Lung cancer

Question 1

Type of lung cancer

Answer 1

Non-small cell lung cancer (85%):
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
- Alveolar cell carcinoma
- Bronchial adenoma
Small cell lung cancer (15%)

Question 2

Features of small cell lung cancer

Answer 2

Smokers
Paraneoplastic:
- SIADH
- ACTH → Cushing’s
- Lambert-eaton myasthenic syndrome

Question 3

Features of adenocarcinoma

Answer 3

Non-smokers
Peripheral
Early metastases
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy (HPOA)

Question 4

Features of squamous cell carcinoma of the lung

Answer 4

Smokers
Central
Spreads locally with late metastasis
Paraneoplastic:
- PTHrP
- Ectopic TSH
- Hypertrophic pulmonary osteoarthropathy (HPOA)

Question 5

Features of large cell carcinoma

Answer 5

Peripheral
Poor prognosis
b-hCG

Question 6

2ww chest x ray guidelines for lung cancer

Answer 6

Age <40yo AND:
≥2 symptoms
OR
current/past smoker and ≥1 symptom/s:
- cough
- SOB
- chest pain
- fatigue/weight loss/appetite loss

Age >40 AND >1 symptoms:
- persistent/recurrent chest infection
- Clubbing
- Supraclavicular lymphadenopathy / persistent cervical lymphadenopathy
- Chest signs consistent with lung cancer
- thrombocytosis

Question 7

Management for non-small lung cancer

Answer 7

Surgery (20% suitable → spirometry (FEV1 ≥1.5L) and mediastinoscopy (mediastinal LNs))
Curative/palliative radiotherapy

Question 8

Management for small cell lung cancer

Answer 8

Early stages (T1-2a, N0, M0) → surgery
Non-early stages, limited disease → combination chemoradiotherapy
Non-early stages, extensive disease → palliative chemotherapy

Question 9

COmplications of lung cancer

Answer 9

Local:
Lung collapse
Pleural effusion
Haemorrhage
Phrenic/recurrent laryngeal nerve palsy
Horner’s syndrome
SVCO

Systemic
Ectopic hormone production
Gynaecomastia
Dermatomyositis