Lung Cancer

Question 1

Lung cancer

Bit of epidemiology to get started

Proportion of cancers?

Answer 1

19% of all cancers
40000 cases/ year (UK)
Responsible for 27% of cancer deaths

Question 2

Lung cancer

2 clinical groups

One of which subdivides into 4 main categories

Answer 2

1) Small cell 15%
2) non-small cell 85%

i) squamous 35%
ii) adenocarcinoma 27%
iii) large cell 10%
iv) alveolar cell carcinoma 1%

Question 3

Small cell tumours

Answer 3

Grow quickly

Can secrete
ADH (SIADH) - low Na
ACTH - (cushings)

ACTH - adrenocorticotrophic hormone - usually from anterior pituitary gland, stimulates cortisol secretion from adrenal gland

Question 4

Non small cell

Answer 4

Grow slower

Squamous cell carcinomas can secrete PTH - Ca up

Question 5

Symptoms

Answer 5

Cough 
Haemoptysis
Dysponea
Chest pain 
Weight loss 

Recurrent/slow healing pneumonia’s
Lethargy
Anorexia

Question 6

Signs

Answer 6

Clubbing
Cachexia
Anaemia
Enlarged lymph nodes - supraclavicular/axillary
Consolidation, collapse, pleural effusion or nothing in lungs

HPOA - hypertrophic pulmonary osteoarthropathy - wrist pain (substances released by tumour cause inflammation of extremities - most common in non small cell)

HPOA - 1 Timothy 3:16
This Christian life is a great mystery, far exceeding our understanding, but some things are clear enough: He appeared in a human body, was proved right by the invisible Spirit, was seen by angels. He was proclaimed among all kinds of peoples, believed in all over the world, taken up into heavenly glory.

Question 7

Signs of spread (general for cancer)

Answer 7

Brain - confusion, fits, cerebellar syndromes, neuropathy etc
Bone - bone tenderness, anaemia (etc) calcium up
Liver - hepatomegaly
Adrenal gland - Addison’s

Question 8

Complications

Answer 8

Recurrently laryngeal nerve palsy (voice changes) 
Phrenic nerve palsy
Svc obstruction 
Horners syndrome 
Rib erosion 
Pericarditis
Atrial fibrillation

Question 9

Tests

Answer 9

Chest x Ray

• peripheral nodule
• hilar enlargement
• consolidation
• lung collapse
• bony secondaries

Cytology

• sputum
• pleural fluid aspirate

Lymph node - fine needle aspiration/biopsy
Ct - stage tumour
Broncoscopy - for histological grade

Question 10

Non small cell treatment

Answer 10

Stage 1-2
Chop it out
radiotherapy if poor lung reserve
More advanced - more chemo (cetuximab and the chaps - don’t concern yourself too much with these)

Question 11

Small cell treatment

Answer 11

Lots of fancy chemo drugs - ultimately it’s usually too late by presentation

Remember CDVE therapy - which is an acronym for the cocktail usually prescribed, but don’t lose too much sleep over it

Question 12

7 cancers which commonly spread to the lung

Answer 12

Cool Kids Love Patrick's Minimally Boring Teaching
Colorectal
Kidney
Lymphoma
Prostate
Melanoma (skin)
Breast
Thyroid

Question 13

Spot the odd one out
Lung cancer.
Tuberculosis.
Bronchiectasis.
Cystic fibrosis.
Pulmonary Embolism
Interstitial lung disease.
Idiopathic pulmonary fibrosis.
Sarcoidosis.

Clue - which one doesn’t give you clubbing

Answer 13

Pulmonary Embolism

Some other causes too. These are main resp ones

Question 14

Side effects of radiotherapy

Answer 14

Fatigue
Anorexia
Cough
Oesophagitis 
Systemic symptoms
Skin reactions
Nausea (rare)
Alopecia - only if head irradiated

Question 15

Side effects of chemotherapy

Answer 15

Alopecia
Nausea/vomitting
Peripheral neuropathy
Constipation/diarrhoea
Rash
Fatigue
Mucositis
Anaphylaxis
Bone marrow suppresion - anaemia, neutropenia, thrombocytopenia

Question 16

Staging - explain TNM in extra lay terms

Answer 16

T is for Tumour - how big is it, invasion of local structures
N is for nodules - lymph nodes infiltrated, and how far away they are
M is for metastasis - and its best to not have these