Lung Cancer

Question 1

What are the types of lung cancer?

Answer 1

Small cell
Non-small cell
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
Mesothelioma
Neuroendocrine tumour

Question 2

What features characterises Hypertrophic pulmonary osteoarthropathy?

Answer 2

= fibrous proliferation
- clubbing
- disabling arthralgia
- arthritis
- periostitis

Question 3

What are the features of Horner’s syndrome?

Answer 3

• due to Non-small cell lung cancer
• TRIAD: mitosis, ptosis, anhidrosis

Question 4

What are the signs and symptoms of hypercalcaemia?

Answer 4

(NSCLC)
- polyuria
- polydipsia
- abdo pain
- constipation
- lethargy
- confusion

Question 5

What are the investigations that should be completed for a suspected lung Ca?

Answer 5

Bloods: FBC, U+E, LFT, bone profile, CRP
Tumor markers (CEA)
Sputum cytology (malignant cells)
Bronchoscopy, biopsy, thoracoscopy

Question 6

What are the Urgent CXR criteria?

Answer 6

Age +40 and 2 of:
- ever smoked
- cough
- chest pain
- SOB
- anorexia
- weight loss
- fatigue

Age +40 and 1 of:
- chest signs consistent with lung Ca
- finger clubbing
- persistent chest infections
- persistent supraclavicular / cervical lymphadenopathy
- thrombocytosis (^ platelets)

Question 7

What are the symptoms of lung cancer specific to NSCC?

Answer 7

Hypercalcaemia (polyuria, polydipsia, abdo pain, constipation, confusion, lethargy)
Horner’s syndrome (miosis, ptosis, anhidrosis, enophthalmos)

Question 8

What are the symptoms of lung cancer specific to SCC?

Answer 8

Rapidly progressing symptoms
Superior vena cava obstruction
SIADH (confusion, hallucinations, seizures, anorexia, n/v)
Ectopic Cushing’s syndrome (moon face, acne, purple striae, prox muscle weakness, peripheral oedema, HTN, metabolic acidosis, hypokalaemia)
Bulky mediastinal disease
Bone/brain mets

Question 9

What are the management options for SCC?

Answer 9

Chemoradiotherapy
Prophylactic cranial radiotherapy

Question 10

What are the management options for NSCC?

Answer 10

In operable: radical radiotherapy
Stage 1+2: surgical resection
Stage 2/3: adjuvant chemotherapy
Stage 3: concurrent chemo/RT, radical RT alone, palliative chemo/RRT
Metastatic disease: chemo, targeted immunotherapy (non-squamous tumours e.g. tyrosine kinase inhibitors / MCAb)

Question 11

What is an example of a monoclonal antibody used for metastatic lung disease?

Answer 11

pembrolizumab

Question 12

What is en example of a EGFR tyrosine kinase inhibitor used for non-squamous tumours?

Answer 12

gefitinib
erlotinib