Clinical features and staging

Question 1

What are the symptoms of lung cancer? (10)

Answer 1

Chronic cough
Coughing up blood
Wheezing
Chest and bone pain
Chest infections
Difficulty swallowing
Raspy, hoarse voice
SOB
Unexplained weight loss
Nail clubbing

Question 2

What are some metastatic symptoms of lung cancer?

Answer 2

Bone pain
Spinal cord compression
Cerebral metastasis
Thrombosis

Question 3

What are some symptoms of spinal cord compression?

Answer 3

Limb weakness
Paraesthesia
Bladder/bowel dysfunction

Question 4

What are symptoms of cerebral metastasis?

Answer 4

Headache
Vomiting
Dizziness
Ataxia
Focal weakness

Question 5

What are some symptoms of paraneoplastic?

Answer 5

Hyponatraemia
- SIADH
Anaemia
Hypercalcaemia
- Parathyroid hormone related protein
- Bone metastasis
Dermatomyositis/polymyositis
- Proximal muscle weakness
Eaton-Lambert syndrome
- Upper limb weakness
- Cerebral ataxia
- Sensorimotor neuropathy

Question 6

What are some clinical signs of lung cancer?

Answer 6

Chest signs
- Absent breathing
- Crackling/unusual signs
Finger clubbing
Lymphadenopathy
Horner’s syndrome
Pancoast tumour
- Tumour in apex of lung infiltrate sympathetic chain&raquo_space;> causes sweating problems
Superior vena cava obstruction
Lymphadenopathy
Hepatomegaly
Skin nodules

Question 7

What are some risk factors of lung cancer?

Answer 7

Smoking
Passive smoking
Exposure to asbestos, radon, air pollution, diesel exhaust, arsenic

Question 8

When do you order a CT?

Answer 8

If patient has had a chronic cough for > 3 weeks
OR
Red flag symptoms
- Haemoptysis

Question 9

Why do a full blood cell count?

Answer 9

To look for anaemia
Platelets and WBC count

Question 10

What other tests must you do if suspected lung cancer?

Answer 10

Renal, liver function tests
Calcium
Clotting screen
Spirometry
CT
Tissue diagnosis

Question 11

What do a calcium test?

Answer 11

Lung cancer can cause hypercalcaemia

Question 12

Why do a renal function test?

Answer 12

In order to get a CT patient needs good renal function

Question 13

What are the means to get a tissue sample for tissue diagnosis?

Answer 13

*Bronchoscopy
*EBUS
Image guided lung biopsy
Image guided liver biopsy
FNA or neck node metastasis
Excision of cerebral metastasis
Bone biopsy
Mediastinoscopy/otomy
Surgical excision biopsy

• = common

Question 14

What things are discussed in an MDT meeting?

Answer 14

Treatment decisions
- Performance status
- Patient wishes
- Histological type and stage
- Aims of treatment
Treatment options
Palliative management

Question 15

What are the treatment options for lung cancer patients (summary)?

Answer 15

Surgery
Radiotherapy
Chemotherapy
Best supportive care
Co-ordination

Question 16

What are the key aspects of palliative management?

Answer 16

Symptoms control
Quality of life
Community support
Decision and planning
- DNACPR
- End of life care plan
MDT including lung cancer nurse and hospice

Question 17

What are some means of symptom control in palliative care?

Answer 17

Chemotherapy
Radiotherapy
Opiated, bisphosphonates, benzodiazepines
Treatment of hypercalcaemia, dehydration, hyponatraemia