Lung cancer

Question 1

How is lung cancer initially classified histologically

Answer 1

Small cell lung cancer - 15 % worse prognosis

non-small cell lung cancer

Question 2

What can NSCLS be broken down into

Answer 2

Adenocarcinoma
Squamous
Large cell
alveolar cell carcinoma
bronchial adenoma

Question 3

Describe an adenocarcinoma

Answer 3

most common
peripherally located
seen in NON SMOKERS
associated with exposure to asbestos

Question 4

Describe squamous cancer

Answer 4

Centrally located

cavitating lesions are more common

metastasise late

Question 5

Describe large cell cancer

Answer 5

peripherally located
poorly differentiated
poor prognoss

Question 6

Describe alveolar cell carcinoma

Answer 6

not related to smoking

lots of sputum produced

Question 7

Describe bronchial adenoma

Answer 7

mostly carcinoid
usually clinical silent

Question 8

What may someone with lung cancer present with

Answer 8

persistent cough
haemoptysis
dyspnoea
chest pain
weight loss/anorexia

hoarseness – pancoast tumours pressing on recurrent laryngeal nerve

superior vena cava syndrome

Question 9

What may be seen one examination if someone has lung cancer

Answer 9

fixed , monophonic wheeze

supraclavicular lymphadenopathy or persistent cervical lymphadenopathy

clubbing

Question 10

What are some paraneoplastic features from small cell lung cancer

Answer 10

ADH- hyponatremia

Lambert-eaton syndrome

Question 11

What are some paraneoplastic features from squamous cell cancer

Answer 11

PTH secretion causing hypercalcaemia

clubbing

hypertrophic pulmonary osteoarthropathy

ectopic TSH - hyperthyroidisim

Question 12

What are some paraneoplastic features associated with adenocarcinomas

Answer 12

gynaecomastia

Hypertrophic pulmonary osteoarthropathy

Question 13

When do you do 2 week wait referral

Answer 13

If chest x ray findings suggest lung caner

aged 40 and over with unexplained haemoptysis

Question 14

When do you offer an urgent chest x ray ( within 2 weeks )

Answer 14

assess lung cancer in people >40 if have 2 or more of following unexplained symptoms OR if ever smoked and have 1 or more

• cough
  -fatigue
  -SOB
  -chest pain
  -weight loss
  -appetite loss

OR if any of following symptoms

• persistent/recurrent chest infection
• finger clubbing
  -supraclavicular lymphadenopathy
  -chest signs consistent with lung cancer
  -thrombocytosis

Question 15

What is gold standard investigation and what is first line

Answer 15

first line - PA CXR

gold standard- CT

Question 16

What other investigations can be carried out

Answer 16

Bronchoscopy and biopsy

PET scan - for NSCLC- to establish eligibility for curative scan

Bloods

Question 17

What is management for small cell lung cancer

Answer 17

usually metastatic by diagnosis

consider surgery in very early stages

combo of chemo/radio

palliative chemo in extensive disease

Question 18

What is management for non-small cell lung cancer

Answer 18

Use risk score to evaluate risk of surgery

Mediastinoscopy prior to surgery

curative/palliative radiotherapy

poor response to chemo

Question 19

What are some contraindications to surgery

Answer 19

• asses general health
  -metasteses present

FEV <1.5 LITRES

malignant pleural effusion

tumour near hilum

vocal cord paralysis

SVC obstruction