Lung Cancer

Question 1

What are the risk factors for LC?

Answer 1

• Smoking (SCLC)- 80%
• Active smoking (83%)
• Environmental tobacco smoke exposure in non-smokers
• Air pollution
• Age
• Ionising radiation
• Occupational exposures - asbestos, Silicia, diesel engine exhaust, paint fumes, arsenic and inorganic arsenic compounds
• Family history

Question 2

What are the symptoms of lung cancer?

Answer 2

• Coughing
• Weightloss
• Shortness of breath
• Chest pain
• Haemoptysis (coughing up blood/sputum streaked w blood)
• fever, weakness, lethargy
• Patients may present with difficulty swallowing. wheezing

Question 3

What are paraneoplastic syndromes of lung cancer?

Answer 3

• up to 12% of patients
• Most endocrine realated to SCLC
• Cushing’s syndrome wih facial edema and cachexia hypokalemic alaklosis
• Inappropriate ADH secretion ( low Na resulring from high urine osmolality and low serum osmolality)- causes irritability, confusion, weakness and seizure in extreme cases
• Parathormone-like effect - hypercalacaemia, lethargy ,pulyuria, poolydipsia, constipation, abdominal pain
• Gonadotropin effects- gynecosmastia, testicular atrophy

Question 4

What is small cell lung cancer (SCLC)?

Answer 4

• aka oat cell carcinoma
• e.g. small cell carcinoma
• 80% of all lung cancer
• more prevelant in m
• associated with cigarette smoking
• Usually accompanied by a paraneoplastic syndrome
• More sensitive to chemotherapy
• Poorest survival rate

Question 5

What is non-small cell lung cancer?

Answer 5

• 3 main subtypes:
• Squamous cell carcinoma, addenocarcinoma and large cell carinoma
• Squamous : 30% off all lung cancers, associated w smoking and exposure to chemical carciongens. Starts in the flat cells lining the airways of the lungs (bronchi)
• Adenocarcinoma accounts for 30% of invasive lung cancers ; has a peripheral location and early lymphatic spread; most common type of NSCLC especially in non-smokers
• Large cell carcinoma accounts for 10% of all lung cancers; may show features of squamous or glandular differentiation or both. Tends to grow and spread more quickly than adenocarcinoma and squamous cell carcinoma; has the poorest 5-year survival rate of all NSCLCs

Question 6

How is lung cancer diagnosed?

Answer 6

• Chest x-ray:
• solitary pulmonary nodule/mass
• up to 80% of solitary pulmonary nodules in the over-50 age group are cancer
• Chest x-ray may also be used to evaluate the size of the tumout and possible involvement of lymph nodes in the chest
  CT SCAN:
• useful in identification of lymph node involvement

Question 7

What is the sreening test for early detection of LC?

Answer 7

• CDT- lung - blood test enables early detection of lung cancer
• currently in clonical use

Question 8

What is the biopsy of LC?

Answer 8

-Lung biopsy usually performed when clinical symptoms or findings on a chest x-ray or CT scan suggest lung cancer
- Biopsy sample then sent to pathologist for confirmation, and then staging is necessary to determine how far the cancer has spread

Question 9

What are some complications of LC?

Answer 9

• 30% presenting with symptoms of metastic disease , bone fracture, CNS symptoms (brain), jaundice (liver)
• Local spread to nodes characterised by clinical sydromes
• SVC (compression from paratrachial nodes)
• Horners syndrome (cervical sympathetic chain)

Question 10

What is the prognosis of LC?

Answer 10

• Most metastasise to distant sites (70%) on presentation (brain. liver, bone, adrenal)
• 25% have regional lymph node involvement on diagnsosis
• Most inoperable (75% NSCLC, age is a factor)
• 1 year survival rate = ~30%
• 5 year survival overall ~ 9%
• 5 year survival for localised lung lesion ~45%