Lung cancer

Question 1

How common is lung cancer?

Answer 1

• third most common in UK
• 1 a day in tayside
• 120 a day in UK

Question 2

What is the presentation of lung cancer?

Answer 2

• primary tumour
• local invasion
• metastatic
• non-metastatic

Question 3

What are the symptoms of the primary tumour that can be seen?

Answer 3

• cough
• breathlessness
• haemoptysis due to fragile blood supply of the tumour
• weight loss
• chest pain
• stridor
• recurrent pneumonia in one area due to compression of airway so bacterial build-up

Question 4

What are the common places lung cancer can locally invade to?

Answer 4

• recurrent laryngeal nerve = hoarse voice
• pericardium = breathlessness, atrial fibrillation and pericardial effusion
• oesophagus = dysphagia
• brachial plexus = hand muscle wasting
• pleural cavity = effusion
• superior vena cava = distended external jugular vein and anastamoses

Question 5

Where are the common metastases sites for lung cancer?

Answer 5

• liver
• brain
• bone
• adrenal glands
• skin
• lung

Question 6

What are the non-metastatic symptoms of lung cancer?

Answer 6

• finger clubbing
• hypertrophic pulmonary osteoarthropathy
• weight loss
• hypercalcaemia (stones, bones, groans, thrones and psyciactric overtones)
• hyponatamia (low sodium)

Question 7

How do you make the diagnosis of lung cancer?

Answer 7

• history (cough, haemoptysis etc)
• examination (clubbing, breathlessness etc)
• investigations (blood count, coagulation, spirometry, CXR, CT, PET for metabolic activity, bronchoscopy, CT guided biopsy, endobronchial ultrasound)

Question 8

What are the four most common smoking tumours?

Answer 8

• adenocarcinoma
• squamous carcinoma
• small cell carcinoma
• large cell carcinoma

Question 9

What are the two less common lung cancers?

Answer 9

neuroendocrine and bronchial gland tumours

Question 10

What is the best treatment for small cell cancer?

Answer 10

chemotherapy but there is rapid resistance

surgery is not an option

Question 11

What are the four types of bronchial tumours?

Answer 11

• squamous metaplasia
• dysplasia
• carcinoma in situ
• invasive malignancy

Question 12

What are the two important factors in prognosis indication?

Answer 12

• tumour stage

- histological subtype

Question 13

What is the median survival for lung cancer?

Answer 13

6 months

Question 14

What are the types of surgery for lung cancer?

Answer 14

pneumonectomy or lobectomy which is either by thoracotomy of by VATS

Question 15

What is SABR?

Answer 15

4D radiotherapy with many more beams each with a lower dose

Question 16

What is a disadvantage of radiotherapy?

Answer 16

there can be collateral damage to oesophagus, spinal cord or adjacent lung tissue

Question 17

What is cytotoxic chemotherapy?

Answer 17

• rarely curative
• longer survival
• better response in small cell cancer
• major side effects
• whole body treatment

Question 18

What types of supportive care are offered?

Answer 18

• photodynamic therapy

- stent insertion for stridor

Question 19

What are some co-morbidities for lung cancer?

Answer 19

• COPD

- ischaemic heart disease