clinical features and staging of lung cancer

Question 1

what are the risk factors for lung cancer?

Answer 1

-smoking
-passive smoking
-environmental factors:
asbestos
radon
air pollution
diesel exhaust

Question 2

what is the relationship between smoking and environmental factors such as asbestos in lung cancer development?

Answer 2

synergistic

Question 3

what are the local pressure effects of lung cancer?

Answer 3

• chronic coughing
• SOB
• wheeze
• chest and bone pain
• haemoptosis

Question 4

what is a local pressure effect?

Answer 4

an symptom causes directly by the lung cancer (opposite of a systemic effect)

Question 5

what are the main symptoms of lung cancer?

Answer 5

• chronic cough (>3 weeks)
• wheeze
• chest and bone pain
• recurrent chest infection
• difficulty swallowing
• raspy, hoarse voice
• shortness of breath
• unexplained weight loss
• nail clubbing

Question 6

what are the symptoms of metastases to the bones?

Answer 6

bone pain

Question 7

what are trhe symptoms of compression on the spinal chord by a tumour?

Answer 7

limb weakness
paraesthesia
bladder/bowel dysfunction

Question 8

what are the symptoms of cerebral metastases?

Answer 8

• headache
• vomiting
• dizziness
• ataxia (lack of voluntary coordination of muscle movements)
• focal weakness

Question 9

what may metastases cause in the cvs?

Answer 9

thombosis

Question 10

what are paraneoplastic syndromes?

Answer 10

clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease.

Question 11

what are some paraneoplastic effects of lung cancers?

Answer 11

anaemia
hypercalcaemia
hyponatraemia (low sodium content in the blood)

Question 12

what are the clinical signs of lung cancer?

Answer 12

chest signs
clubbing
lymphadenopathy
Horner's syndrome
pancoast tumour
SVC obstruction
hepatomegaly
skin nodules (metastases)

Question 13

what are the initial investigations carried out for lung cancer?

Answer 13

• CXR
• FBC
• Renal, Liver functions
and Calcium
• Clotting screen
• Spirometry

Question 14

why is a CXR carried out if LC is suspected?

Answer 14

to check for any abnormallities such as masses

Question 15

why is a FBC carried out if LC is suspected?

Answer 15

to check for anaemia

Question 16

why is a renal function carried out if lung cancer is suspected?

Answer 16

good renal function is essential for a contrast CT to be carried out

Question 17

why is a calcium test carried out if lung cancer is suspected?

Answer 17

in lung cancers calcium levels are often elevated

Question 18

what is the investigation carried out after an abnormality is discovered on the CXR? why is it done?

Answer 18

CT or PET CTscan

to stage the cancer

Question 19

what investigations are done after the CT scan?

Answer 19

tissue diagnosis:

• bronchoscopy
• ebus
• image guidedlung biopsy
• image guided liver biopsy
• fine needle aspiration of neck node or skin metastases
• excision of cerebral metastasis
• bone biopsy
• mediastinoscopy/otomy
• surgical excision biopsy

Question 20

what is the most common type of lung cancer? it also has the best prognosis

Answer 20

adenocarcinoma

Question 21

what is radical treatment of lung cancer?

Answer 21

treatment with the intent to cure

Question 22

what is palliative treatment?

Answer 22

treatment with the intent to improve quality of life, not cure.

Question 23

what must be taken into account before treatment is started?

Answer 23

• performance status
• patient’s wishes
• histological type and stage
• the aims of treatment, radical or palliative

Question 24

what is a performance status of 0?

Answer 24

fully active

Question 25

what is a performance status 1?

Answer 25

symptoms but ambulatory (able to walk)

Question 26

what is a performance status of 2?

Answer 26

up and about for >50% of the day but unable to work

Question 27

what is a performance status of 3?

Answer 27

up and about <50% of the day and limited self care

Question 28

what is a performance status if 4?

Answer 28

bed or chair bound