Lung Cancer

Question 1

Rare/Common:
Primary (benign)
Malignant

Answer 1

Rare

Common

Question 2

Causes

Answer 2

Smoking
Asbestos
Atmospheric pollution
Radiation

Question 3

Classification (types)

Answer 3

Adenocarcinoma (NSCLC) - most common in non-smoker
Squamous cell carcinoma (NSCLC)
Small cell carcinoma (SCLC) - most common in smokers
large cell carcinoma (NSCLC)

Question 4

SCLC

Answer 4

Widespread metastases occur very early 
Worst prognosis
Rarely suitable for surgery
ACTH hormone production 
Expresses nuclear antigen p63
Infiltrates bronchial submucosa 
Management: Cytotoxic chemotherapy

Question 5

NSCLC

Answer 5

Adenocarcinoma - expresses TTF1, targeted therapy is becoming available
Prognosis is better than that of SCLC
Management: surgery, radical radiotherapy (potentially curable), palliative care

Question 6

Bronchial tumours

Answer 6

Large airway tumours
Squamous metaplasia
Dysplasia
Carcinoma in Situ 
Malignancy

Question 7

Carcinoid tumours

Answer 7

Malignant
Low grade
resectable and are usually treated by surgery
Mucous build up

Question 8

Stages of lung cancer (4)

Answer 8

Primary tumour
Local invasion
Metastases
non-metastases

Question 9

Clinical presentation of Primary tumour

Answer 9

cough, haemoptysis
breathlessness - obstruction of bronchial tree branch
unexplained weight loss
hoarse voice
tiredness, lethargy
stridor

Question 10

Clinical presentation of Local invasion

Answer 10

Hoarse voice - recurrent laryngeal nerve palsy
Pericardium - breathlessness
Oesophagus - dysphagia
Brachial plexus - Pancoast tumour (apex), pain, muscle wasting
Pleural cavity - pleural effusion
SVC - obstructs drainage of blood from arms and head. Headache, distended veins
Chest wall - neuropathic pain

Question 11

Clinical presentation of Metastases

Answer 11

Brain - gradual onset, weakness, headaches, fits
Liver - painless jaundice, abnormal Alk Phos
Bone - localised pain worse at night

Question 12

Clinical signs

Answer 12

Finger clubbing
Lymphadenopathy
Tracheal deviation (towards affected lung)
Dull percussion

Question 13

Investigations

Answer 13

CXR
CT scan
PET scan - assesses function rather than structure
Tissue tests - CT guided lung biopsy (for tissues not reached by bronchoscopy) / bronchoscopy (useful in tumours which are central and reachable)
EBUS - Visualise hilar and mediastinal structures, target and sample lymph nodes

Question 14

Treatment options - surgery

Answer 14

If disease is localised
No metastases
Tumour must be >2cm away from the carina

Pneumonectomy/Lobectomy via

• thoracotomy -> large incision to gain access to lung
• VATS -> key hole technique

Question 15

Treatment options - Chemotherapy

Answer 15

Must know the cell type as each different cancer responds differently to different agents.
Rarely curative, longer survival
Targets rapidly dividing cells
Side effects - nausea, vomiting, tiredness, hair loss etc

Question 16

Treatment options - Radiotherapy

Answer 16

Direct treatment to the tumour itself
Lie patient still and external beams from many directions target tumour
Not good for metastases