Lung Cancer

Question 1

What are the two main categories of lung cancer?

Answer 1

Small cell lung cancer and non small cell

Question 2

What are the three main types of non small lung cancer?

Answer 2

adenocarcinoma
squamous cell carcinoma
large cell carcinoma
(and other types

Question 3

How can small cell lung cancers be responsible for some paraneoplastic syndromes?

Answer 3

they contain neurosecretory granules that release neuroendocrine hormones

Question 4

What is mesothelioma lung cancer?

Answer 4

cancer of the mesothelial cells of the pleura
linked to asbestos inhalation
up to 45 years latency period
v poor prognosis - essentially palliative

Question 5

Presentation of lung cancer?

Answer 5

Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

Question 6

Referral criteria for suspected lung cancer?

Answer 6

CXR within 2 weeks to pts over 40 yrs and:

Clubbing
Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
Recurrent or persistent chest infections
Raised platelet count (thrombocytosis)
Chest signs of lung cancer

two or more unexplained symptoms and never smoked
one or more unexplained symptoms and smoked or asbestos exposure

Question 7

What are the unexplained symptoms in lung cancer?

Answer 7

Cough
Shortness of breath
Chest pain
Fatigue
Weight loss
Loss of appetite

Question 8

Potential findings on CXR for urgent lung cancer?

Answer 8

Hilar enlargement
Peripheral opacity (a visible lesion in the lung field)
Pleural effusion (usually unilateral in cancer)
Collapse

Question 9

Other investigations for lung cancer?

Answer 9

staging CT scan
PET CT
Bronchoscopy with endobronchial ultrasound (EBUS)
Histological diagnosis

Question 10

Treatment options for non-small and small cell lung cancer?

Answer 10

MDT discussion:

non-small cell:
surgery
radiotherapy
chemo

small cell = chemo and radio

Question 11

Name 3 ways of surgery to remove lung cancer tumour?

Answer 11

segmentectomy
lobectomy
pneumonectomy

Question 12

Name three types of surgery to remove lung cancer tumour?

Answer 12

thoracotomy
VATS (key hole)
robotic surgery

Question 13

What are the three types of thoracotomy incisions?

Answer 13

Anterolateral thoracotomy with an incision around the front and side
Axillary thoracotomy with an incision in the axilla (armpit)
Posterolateral thoracotomy with an incision around the back and side (the most common approach to the thorax)

Question 15

Why is right upper lobe the most common site for lung cancer?

Answer 15

Right bronchi is straighter than left so easier for smoke to go down it. Smoke rises so will go to upper lobe instead of lower