Lung Cancer

Question 1

Descrb ethe epidemiology of lung cancer

Answer 1

As

Question 2

What are risk factors for lung cancer other than smoking

Answer 2

• Asbestos (?~1000 deaths/ year • Radon (from mining or indoor exposure) ~ 1500
deaths / year • Other “occupational carcinogens”
– chromium, nickel, arsenic • Genetic/familial factors (relative risk ~ 1.6) • Around 5000 cases a year in never smokers

Question 3

What is mesothelioma

Answer 3

Mesothelioma - cancer of the pleura

Question 4

Describe the staging for lung cancer

Answer 4

t - tumours size, how many nodules, where the are located (eg 4cm tumour = t2, but if I another next to it, T3, if another in other lobe, T4)
N0 - no lymph node, n1, n2 further away on same side, n3 - other side. N2/3 is inoperable
M1a - mass on opposite lung, mets outside chest on.1 organ = m1b. More than one met eg 2 organs - m1c,

Question 5

Where do lung cancers commonly metastasise to

Answer 5

Brain, draining lymph nodes, pericardium, lung, pleura, liver, adrenals, bone

Question 6

What are the imaging techniques used and wat is staging ct

Answer 6

• Imaging
All: CXR,
Staging CT scan (Staging ct - Staging ct - dont do chest only - go to pelvis to makes ure.u get liver and adrenals. Only do head ct if they have associated symptoms)

Some: Pet Scan MRI USS Bone scan ECHO

Question 7

Describe tissue sampling for lung cancer

Answer 7

Get biopsy from ets first bc u get tissue diagnosis and staging information
Bronchoscopy - Endobrochial Bx,
wash, EBUS, radial EBUS, EUS
USS - neck node, lung/chest wall
mass, pleural fluid, liver
CT biopsy - lung, pleura
Thorocoscopy - medical
Surgical - mediastinoscopy, VATS pleural bx, rigid bronchoscopy, neck and axillary nodal excision, VATS excision bx, adrenal bx, brain bx, bone bx
Biopsies have risk.. eg pneumothorax. Only want to do tests i i will make a difference. If it wont, dont do it,

Question 8

What are the symptoms or primary lung tumours

Answer 8

COUGH, dyspnoea, wheezing, haemoptysis, lung infection, chest/shoulder pain, weight loss, lethargy/malaise,
no symptoms - commonest

Question 9

What are the symptoms for lung cancer with regiona mets

Answer 9

Bloated face (SVC obstruction)
Hoarseness  (LRLN palsy)
Dyspnoea (anaemia, pleural/pericardial effusions)
Dysphagia (oesophageal compression)
Chest pain (parieta lpleura involvement)

Question 10

Describ ethe symptoms or lung cancer with distant mets

Answer 10

Bone pain/ fractures 
CNS symptoms (headache, Diplopoda, confusion)

Question 11

What are the metabolic symptoms of lung cancer

Answer 11

Third, constipation (hypercalcaemia), seizures (hyponatreima, siadh, small cell)

Question 12

What are the signs of lung cancer

Answer 12

Finger clubbing, svc obstruction
• 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 13

Wha are oaraneoplastic syndrome associated with lung cancer

Answer 13

S

Question 14

Describe the types of biopsy for lung cancer

Answer 14

No Biopsy or one or more of the following: •Bronchoscopy – standard or with endobronchail ultrasound (EBUS) •Cervical lymph node fine needle aspiration (FNA) •Pleural fluid aspiration (thorocentesis) •CT guided lung biopsy •CT guided pleural biopsy •CT/USS guided liver biopsy •Adrenal biopsy •Skin biopsy •Bone biopsy •Brain biopsy •Lymph node biopsies (axillary, abdominal)
Biopsies have risk.. eg pneumothorax. Only want to do tests i i will make a difference. If it wont, dont do it,

Question 15

What are types of lung cancer

Answer 15

Carcinoma is an invasive malignant epithelial tumour
Main types are: Non-Small Cell Lung Cancer:
•Squamous cell carcinoma ~ 40%
•Adenocarcinoma ~ 35%
•Large Cell Carcinoma ~ 5% Small Cell Carcinoma
~ 12% Rare tumours (e.g. carcinoid) ~ 5%

Question 16

What are the molecular markers r lung cancer

Answer 16

EGFR mutations 
ALK mutation 
KRAS mutations 
PD1 mutations 
PDL1mutations

Question 17

Describe teh MDT for lung cancer

Answer 17

S

Question 18

What is performancee status

Answer 18

S

Question 19

What are Trent options for lung cancer

Answer 19

• Surgery
– Mostly for Non-Small Cell (20-25% operable). The best chance of cure

• Radiotherapy
– ‘Radical’ - with curative intent (includes stereotactic RT) – ‘Palliative’ - symptom control

• Combination chemotherapy
– Small Cell - potentially curative in a minority
– Non-Small Cell - modest survival increase, symptom control – ‘Neoadjuvant’ therapy- chemo before surgery (to ‘downstage’ the tumour to allow subsequent surgery)) – ‘!djuvant’- chemo after surgery (no benefit if < stage 2)

• Combination Therapy
– Combination chemo-radiotherapy – potentially curative

• ‘Biological’ (‘Targeted’) therapies

• Based on mutational analysis (EGFR, ALK, RAS, PD1, PDL1)
• A potential ‘game changer’

• Palliative Care & other treatment

• Active symptom control eg analgesia, radiotherapy, airway stents, anxiolytics, nutritional support, patient support
  groups. Treatment of tobacco addiction, coronary heart disease & other conditions