Lung cancer

Question 1

How common is lung cancer?

Answer 1

It is third most common cancer in the UK. Around 30%-35% are adenocarcinoma (peripheral), 30% are squamous.

Question 2

What is the most common type of lung cancer?

Answer 2

Adenocarnioma is taking over from squamous

Question 3

Where are adenocarcinomas and squamous carcinomas found?

Answer 3

Adenocarcinoma is peripheral.

Central = squamous

Question 4

What are the red flags of lung cancer?

Answer 4

 Cigarette smoking is a major risk factor
 Associated with pre-existing COPD
 A prolonged unexplained cough raises suspicion
 Haemoptysis is associated (as in many other lung disease too)
 Back pain could indicate spinal metastases
 Weight loss is as a result of paraneoplastic consequences

Question 5

What is the two groups of emphysema?

Answer 5

Centrolobular - smoking

Panlobular - alpha1 antitrypsin

Question 6

What are the paraneoplastic conditions of lung cancer?

Answer 6

1. Squamous
   (please take care)
   PTHrp associated hypercalcemia
   TSH secretion - hyperthyroidism
   Clubbing
2. Small cell (kulchitsky)
   (sal)
   SIADH release
   ACTH release
   Lambert eaten
3. Adenocarcinoma
   gynecomastia

Question 7

What are the tests/ investigations for lung cancer?

Answer 7

CXR

PET

CT-guided biopsy

Surgical biopsy

EBUS - TBNA - endobronchial ultrasound - tissue biopsy needle aspiration

Bronchoscopy

Question 8

What is EBUS - TBNA?

Answer 8

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA)

Question 9

What constitutes an immediate referral?

Answer 9

Complications like SVCO

Lower limb weakness

Stridor

Question 10

What constitutes a 2 week wait?

Answer 10

 A normal CXR where there is a high suspicion of lung cancer
 A history of asbestos exposure and recent onset of chest pain,
shortness of breath or unexplained systemic symptoms where a
CXR indicates pleural effusion, pleural mass or any suspicious
lung pathology.

Question 11

What are some features of lung cancer?

Answer 11

Haeomptysis, dysponea, dysphonia

Question 12

What are the complications of lung cancer?

Answer 12

Question 13

How might lung cancer be treated? (RCT)

Answer 13

 Radiotherapy
 Offered to those not suitable for surgery with stage I-III disease or
post-operative patients with incomplete resection
 Need lung function tests also
 Chemotherapy
 For Stage III-IV to improve disease control and quality of life
 First line usually for Small Cell Carcinoma
 Patients with SCLC should be offered multi-drug regimens
 Targeted (biological) therapies
 Growth inhibitors eg. EGFR inhibitors (tyrosine kinase inhibitors)
 Monoclonal antibodies eg. Bevacizumab

Question 14

What is the staging criteria?

Answer 14

T(0-4)

N (0-4)

M(0-1)

Question 15

Where does lung cancer metastasise to?

Answer 15

Breast bone POCket

Breast

Bone

Prostate

Ovary

Colon