Lung Cancer

Question 1

1. What clinical features can be seen in lung cancer?

2. When would hoarseness be caused by lung cancer?

Answer 1

1. • cough - haemoptysis
   • dyspnoea
   • chest pain
   • weight loss + anorexia
   • superior vena cava obstruction

exam findings: 
- fixed monomorphic wheeze 
- supraclavicular / cervical 
lymphadenopathy
clubbing 

2. when pancoast tumours press on the recurrent laryngeal nerve

Question 2

What paraneoplastic features can be seen with the following lung cancer types:

1. small cell
2. squamous cell
3. adenocarcinoma

Answer 2

1. • ADH secretion (leads to hyponatraemia)
   • ACTH secretion
     
     • hyperglycaemia
     • hypertension
     • alkalosis
     • muscle weakness
     • hypokalaemia
   • Lambert-Eaton syndrome (difficulty walking, muscle tenderness)
2. • PTH-rp (therefore hypercalcaemia)
   • clubbing
   • TSH (therefore hyperthyroidism)
   • hypertrophic pulmonary osteoarthropathy (will get pain in the long bones)
3. • gynaecomastia
   • hypertrophic pulmonary osteoarthropathy

Question 3

What investigations can be done in lung cancer?

Answer 3

• contrast enhanced CT > CXR but CXR can be done first
• bronchoscopy with biopsy for discovering pathology after CT
• PET scan for mets (local and distant) in non-small cell cancer
• FBC may show increased platelets

Question 4

Non-small cell management

1. How many get surgery?
2. What is likely to be offered?
3. What is often done before surgery?
4. What are the contraindications to surgery?

Answer 4

1. 20%
2. radiotherapy (curative or palliative
   - > NSCLC does not respond to chemo
3. mediastinoscopy - to assess for nodal metastasis
4. • stage 3b or 4 (mets)
   • vocal cord paralysis
   • SVCO
   • tumour near hilum
   • pleural effusion
   • FEV1 < 1.5L

Question 5

Lung cancer referral

1. When should you refer someone urgently?
2. When should you order an urgent chest x-ray?
3. When should you consider a CXR?

Answer 5

1. • CXR suggesting lung cancer
   • > 40 and unexplained haemoptysis

2. 
>40 and any 2 of the following 
- cough 
- dyspnoea 
- chest pain 
- weight loss OR anorexia 
- fatigue 
- smoker 

3. > 40 years old and one of
   - clubbing
   - supraclavicular or persistent cervical lymphadenopathy
   - persistent / recurrent chest infection
   - chest findings suggestive of lung cancer
   - thrombocytosis

Question 6

How is small cell lung cancer most commonly treated?

radical or palliative

Answer 6

chemo +/- radiotherapy

Question 7

Lung Cancer types

1. What is the most common type of lung cancer?
2. Which type of cancer is associated with sputum production?

Answer 7

1. adenocarcinoma
   - > accounts for over half of cancers in never-smokers
2. alveolar cell carcinoma