Clinical Features of Lung Cancer

Question 1

Which type of cancer is the leading cause of cancer death

Answer 1

Lung cancer

Question 2

How many cancer deaths are from lung cancer?

Answer 2

1 in 5

Question 3

How many lung cancers can be attributed to smoking?

Answer 3

> 85%

Question 4

List the direct and indirect clinical features of lung cancer

Answer 4

Direct
•Chronic cough (>3 weeks)
•Coughing up blood
•Wheeze
•Chest & bone pain
•Chest infections

Indirect
•Difficulty swallowing (tumour pressing o oesophagus)
•Raspy, hoarse voice (recurrent laryngeal nerve)
•Shortness of breath (secondary PE)
•Unexplained weight loss
•Nail clubbing

Question 5

What are the clinical signs associated with lung cancer?

Answer 5

• Chest signs
• Clubbing
• Lymphadenopathy (esp in the neck)
• Horner’s syndrome
• Pancoast tumour
• Superior vena cava obstruction (neck swelling and dilated vessels in upper arms)
• Lymphadenopathy
• Hepatomegaly
• Skin nodules (metastases)
• Neurological symptoms (mets to the CNS)

Question 6

What would you expect to see in a patient who has spinal cord compression as a result of metastatic cancer?

Answer 6

Limb weakness
paraethesia
Bladder/bowel dysfunction

Question 7

What initial investigations that should be ordered for patient with suspected lung cancer?

Answer 7

1. CXR
2. FBC (including renal function, liver function and calcium)
3. Clotting screen
4. Tissue biopsy (lung, lymph node, liver, bone as appropriate)

Question 8

If the tumour is accessible via the bronchi, what can be used to take a biopsy?

Answer 8

bronchoscopy

Question 9

What is EBUS?

Answer 9

The method used to take a sample of the lymph nodes around the bronchi taken using a probe and ultrasound guidance

Question 10

What method is used to take a biopsy if the lesion is deeper in the lung?

Answer 10

Image guided lung biopsy

Question 11

What method is used to take a liver biopsy?

Answer 11

Image guided liver biopsy

Question 12

What method is used to take a biopsy of neck nodes or skin lesions?

Answer 12

Fine needle aspiration

Question 13

What are the most common types of lung cancer

Answer 13

Adenocarcinoma (40%)
Squamous cell carcinoma (30%)
Small cell carcinoma (15%)
Large cell carcinoma (10%)

Question 14

What are the three aspects considered when staging a tumour?

Answer 14

T- Tumour size

N- Nodal Status (N0-N4)

M- distant metastasis (M0, M1A, M1B)

Question 15

Explain the 1-4 scoring system used to assess the performance status of a patient

Answer 15

0= fully active

1= Symptoms but ambulatory

2= “Up and about” >50% of the time, unable to work

3= “up and about” <50% of the time, limited self-care

4= Bed/chair bound

Question 16

Which 5 factors are considered when making lung cancer treatment decisions

Answer 16

1. performance stats of the patient
2. patient’s wishes
3. Histological type and stage
4. Multidisciplinary team options
5. Aims of treatment (radical or palliative)

Question 17

Name the three types of surgery that can be used to treat lung cancer if appropriate

Answer 17

Wedge resection
Lobectomy
Pneumonectomy

Question 18

What chemotherapy is used to treat small cell lung cancer?

Answer 18

cisplatin/etoposide

Question 19

What chemotherapy is used to treat adenocarcinoma?

Answer 19

cisplatin/pemetrexed

Question 20

What chemotherapy is used to treat squamous cell lung cancer?

Answer 20

cisplatin/gemcitabine

Question 21

Which drugs are used to manage generalised pain in palliative cancer patients?

Answer 21

Opiates

Question 22

Which drugs are used to manage bone pain in palliate cancer patients?

Answer 22

Bisphosphonates

Question 23

What drugs are used to manage anxiety in palliative cancer patients?

Answer 23

Benzodiazepines