Lung Cancer

Question 1

In which age group is lung cancer normally seen?

Answer 1

Uncommon under the age of 45

Most common cancer in men aged over 65

Question 2

What are the 2 main types of lung cancer?

Answer 2

Small cell and non-small cell

Question 3

What are non-small cell lung cancers comprised of?

Answer 3

adenocarcinomas

squamous cell carcinomas

large cell carcinomas

Question 4

How do SCLCs vary compared to NSCLCs?

Answer 4

they are comprised of much smaller cells and will rapidly metastasise (spread) to other organs

It can be fatal in a few weeks untreated as it spreads rapidly in the early stages

Question 5

What % of lung cancers are small cell?

Answer 5

15 - 20%

rare in non-smokers

Question 6

what are the main symptoms of lung cancer?

Answer 6

1. cough
2. tachypnoea
3. wheeze
4. stridor
5. haemoptysis
6. dysphagia
7. hoarse voice

Question 7

What is stridor?

Answer 7

a harsh vibrating noise when breathing caused by an obstruction of the airways

Question 8

What is haemoptysis?

Answer 8

coughing up blood

this occurs in 50% of cases

Question 9

what is dysphagia?

Answer 9

difficulties with swallowing

Question 10

Why does lung cancer cause bone pain?

Answer 10

due to the spread of the cancer

if bone metastases involve the spine, compression of the spinal cord by the tumour can cause pain with walking and weakness in the legs

Question 11

How does lung cancer affect appearance?

Answer 11

It causes anorexia and weight loss due to lost appetite

Question 12

What is clubbing?

Answer 12

A deformity of the finger or toe nails associated with diseases of the lung and heart

Question 13

How does the nail bed and the ends of the fingers appear in clubbing?

Answer 13

The ends of the fingers are enlarged and appear warm and red

The nail bed becomes spongy and nail bed angle is lost

Question 14

How does the nail change in clubbing?

Answer 14

Nails form a sharper angle with the cuticle

The nail and the skin around it eventually becomes shiny and the nail develops ridges

Question 15

What is lymphadenopathy?

Answer 15

A disease of the lymph nodes where they are abnormal in size, number or consistency

Question 16

Why does lung cancer lead to lymphadenopathy?

Answer 16

Lung cancer spreads first to the lymph nodes near the tumour

these are the regional lymph nodes

Question 17

How does lung cancer cause superior vena cava obstruction?

Answer 17

The vessel wall is compressed by a malignant tumour in the mediastinum

This blocks the blood flow in the vein

Question 18

What is Horner’s syndrome?

Answer 18

Damage to the sympathetic nerves of the face

Question 19

What is Horner’s syndrome characterised?

Answer 19

miosis - constriction of the pupil

ptosis - drooping of the upper eyelid

anhidrosis - absence of sweating in the face

Question 20

What are the investigations for lung cancer?

Answer 20

1. chest x-ray
2. CT/PET scan
3. Bronchoscopy
4. Percutaneous fine needle aspiration/biopsy
5. Mediastinoscopy
6. VATS
7. Bone scan/CT scan of the head
8. Endobronchial ultrasound

Question 21

How does a PET scan work?

Answer 21

It detects gamma rays emitted by a positron-emitting radionuclide (tracer)

Flurodeoxyglucose (FDG) is an analogue of glucose that indicates tissue metabolic activity (cancer)

Question 22

What is a percutaneous fine needle aspiration?

Answer 22

A CT or ultrasound machine is used to guide a small needle through the skin and into the growth in the lung to take a sample

The sample may be taken from tissue in the chest, lymph nodes, lung or the lining of the lung

Question 23

What is a mediastinoscopy?

Answer 23

A way of obtaining a biopsy to see if lung cancer has spread to the lymph nodes around the trachea

Question 24

What is VATS?

Answer 24

Video-assisted thoracoscopic surgery

A surgeon makes one or more small cuts in the chest and uses a small flexible camera to look at parts of the lung

A small biopsy is then taken

Question 25

What is an endobronchial ultrasound (EBUS)?

Answer 25

Uses ultrasound along with a bronchoscope to visualise the airway wall and structures adjacent to it

Ultrasound image shows abnormal structures in the lungs and lymph nodes where biopsies will be taken

Question 26

How is small cell lung cancer treated?

Answer 26

Chemotherapy and radiotherapy

It is not removed by surgery as it is likely to have already spread

Question 27

How is non-small cell lung cancer treated?

Answer 27

Surgery, chemotherapy, radiotherapy

Question 28

How many lung cancer patients are diagnosed at a late stage?

What are the survival rates like?

Answer 28

One of the lowest survival outcomes of any cancer

Over two thirds of patients diagnosed at a late stage

Younger patients have much higher survival rates

Question 29

What % of lung cancer cases are caused by tobacco smoking?

How much does this increase the risk of lung cancer?

Answer 29

90%

smoking increases risk of lung cancer by 8 to 20 times

Question 30

What are the other factors that can cause lung cancer?

Answer 30

1. asbestos exposure
2. radioactive minerals such as radon gas
3. pyrene, arsenic, nickel and napthalene
4. family history

Question 31

What is a paraneoplastic syndrome?

Answer 31

A syndrome that is the consequence of cancer in the body

Unlike mass effect, it is NOT due to the local presence of cancer cells