Lung cancer

Question 1

What is lung cancer the biggest cause of

Answer 1

Cancer related death

Question 2

What is the 5 year survival rate ?

Answer 2

approximately 16%

Question 3

What percentage of LC in the Uk is caused ny smoking ?

Answer 3

72%

Question 4

Risk factors for LC?

Answer 4

• Large number of smoking pack years
• Airflow obstruction
• Increasing age
• Family history of lung cancer
• Exposure to other carcinogens, e.g. asbestos

Question 5

Differentials ?

Answer 5

Pneumonia

Bronchiectasis

Atelectasis

Asthma

COPD

Question 6

Symptoms ?

Answer 6

• Asymptomatic, incidental finding
• Any respiratory symptom/systemic deterioration
• Superior Vena Caval Obstruction
• Horner’s syndrome- Apical lung tumour
• Increased risk of thrombo-embolic disease

Question 7

What resp symptoms or systemic point towards lung cancer ?

Answer 7

• Any resp symptom eg. SOB, cough, chest pain
• weight loss
• fatigue
• night sweats

Question 8

Performance status- indication of patient’s level of fitness- how is this assessed 0-5

Answer 8

• 0 Normal - Fully active without restriction
• 1- Restricted in physically strenuous activity but
  ambulatory and able to carry out light work e.g.,
  light house work, office work
• 2- Ambulatory and capable of all self-care but
  unable to carry out any work activities. Up and
  about more than 50% of waking hours
• 3 Capable of only limited self-care, confined to
  bed or chair more than 50% of waking hours
• 4 Completely disabled. Cannot self-care. Totally
  confined to bed or chair
• 5 Dead

Question 9

Diagnostic tests

Answer 9

• Bloods – FBC, U&E, Calcium, LFT’s, INR
• CXR
• Staging CT – Spiral CT Thorax and Upper Abdo- helps to stratify TNM stage
• Histology- classification
• PET Scan

Question 10

Histology classification of cancer

Answer 10

Classified primarily into two groups which account for about 95% of cases

• Small cell (oat cell) lung cancer (SCLC)
• Non-small cell lung cancer (NSCLC)
  
  • squamous cell,
  • adenocarcinoma
  • large cell carcinoma
  • bronchoalveolar cancer

Others

• Bronchial gland cancer
• Carcinoid tumour

Question 11

How do they take the biopsy?

Answer 11

• US guided neck node FNA for cytology if
  lymphadenopathy
• Bronchoscopy – endobronchial, transbronchial, endobronchial ultrasound (if mediastinal lymphadenopathy)
• CT Biopsy
• Thoracoscopy if pleural effusion present

Question 12

What paraneoplastic syndrome can the cancers give ?

Answer 12

• Small cell lung cancer- can secrete ACTH (Cushing’s syndrome) and ADH (SIADH)
• Squamous lung cancer - PTHrp (hypercalcaemia)
• clubbing, anaemia, Lambert Eaton myasthenic syndrome

Question 13

TNM staging ?

Answer 13

look at notion