Lung Cancer

Question 0

What are some of the signs and symptoms of lung cancer?

Answer 0

Local (non-specific):

• cough
• wheezing
• haemoptysis
• dyspnoea
• chest/shoulder pain
• weight loss
• lethargy/malaise/fatigue
• night sweats

Regional metastases:

• SVC obstruction -> distended veins in neck & chest
• left recurrent laryngeal nerve palsy -> hoarseness
• phrenic nerve palsy -> dyspnoea (abrupt & irreversible)
• dysphagia

Distant metastases:

• bone pain/fractures
• headaches, double vision, confusion (CNS symptoms)

Paraneoplastic:
- endocrine e.g. hypercalcaemia, Cushing’s, SIADH
- neurological e.g. encephalopathy, peripheral neuropathy
- haematological e.g. anaemia, thrombocytosis
- cutaneous e.g. dermatomyositis
- skeletal e.g. finger clubbing
etc.

Question 1

Outline the epidemiology and aetiology of lung cancer.

Answer 1

Most common primary malignant tumour in the world
5yrs survival rate < 10%
25% of cancer deaths in UK (typically 40-70yrs)

• smoking: incidence & mortality follows pattern of smoking in the past, responsible for 80%-90% of cancer deaths, linked to 20% of lung cancer deaths in non-smokers (passive smoking)
• COPD
• asbestos & other occupational carcinogens
• radon exposure
• genetic/familial

Question 2

What are the common sites of lung cancer metastases?

Answer 2

Pleura 
Liver 
Adrenal glands 
Bone
Brain 
Pericardium 

(draining lymph nodes)

Question 3

What is paraneoplastic syndrome?

Answer 3

Signs and symptoms caused by antibodies produced by cancer, not by direct local effects of cancer cells.

Question 4

What are some important investigations performed in suspected lung cancer?

Answer 4

CXR

Na+, LFTs, calcium

CT/PET-CT, isotope bone scan

Bronchoscopy + endobrachial ultrasound (identifies lesions outside of airways and samples them)

CT guided needle biopsy, lymph node biopsy (neck), metastasis biopsy, mediastinoscopy, pleural biopsy

Histology

Question 5

Give some examples of histological features which suggest cancer.

Answer 5

Irregular nuclei shape & no. (pleomorphic)
Size of nuclei (anisonucleosis)
Dark-staining nuclei (hyperchromatic)
Frequent & abnormal mitoses (hyperproliferative)
Prominent & multiple nucleoli
Ulceration
Necrosis
Infiltrative margins
Vascular invasion
Stroma (connective tissue framework of cell) does not resemble normal tissue

Question 6

How can lung cancer be classified?

Answer 6

Non-small cell:
Squamous cell carcinoma (~40%)
Adenocarcinoma (~35%)
Large cell carcinoma (~5%)

Small cell carcinoma (~12%)

Question 7

What is the treatment for lung cancer?

Answer 7

Non-small cell:

• palliative radiotherapy (local symptoms)
• combination chemotherapy (potentially curative)
• targeted drugs (oncogene inhibition)
• surgery (~25%)

Small cell:

• rarely operable (due to metastases)
• combination chemotherapy (multiple drugs) (symptom control)