Clinical Features of Lung Cancer

Question 1

What are risk factors for lung cancer?

Answer 1

Smoking (85%)
Passive smoking
Exposure to asbestos, radon, air pollution

Question 2

List symptoms

Answer 2

Cough > 3 weeks  
Haemoptysis (endobronchial tumour)
Wheeze 
Chest pain 
Chest infections 
Difficulty swallowing
Hoarse voice 
SOB 
Weight loss

Question 3

What are some symptoms of advanced metastatis lung cancer?

Answer 3

Bone pain 
Paraesthesia 
Ataxia 
Dizziness 
Anaemia
Hypercalcaemia 
Thrombosis

Question 4

What are clinical signs of lung cancer?

Answer 4

Nail clubbing
Lymphadenopathy 
Horner's syndrome (pupil constriction)
Pancoast tumour
SVC obstruction 
Hepatomegaly 
Skin nodules (metastases)

Question 5

What is a pan coast tumour and how can it present?

Answer 5

Tumour of apex of the lungs, it might put pressure on or damage a group of nerves that runs from the upper chest into your neck and arms

Question 6

Initial investigations carried out

Answer 6

CXR
FBC - anaemia 
U+Es
LFT
Biochem - Ca increase, Na decrease 
Clotting screen (normal = not PE)
Spirometry

Question 7

Can a CXR diagnose lung cancer?

Answer 7

No, it is a screening test

Question 8

What test is used for staging cancer?

Answer 8

CT and CT-PET

Question 9

What investigations are used for tissue diagnosis?

Answer 9

Bronchoscopy
Endobronchial ultrasound (EBUS)
Image guided lung/liver biopsy
Fine needle aspiration of neck nodes or skin
Excision of cerebral metastases
Bone biopsy
Mediastinoscopy/otomy
Surgical excision biopsy

Question 10

What is classification is used to stage tumours?

Answer 10

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

Question 11

Define stages of T classification

Answer 11

Tx - malignant cells in bronchial secretion
Tis - carcinoma in situ
T1 - < 3cm in distal airway
T2 - > 3cm and 2cm form carina
T3 - > 7cm and invasion to chest was, diaphragm, mediastinal pleura
T4 - invasion to mediastinum, heart, great vessels, trachea, vertebrae, oesophagus

Question 12

Define stages of N classification

Answer 12

N0 - No node involvement
N1 - involves ipsilateral hilar
N2 - involves ipsilateral mediastinal nodes
N3 - involves contralateral mediastinal or hilar nodes

Question 13

Define stages on M classification

Answer 13

M0 - no distant metastases

M1 - distant m present

Question 14

How can tumour be staged from CT scan?

Answer 14

Size 
Mediastinal nodes 
Metastatic disease
Pleural/pericardial effusion 
Diaphragmatic involvement

Question 15

How can MRI help stage tumour?

Answer 15

Determines degree of vascular and neurological involvement in pancoast tumour

Question 16

How can bone scan help stage tumour?

Answer 16

Chest wall invasion and bony metastasis

Question 17

How can echo help stage tumour?

Answer 17

Show presence of pericardial effusion

Question 18

What is treatment dependent on?

Answer 18

Performance status
Patient wishes
Histological types and stage
Aims of treatment i.e. radical or palliative

Question 19

What surgery types are available?

Answer 19

Wedge resection
Lobectomy
Pneumonectomy

Question 20

What types of radiotherapy are available?

Answer 20

Radical
Palliative
Stereotactic

Question 21

What is chemo used for in treatment?

Answer 21

Radical or palliative treatment 
Alone, with radiotherapy, adjuvant (after surgery)
Small cell 
Adenocarcinoma 
Squamous

Question 22

What can be used for palliative treatment?

Answer 22

Chemo
Radiotherapy
Opiate, bisphosphonates, benzodiazepines
Treatment of hypercalcaemia, dehydration, hyponatraemia