clinical features and staging of lung cancer

Question 1

what are the ten signs and symptoms of lung cancer

Answer 1

chronic cough
coughing up blood 
wheezing
chest and bone pain 
chest infections 
difficulty swallowing 
raspy hoarse voice 
shortness of breath 
unexplained weight loss 
nail clubbing

Question 2

what are the metastatic symptoms

Answer 2

bone pain
spinal cord compression - limb weakness, paraesthesia, bladder/bowel dysfunction
cerebral metastases - headache, vomiting, dizziness, ataxia , focal weakness
thrombosis

Question 3

what are paraneoplastic symptoms

Answer 3

hypoatraemia - SIADH 
anaemia 
hypercalcaemia 
- parathyroid hormone related protein 
- bone metastases 
dermatomyositis/polymyositis 
- proximal muscle weakness 
eaton lambert syndrome 
- upper limb weakness 
cerebellar ataxia 
sensorimotor neuropathy

Question 4

what are clinical signs of lung cancer

Answer 4

chest signs 
clubbing
lymphadenopathy 
horners syndrome 
pancoast tumour 
superior vena cava obstruction 
lymphadenopathy 
hematomegaly 
skin nodules (metastases)

Question 5

what initial investigation are done

Answer 5

CXR 
FBC
renal, liver functions and calcium 
clotting screen 
spirometry

Question 6

what investigations are done for tissue diagnosis

Answer 6

bronchoscopy 
EVUS 
imagine guided liver and lung biopsy 
FNA of beck node or skin metastasis 
excision of cerebral metastasis 
bone biopsy 
mediastinoscopy/otomy 
surgical excision biopsy

Question 7

how is patient performance measured

Answer 7

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

Question 8

what treatment options if there

Answer 8

surgery - around 18% of patients

• wedge resection
• lobectomy
• pneumonectomy

radiotherapy

• radical
• palliative
• stereotactic

chemotherapy

• part of radical or palliative
• can be alone or combined w radiotherapy
• small cell
• adenocarcinoma
• squamous

best supportive care

coordination

Question 9

what are the palliative management options

Answer 9

symptom control

• chemo
• radiotherapy
• opiates
• treatment of hypercalcaemia, dehydration and hypotraemia

quality of life
community supprt
decisions and planning, resuscitation status, end of life care
multidisciplinary team including cancer nurse and hospice