Lung Cancer

Question 1

What are the aetiologies?

Answer 1

Smoking
Asbestos exposure
Radon, other carcinogens
Genetic vs environmental factors

Question 2

What are the common symptoms?

Answer 2

Cough 
Fatigue 
Weight loss
SOB
Haemoptysis
Chest pain
Recurrent/persistent chest infections

Question 3

What are the uncommon symptoms?

Answer 3

Wheeze
Hoarse voice
Dysphagia
Fever
Face swelling

Question 4

What are the signs?

Answer 4

Chest signs 
Finger clubbing
Lymphadenopathy
Hepatomegaly
SVC obstruction
Skind nodules
Pan coast tumour 
Horner's syndrome

Question 5

What are the local effects of bronchial obstruction?

Answer 5

Collapse
Endogenous lipid pneumonia
Bronchiectasis

Question 6

What are the local pleural effects?

Answer 6

Inflammatory

Malignant

Question 7

What are the local direct invasion effects?

Answer 7

Chest wall
Phrenic nerve - diaphragmatic paralysis
Brachial plexus -pancoast T1 damage
Cervical sympathetic - horner's syndrome
Mediastinum

Question 8

What are local lymph node metastases effects?

Answer 8

Mass effect

Lymphangitis carcinomatous

Question 9

What are the common sites of distant metastases?

Answer 9

Liver, brain, adrenal glands, bone, skin

Question 10

What are the distant effects secondary to local effects?

Answer 10

Neural

Vascular

Question 11

What are the four types of lung cancer?

Answer 11

Small cell
Non small cell adenoma
Non small cell carcinoma
Large cell

Question 12

What are useful investigations?

Answer 12

CHEST X-RAY
CT THORAX - shows extent of disease include liver and adrenal gland 
PET SCAN - mediastinal involvement
BRONCHOSCOPY
PLEURAL ASPIRATION & BIOPSY

Question 13

What are the different T stages in tumour staging?

Answer 13

Tx - tumour can’t be assessed
T0 - no evidence of primary tumour
Tis - carcinoma in situ
T1a - minimally invasive adenocarcinoma = 1cm
T1b - tumour = 2cm
T1c - tumour = 3cm
T2 - tumour less than 5 but more than 3cm and involves main bronchus, invades visceral pleura or associated with obstructive pneumonitis
T3 - tumour greater than 5 but less than 7cm or directly invades chest wall or phrenic nerve or parietal pericardium or separate tumour nodule in the same lobe as primary
T4 - Tumour greater than 7cm, invades any of diaphragm, mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina, recurrent laryngeal nerve

Question 14

What are the different N stages?

Answer 14

N0 - no regional node metastases
N1 - ipsilateral peribronchial, hilar or intrapulmonary nodes
N2 - ipsilateral mediastinal, sub carinal lymph nodes
N3 - contralateral mediastinal, contralateral hilar, scalene or supraclavicular lymph nodes

Question 15

What are the different M stages?

Answer 15

M1 - distant metastases
M1a - separate tumour nodule in contralateral lobe
M1b - single distant metastases
M1c - multiple distant metastases

Question 16

What is the performance status?

Answer 16

Score of 0-5

Only score of 0-1 usually treated curatively

Question 17

What can radiation be used to cure in the early stages?

Answer 17

Non - small cell lung cancers
Can be an alternative to resection
Can cause radiation fibrosis

Question 18

What can radiation be used to treat palliatively?

Answer 18

Chest wall and bone metastases pain, haemoptysis, occluded bronchi, SVC obstruction

Question 19

What can chemotherapy be used for before surgery?

Answer 19

“down staging of a tumour”

Improve survival after surgery

Question 20

What can surgery be used to treat?

Answer 20

Early stage NSCLC - stage III may receive chemo and then surgery
Resection
Lobotomy
Pneumonectomy

Question 21

What are palliative treatment options?

Answer 21

Opiates
Benzodiazepines
Treatment of hypercalcaemia, dehydration
Support 
Decision and planning