Lung Cancer

Question 0

Describe the typical pattern of symptoms reported by patients with cancer

Answer 0

Primary tumour - cough, dyspnoea, wheeze, haemoptysis, shoulder pain, weight loss, malaise
Regional metastases - SVC obstruction, voice hoarseness (left recurrent laryngeal nerve palsy), dyspnoea (phrenic nerve palsy), dysphagia
Distant metastases - bone pain/fractures, CNS symptoms, finger clubbing

Question 1

Give an account of the aetiological factors involved in lung cancer

Answer 1

Risk factors - genetic, asbestos, COPD, smoking

Question 2

Understand the imaging techniques used in the diagnosis and staging of the disease

Answer 2

Imaging:
CXR - first suspicion
CT scan, bone scan, bronchoscopy, biopsy - diagnosis, staging
MRI

Question 3

Give an account of the histology and classification of common lung tumours

Answer 3

Histology:
Nuclear abnormalities, pleomorphic, hyperchromatic, increased nucleus:chromosome ratio, hyperproliferative
Classification:
Non small cell carcinoma - squamous cell carcinoma, adenocarcinoma
Small cell carcinoma

Question 4

Describe common sites of metastases in lung cancer

Answer 4

Bone
Liver
Adrenals
Brain
Direct/lymphatic/haematogenous spread

Question 5

Describe in outline the different treatments available and how they may affect survival

Answer 5

Surgery (of non small cell carcinoma)
Radiotherapy - radical (curative intent), palliative (symptom control)
Combination chemotherapy
Palliative care
Survival is poor (10-15% live to 5 years), depends on cell type, stage, comorbidities
Median survival = 6 months

Question 6

Describe some of the factors that allow for optimism in lung cancer diagnosis

Answer 6

Incidence falling
Screening/early diagnosis initiatives
Treatment advances
Raised profile
Improved survival