Lung Cancer

Question 1

Describe the epidemiology of lung cancer

Answer 1

35,000 deaths per year UK

Largest killer from cancer

Poor 5 year survival rates, only pancreatic is worse

Mainly diagnosed between 60-80

Question 2

What are the risk factors for lung cancer?

Answer 2

Smoking

Asbestos

Radon

Occupational carcinogens – chromium, nickle, arsenic

Genetic factors

Question 3

Why do we stage a cancer?

Answer 3

Determines prognosis and treatment

Question 4

What does the T in TNM assess?

Answer 4

Tumour =

Size

Location

Number of tumours

Question 5

What does the N in TNM assess?

Answer 5

Lymph nodes =

Node on same side = 1

Distant node effected = 3

Anything above N1 = inoperable

Question 6

What does the M in TNM assess?

Answer 6

Metastasis =

None = 0

Mets = 1

Question 7

Where does lung cancer typically spread to?

Answer 7

Brain

Draining lymph nodes

Pericardium

Lung

Pleura

Liver

Adrenals

Bone

Question 8

How does lung cancer present?

Answer 8

Asymptomatic 9/10

Cough

Dyspnoea

Haemoptysis

Bone pain

Cardiac tamponard

Headaches

Lung infections = lung more susceptible to infections – blockage,

Question 9

What are the signs of lung cancer?

Answer 9

Cachexia

Pale conjunctiva

Cervical lymphadenopathy

Horners Syndrome

Consolidation

Signs of pleural effusion

Muffled heart sounds

Liver enlargement

Skin metastases

Neurological long tract signs

NO SIGNS

Question 10

What investigations can be used to stage lung cancer

Answer 10

Imaging = CXR, CT, MRI, USS, bone scan, ECHO, PET scan (looks for increased uptake in glucose, cancer cell use glucose more)

Tissue sampling = bronchoscopy, USS, CT biopsy, thoroscopy, surgical

Question 11

What s the risk of a pneumothorax on CT guided biopsy?

Answer 11

10-20%

Question 12

When is a CT/biopsy not performed?

Answer 12

When it is clearly end-stage

Question 13

How is a staging CT different to a normal chest CT?

Answer 13

Image covers chest, abdo and top of the pelvis

Question 14

What are the main types of lung cancer?

Answer 14

85% Non-small cell lung cancer = squamous cell carcinoma, adenocarcinoma, large cell carcinoma

Small cell carcinoma = grows more quickly but is more responsive to chemo

Question 15

How is lung cancer managed?

Answer 15

Surgery = mostly for non-small cell, best chance of cure

Radiotherapy

Combined chemo

Combination therapy = chemo and radiotherapy

Biological targeted therapies

Palliative care