Clinical Features of Lung Cancer and Staging

Question 1

Risk factors for lung disease

Answer 1

• Smoking (more than 85%)
• Passive smoking
• Exposure to Asbestos, Radon, air pollution and diesel exhaust

Question 2

10 Clinical features - symptoms of lung cancer

Answer 2

1. Chronic coughing
2. Coughing up blood
3. Wheezing sound
4. Chest and bone pain
5. Chest infections
6. Difficulty swallowing
7. Raspy, hoarse voice
8. Shortness of breath
9. Unexplained weight loss
10. Nail clubbing

Question 3

Clinical signs of lung cancer

Answer 3

• Chest signs
• Clubbing
• Lymphadenopathy
• Horner’s syndrome
• Pancoast tumour
• Superior vena cava obstruction
• Lymphadenopathy
• Hepatomegaly
• Skin nodules (metastases)

Question 4

Initial GP investigations for lung cancer

Answer 4

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

Question 5

Staging in Lung cancer

Answer 5

T and M
Nodes (N)
Stages (1-4)
CT and CT-PET

Question 6

Treatment decisions for lung cancer

Answer 6

• Performance status
• Patient wishes
• Histological type and stage
• Multidisciplinary team
• Aims of treatment e.g. radical or palliative

Question 7

Performance status for lung cancer

Answer 7

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

Question 8

Treatment for lung cancer

Answer 8

• Surgery
  
  • Wedge resection
  • Lobectomy
  • Pneumonectomy
• Radiotherapy
  
  • Radical
  • Palliative
  • Stereotactic
• Chemotherapy
  
  • Part of radical or palliative treatment
  • Alone, combined with radiotherapy, adjuvant (after surgery)
  • Targeted agents e.g Tyrosine Kinase Inhibitors and monoclonal antibodies
    
    • erlotinib, gefitinib, crizotinib
  • Small cell e.g. cisplatin/etoposide
  • Adenocarcinoma e.g. cisplatin/pemetrexed
  • Squamous e.g. cisplatin/gemcitabine
• Best supportive care
• Co-ordination – Lung Cancer Specialist Nurse

Question 9

Palliative management for lung cancer

Answer 9

• Symptom control
  ~ May include chemotherapy
  ~ May include radiotherapy e.g. pain, haemoptysis
  ~ Opiates, Bisphosphonates, Benzodiazepines
  ~ Treatment of hypercalcaemia, dehydration, hyponatraemia
• Quality of life
• Community support
• Decisions and planning, resuscitation status, end of life care
• Multidisciplinary team including lung cancer nurse and
  hospice