Lung Cancer

Question 0

What are the risk factors of lung cancer?

Answer 0

Age- especially over 40
Smoking
Occupation- asbestos, mining, ship building, petroleum refining

Question 1

What is the lifetime risk of lung cancer in men?

Answer 1

1 in 11

Lung cancer shows a male preponderance

Question 2

What are the most common histlogical types of lung cancer?

Answer 2

Small cell- 18%- assoc. w/ ADH/ACTH
Non small cell - 82%

Non small cell includes:
Squamous cell- 32%
Adenocarcinoma- 26%
Large cell - 10%
NSCLC not otherwise specified

Question 3

What presentations are associated with squamous, bronchioalveolar and small cell lung cancers?

Answer 3

Clubbing- squamous cell
Sputum production - bronchioalveolar
Neuroendocrine - small cell

Question 4

investigations for lung cancer?

Answer 4

CXR- 90% visible
Sputum cytology- 80%
Bronchoscopy - allows biopsy and washings
Transthoracic biopsy for peripheral tumours under radiological guidance
Mediastinoscopy for biopsy of abnormal lymph nodes

Question 5

Which tumour markers may be positive in lung cancer?

Answer 5

Neuron specific enolase, LDH

Question 6

Where does lung cancer typically metastasise to?

Answer 6

Liver
Brain
Bone
Adrenal glands
Lung
Skin

Question 7

What paraneoplastic syndromes can occur in lung cancer?

Answer 7

SIADH- dehydration, low plasma sodium 
Ectopic adrenocorticotrophic syndrome- cushings
Non metastatic hypercalcaemia
Atrial natriuretic peptide- dehydration
Eaton lambert myasthenia
Paraneoplastic cerebellar degeneration

Question 8

What is the TNM staging for lung cancer?

Answer 8

T1- less than 3cm
T2- 3 to7 cm, invading bronchus
T3- greater than 7cm, invades local structures
T4- organ invasion
N1- ipsilateral bronchopulmonary and hilar nodes
N2-ipsilateral mediastinal/subcarinal nodes
N3- contra lateral/supraclavicular nodes

Question 9

How does the TNM staging correspond to the stages of lung cancer?

Answer 9

Stage1- T1/2
Stage 2-
Stage 3- N3
Stage 4- M1

Question 10

How is small cell lung cancer managed?

Answer 10

Mostly systemic at presentation

Chemotherapy

• 90% respond, 50% completely
• relapse common within 12 months

Radiotherapy

• adjunct to treat primary tumour
• prophylactic cranial irradiation
• for palliative

Question 11

What is the prognosis of small cell lung cancer?

Answer 11

With treatment, 11 months median survival

Question 12

What is the management of non small cell lung cancer?

Answer 12

Surgery
for stage 1/2 - good prognosis
Lobectomy preferred with chemo

Radiotherapy
Part of concurrent chemo-rad
Palliative for brain mets, SVCO

Chemotherapy
Palliative
30% short lived response rate

Targeted therapy
First line if eGFR mutation
Erlotinib
Gefitinib

Question 13

What is the five year survival for stage 1,2,3,4 NSCLC

Answer 13

1- 50%
2- 40%
3- 25-5%
4- median survival less than 3 months