Lung Cancer

Question 1

How do we stage lung cancer?

Answer 1

TNM- tumour, lymph node, metastases
T1-4
N0-3
M0-1c

Question 2

What are the WHO performance status criteria for lung cancer

Answer 2

0- asymptomatic
1- symptomatic but completely ambulatory
2- symptomatic but <50% in bed
3- symptomatic and >50% in bed
4- bedbound
5- death

Question 3

What are the types of lung resections?

Answer 3

Wedge resection
Segmental resection
Lobectomy
Pneumonectomy

Question 4

What treatments are available depending on how far along the disease is?
What is the action mechanism for immunotherapy?

Answer 4

Early disease- surgery and radio therapy with intent to cure
Locally advanced disease- Surgery and adjuvant chemotherapy
Metastatic disease- chemo if no mutation and PDL-1<50%
Oncogene directed systemic therapy if there are targetable mutations (rashes and diarrhoea side effects)
If PDL-1 positive & no mutation-immunotherapy
Palliative care (symptom control, education, psychological support, planning)

Question 5

What causes lung cancer?

Answer 5

Smoking
Passive smoking
Asbestos
Cooking fumes
Air pollution

Question 6

What is the gold standard service order of examining potential lung cancer?

Answer 6

Chest x-ray
Chest CT
PET-CT
Biopsy via bronchoscopy or aspiration

Question 7

What are the types of lung cancer? What % do they each make up for lung cancer?

Answer 7

Adenocarcinoma-40%
Squamous cell carcinoma-30%
Large lung cell cancer-15%
Small lung cell cancer-15%

Question 8

What are the symptoms for lung cancer? How do these change when metastasis happens?

Answer 8

Key symptoms:cough, weight loss, breathlessness, fatigue, chest pain
Metastasis:neuro features eg focal weakness and seizures
Bone pain, clubbing, hypercalaemia, hyponatraemia
Horners syndrome

Question 9

What is the pathogenesis of lung cancer?

Answer 9

Inhaled carcinogens react with the epithelium to form DNA adducts (pieces of carcinogen bound to DNA) causing mutations