Clinical features and staging of lung cancer

Question 1

How many cancer deaths are due to lung cancer?

Answer 1

1 in 5, most common cancer in both sexes

Question 2

What % of lung cancers are associated with smoking?

Answer 2

85%

Question 3

What are the risk factors for lung cancer?

Answer 3

Smoking
Passive smoking
Asbestos
Genetics

Question 4

What are the symptoms of lung cancer?

Answer 4

Cough >3 weeks
Haemoptysis
Wheeze
Chest and bone pain
Weight loss
Chest infections
Difficulty swallowing
Paraesthesia in upper limbs
Raspy hoarse voice
SOB
Nail clubbing

Question 5

What are some symptoms of advanced metastatis lung cancer?

Answer 5

Bone pain
Weakness of the limbs 
Paraesthesia
Bladder/bowel dysfunction
Headache
Vomiting
Dizziness
Ataxia
Vocal weakness
Thrombosis

Question 6

What are some paraneoplastic symptoms of advanced lung cancer?

Answer 6

Hyponaetraemia - SIADH
Anaemia
Hypercalcaemia
Dermatomyositis/polymyositis
Eaton-Lambert syndrome 
Cerebral ataxia
Sensorimotor neuropathy

Question 7

What is SIADH?

Answer 7

Syndrome of inappropriate ADH secretion, leading hyponatraemia, hypoosmolality and impaired water secretion

Question 8

What is Eaton-Lambert syndrome?

Answer 8

Weakness of upper limbs

Question 9

What are the clinical signs of lung cancer?

Answer 9

Clubbing
Chest signs
Lymphadenopathy
Horners syndrome
Pancoast tumours
Superior vena cava obstruction
Hepatomegaly
Skin nodules

Question 10

What is Horners syndrome?

Answer 10

Signs and symptoms of disruption of nerve pathway, particularly the sympathetic ganglion, from the brain to the face and eye on one side, leading to decreased pupil size, decreased sweating on the side of the face affected

Question 11

What is a pancoast tumour?

Answer 11

Found in pulmonary apex, usually in NSCLC, which can cause compression of brachiocephalic vein, recurrent laryngeal nerves, vagus nerves or the sympathetic ganglion (leading to Horners syndrome)

Question 12

What investigations are used for lung cancer?

Answer 12

CXR
CT
FBC - anaemia common in cancer
Renal and liver function tests
Calcium levels
Clotting screen - clotting normal = not PE
Spirometry - patient fitness
Bronchoscopy
Endobronchial ultrasound
Image guided lung and liver biopsy
Fine needle aspiration of neck nodes or skin
Excision of cerebral metastases
Bone biopsy
Mediastinoscopy/otomy
Surgical excision biopsy

Question 13

What are the 4 types of lung cancer, their origin and their relative frequencies?

Answer 13

Squamous - 30%, epithelial cells
Adenocarcinoma - 27-40%, glands
Large cell - 10-15%, poorly differentiated
Small cell - 15-20%, neuroendocrine cels

Question 14

How do you stage tumours?

Answer 14

TNM classification
T - size of primary tumour and its invasion
N - lymph node involvement
M - distant metastasis

Question 15

How many people with stage I lung cancer are alive at the end of year 1?

Answer 15

90%

Question 16

How many people with stage II lung cancer are alive at the end of year 1?

Answer 16

85%

Question 17

How many people with stage III lung cancer are alive at the end of year 1?

Answer 17

50%

Question 18

How many people with stage IV lung cancer are alive at the end of year 1?

Answer 18

24%

Question 19

At what stage can we offer curative treatments?

Answer 19

stage 1 and 2

Question 20

What type of lung cancer usually has better prognoses?

Answer 20

Adenocarcinoma

Question 21

What type of lung cancer usually has the worst prognoses?

Answer 21

Small cell

Question 22

What imaging techniques are useful in investigations and staging?

Answer 22

CXR
CT/MRI
PET scans and glucose analogs

Question 23

How do we rank performance status from 0-4?

Answer 23

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

Question 24

What % of patients undergo surgery?

Answer 24

18%

Question 25

Describe palliative treatment for lung cancer

Answer 25

Chemo/radio
Opiates or other analgesics
Bisphosphonates (prevents bone loss)
Anti-emetics
Treat hypercalcaemia, dehydration etc