Lung cancer

Question 1

Lung cancer classification

Answer 1

Small Cell (20%)
Non-small cell (80%)
-Adenocarcinoma (35%)
- Squamous cell (30%)
- Large Cell (10%)

Question 2

Lung cancer risk factors

Answer 2

Smoking
Environmental: Radon, Asbestos
hyrdrocarbons, radiation, occupation ezposure to arsenic/chromium/nickel
Pre exisitng lung diseasse
HIV
Hodgkin’s lymphoma

Question 3

Small Cell lung cancer features

Answer 3

• Rare in non-smokers
• centrally located
• SIADH leads to hyponatraemia
• Lambert-Eaton myasthenic syndrome (Difficulty walking and muscle tenderness )
• Addison’s presentations
• Cushings presentations (ectopic ACTH)
• spreads very early and is almost always inoperable at presentation.

Question 4

Adenocarcinoma lung cancer features

Answer 4

• Peripheral tumours
• EGFR, ALK, ROS -1, PDL-1 found in 10% of lung adenocarcinoma
• Proportionally more common in non-smokers, women and in the Far East and least likely to be related to smoking
• Most likely to cause pleural effusion
• associated with gynaecomastia and hypertrophic pulmonary osteoarthropathy

Question 5

Squamous cell lung cancer features

Answer 5

• Arise centrally in larger bronchi
• Cavitating lung lesions
• Hypercalcaemia , hyperparathyroidism
• Also associated with clubbing and HPOA

Question 6

Lung cancer symptoms

Answer 6

Respiratory: Cough ,Haemoptysis, breathlessness, wheeze, stridor, chest pain, hoarse voice

Question 7

Pancoast tumour symptoms

Answer 7

brachial plexus invasion - causing C8/T1 palsy with small muscle wasting in the hand and weakness as well as pain radiating down the arm .
compression of the sympathetic chain - horner syndrome
1. miosis- excessive constriction of the pupil of the eye.
2. ptosis
3. anhidrosis- inability to sweat normally.

Question 8

Superior vena caval obstruction symptoms

Answer 8

superior vena cava (SVC) is blocked or compressed by a tumour
- head and neck oedema, distended neck veins, cough, dyspnea, orthopnea,headache (which can be worse on bending over), distorted vision, nasal stuffiness, nausea and light-headedness.

Question 9

most common lung cancer

Answer 9

Non-small cell (80%):

1. Adenocarcimona (35%)
2. Squamous cell (30%)
3. Large Cell (10%)

Question 10

2ww lung cancer referral if

Answer 10

Have chest X-ray findings that suggest lung cancer, or
Are aged 40 years and over with unexplained haemoptysis.

Question 11

Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over if they have two or more of the following unexplained symptoms, or if they have ever smoked and have one or more of the following unexplained symptoms:

Answer 11

Cough.
Fatigue.
Shortness of breath.
Chest pain.
Weight loss.
Appetite loss.

Question 12

Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over with any of the following:

Answer 12

Persistent or recurrent chest infection.
Finger clubbing.
Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy.
Chest signs consistent with lung cancer.
Thrombocytosis.