LUNG CANCER

Question 0

How do small cell cancers differentiate?

Answer 0

Poorly differentiated 
NEUROENDOCRINE tumours 
- producing ACTH -> cushings 
- ADH -> SIADH
Grow and spread very quickly

Question 1

What are the major types of cancer and what do they include?

Answer 1

Small cell lung cancer 5% prognosis 5 years.  
Non-small cell lung cancer 
- adenocarcinoma 
- SCC
- large cell carcinoma

Question 2

S + S?

Answer 2

Broken down into:
Respiratory 
- cough with HAEMOPTYSIS 
- wheeze 
- SOB 
- dull chest pain 

Mass effect

• dysphagja (oesophageal obstruction)
• hoarse voice (recurrent laryngeal nerve paralysis)
• Horners syndrome (sympathetic nerve paralysis)
• small wrist wasting (brachial plexus compression)
• SVC obstruction - SOB, dilated neck veins

Metastatic disease
- LBBBA

Paraneoplastic syndrome

• PTHrP : hypercalcemia
• ACTH : Cushing’s syndrome
• SIADH : hyponatraemia
• hypertrophic pulmonary osteoarthropatht

Question 3

Ix?

Answer 3

LAB 
CBE EUC LDT CRP BGL
Sputum cytology 
Biopsy 
Pleural fluid thoracocentesis 

RAD 
CXR 
CT CHEST better 
Metastases 
- WBBS 
- PET 
- CT head, liver, adrenals

Question 4

What staging for lung cancer?

Answer 4

Anatomical - TNM

Physiological (to assess ability to withstand anti-tumour treatment)

• FEV1 (aids in deciding lobectomy or pneumonectomy)
• exercise testing
• correct reversible derangement (electrolytes, anaemiac, arrhythmia)
• CVS risks

Question 5

Management of NSCLC?

Answer 5

Stage 1/2 -> surgery with curative intent.
Contraindications to surgery
- malignant pleural effusion 
- contra lateral lymph node involvement 
- poor lung function 

If N0 or N1: surgery +/- chemo
If N2/N3: chemo radiation

Question 6

Management of SCLC?

Answer 6

CHEMO IS MAIN STAY

If limited stage do concurrent chemo and radio.

Question 7

What is used for chemo in lung cancer?

Answer 7

Cisplatin and carboplatin for both NSCLC and SCLC.