative

Question 14

How is performance status determined ?

Answer 14

0= fully active
1= symptoms but ambulatory
2=' up and about' >50%, unable to work
3=' up and about' <50%, limited self care 
4=  bed or chair bound

Question 15

What are the surgical options for lung cancer treatment ?

Answer 15

Surgery ~ 18% of patients
Wedge resection
Lobectomy
Pneumonectomy

Question 16

What are the radiotherapy options for treatment ?

Answer 16

Radiotherapy:

- radical
- palliative 
- stereotactic

Question 17

What are the chemotherapy options for treatment ?

Answer 17

Chemotherapy:

- part of radical or palliative treatment
- alone, combined with radiotherapy, adjuvant (after surgery)
- targeted agents e.g. tyrosine kinase inhibitors and monoclonal antibodies 
- small cell e.g. cisplatin/ etoposide 
- adenocarcinoma e.g. cisplatin/ pemetrexed
- squamous e.g. cisplatin/ gemcitabine

Question 18

How can palliative management control symptoms ?

Answer 18

Chemotherapy
Radiotherapy e.g. Pain, haemoptysis
Opiates, bisphosphateases, benzodiazepines
Treatment of hypercalcaemia, dehydration, hyponatraemia

Question 19

What does palliative management apart from symptom control exists ?

Answer 19

Quality of life
Community support
Decisions and planning, resuscitation status, end of life care
MDT including lung cancer nurse and hospice