Lung Cancer

Question 1

What are the 3 types of non small cell carcinoma?

Answer 1

Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

Question 2

Squamous cell and adenocarcinoma produce hormonally active proteins, what are they?

What other major differences are seen between these cancers.

Answer 2

SCC: PTH-related protein (causes hypercalcaemia)
AC: Thyroid transcription factor.

SCC are well differentiated and central, 90% occur in smokers and metastases late.
AC originates from glandular tissue in the peripherally, 70% associated with smoking, invasion of pleura and mediastinal lymph nodes are common.

Question 3

Describe small cell lung cancers.

Answer 3

Neuroendocrine
Rapidly spreading, more metastatic. 
Usually arise at hilar bronchus.
99% associated with smoking.
Respond to chemo but have poor prognosis.

Question 4

Investigations for lung cancer.

Answer 4

Cytology of sputum
CXR
(PET)-CT: stage tumour
Bronchoscopy 
Peripheral aspiration or biopsy
Bloods:
FBC: anaemia 
LFTS: liver mets
U&E: hypercalcaemia

Question 5

Prognosis of non-small cell and small cell.

Answer 5

Non-small w/o spread: 50% at 2 years
Non-small with spread: 10%
Small cell w/o treatment: 3 months
with treatment: 1-1.5 years

Question 6

How will lung cancer present on CXR.

Answer 6

If cancer is causing symptoms it will be visible on CRX or if it over 1cm in diameter.
Peripheral nodule, hilar enlargement, consolidation, lung collapse, pleural effusion or bony secondaries.

Question 7

Which 3 presenting complaints would prompt immediate investigation?

Answer 7

Breast Lumps
Mole Changes
Bleeding