Lung Cancer

Question 1

What are the most common cancers in the uk?

Answer 1

1) Breast
2) Prostate
3) Lung cancer

Question 2

What is the biggest cause of lung cancer?

Answer 2

Smoking

Question 3

What are the different types of lung cancers?

Answer 3

Non-small cell lung cancers (80%)
> Adenocarcinoma (40%)
> Squamous cell carcinoma (20%)
> Large cell carcinoma (10%)
>Others (10%)

Small cell lung cancer (20%)

Question 4

What signs and symptoms indicate lung neoplasm?

Answer 4

• SOB
• Cough
• Haemoptysis
• Finger clubbing
• Weight loss
• Recurrent pneumonia
• Lymphadenopathy - supraclavicular lymph nodes

Other paraneoplastic features
- Small Cell Lung Cancer
> Hyponatremia - SIADH
> Cushing’s syndrome - ectopic ACTH
> Lambert-Eaton Syndrome - Abs against vgCa2+ channels in presynaptic motor neurone - weakness of proximal muscles, diplopia (intraocular muscle), slurred speech, dysphagia (pharyngeal muscles), levator muscles (ptosis). Also show autonomic dysfunction (dry mouth, blurred vision, impotence, dizziness) and post-tentanic potentiation (improvement in reflexes after maximal contraction)
> Limbic encephalitis - anti-Hu antibodies - confusion, seizures, memory impairment, hallucinations

• Squamous cell carcinoma
  > Hypercalcaemia -> PTH-r protein secretion
  > Hypertrophic pulmonary osteoarthropathy (HPOA)
• Adenocarcinoma
  > Gynaecomastia
  > HPOA

other paraneoplastic features include:

• pancoast tumor - Horner’s syndrome (anhidrosis, mitosis, partial ptosis)
• hemidiaphragm - phrenic nerve palsy
• SVC obstruction - Pemberton’s sign (facial swelling, difficulty breathing and distended veins whilst raising arm up)

Question 5

What is the first line investigation for a lung neoplasm?

What features would indicate a lung cancer via this first line investigation?

What other investigations can be carried out for a lung neoplasm?

Answer 5

1) Chest X ray is the first line investigation

Findings

• Hilar lymphadenopathy
• Peripheral opacity
• Pleural effusion - unilateral in lung cancers
• Lung collapse

2) Contrast-enhanced CT of CAP to assess staging of cancer and lymph node involvement.
3) PET-CT - to assess for metastasis
4) Bronchoscopy with endobrochial ultrasound (EBUS) –> for better definition of the tumor and for biopsy purposes

Histological diagnosis required

• percutaneously
• bronchoscopy

Question 6

What are the treatment options for lung cancers?

Answer 6

Non-small cell lung cancer
> Surgery (lobectomy, wedge resection, segmentectomy) normally curative.
> Radiotherapy if caught early
> Chemotherapy - palliative - later stages of disease

Small cell lung cancer
> Radiotherapy + chemotherapy
> Poorer prognosis

Endobronchial treatment with stents or debunking to relieve bronchial obstruction for palliative purposes.

Question 7

What is mesothelioma due to?

Answer 7

Abestosis

Delayed onset (huge latent period of up to 45 years)

Very poor prognosis (8-14 months)

Palliative therapy, but chemotherapy may help to improve survival