Lung Cancer

Question 1

Define Lung cancer

Answer 1

Cancer arising in the epithelium of the air passages (bronchial) or lung. Classified as small cell lung cancer (SCLC) or non-small cell cancer (NSCLC)

Question 2

What is the difference between small cell and non-small cell lung cancer

Answer 2

Small-cell lung cancer (SCLC) – 15%
Small densely packed cells, scant cytoplasm, absence of nucleoli
Associated with SIADH and ectopic ACTH + Lambert-Eaton syndrome

Non-small cell lung cancer (NSCLC) – 85%
Adenocarcinoma (40%) – tend to be located more peripherally, associated with non-smokers
Squamous cell carcinoma (30%) – tend to involve central airways, metastasise later in disease course
Large cell carcinoma (15%) – tend to arise centrally, undifferentiated tumours without histological features of above

Question 3

Risk factors for Lung Cancer

Answer 3

Cigarette smoking
Passive smoking
Asbestos
Chromium, arsenic, iron oxides
Radiation

Question 4

Epidemiology of Lung cancer

Answer 4

Second most common cancer in the UK

Incidence 60% higher in men

Question 5

Symptoms of Lung Cancer

Answer 5

Cough (80%) - persistent
Haemoptysis 
Dyspnoea 
Chest pain 
Recurrent or slowly resolving pneumonia 
Lethargy, Anorexia, Weight loss
Dysphagia 
Wrist pain (pulmonary osteoarthropathy)

Mets to: brain, bone, liver, lymph

Question 6

Signs of Lung cancer on examination

Answer 6

Cachexia
Anaemia
Clubbing (esp. SqCC)
Supraclavicular or axillary nodes
Signs of consolidation, collapse, pleural effusion (wheeze, crackles, reduced breath sounds, dullness to percussion)

Cervical or supraclavicular adenopathy (regional spread to hilum and mediastinum, then to supraclavicular fossae and cervical chains)
Horner’s
Facial swelling
Dilated neck or chest abdominal wall veins (SVC compression)
Gynaecomastia (adenocarcinoma)

Question 7

Investigations for Lung Cancer

Answer 7

CXR: central mass | hilar enlargement | lymphadenopathy | pleural effusion | consolidation | lung collapse
CT contrast chest: massive lymphadenopathy and tumour visualisation + staging (CAP)
Bronchoscopy ± biopsy: lesion + confirmation of a malignancy

Sputum cytology: malignancy cells

U+Es: ?SIADH

Bone scan: ?mets
PET: ? mets

Thoracentesis: for pleural effusion -> malignant cells found
Thoracoscopy: pleural involvement