Lung cancer

Question 1

Define:

Answer 1

Primary malignant neoplasm of the lung

Two different types - small cell -20% (most associated with smoking, small and fast growing and so has a worse prognosis) and non-small cell-80% (adenocarcinoma, large cell, squamous cell, carcinoid –> slow to divide and spread)

Question 2

Aetiology/risk factors:

Answer 2

Smoking
Asbestos
Atmospheric pollution
Occupational hazards - polycyclic hydrocarbons, nickel, radon gas, chromium, arsenic, iron oxides

Question 3

Epidemiology:

Answer 3

Most common fatal cancer in the west (18% mortality)

3x more likely in males

Question 4

Early symptoms:

Answer 4

May be asymp

Cough

Hameoptysis

Chest pain

Dysponea

Recurrent pneumonia

Question 5

Symptoms of invasion:

Answer 5

On the brachial plexus - shoulder/arm pain

Pressing on the sympathetic nerves leads to Horner’s syndrome.

Pressing on the SVC leads to backlog of blood leading to flushed face and face and arm oedema

Compression of the recurrent larnygeal nerve - hoarse voice

Dysphagias

Arrythmias

Question 6

Signs of metastases:

Answer 6

Bone pain
Fractures
Fatigue 
Weight loss
Night sweats

Question 7

Signs:

Answer 7

May have none

Signs of lobar collapse or pleural effusions (stoney dull percussion + decreased vocal tactile fremitus)

Fixed monophonic wheeze

Signs of metastases - bone tenderness/pain, lymphadenopathy, hepatomegaly, fits and confusion, proximal myopathy, cerebellar syndrome + peripheral neuropathy

Cachexia

Clubbing

Anaemia

Hypertrophic pulmonary osteoarthropathy causing wrist pain

Lymphadenopathy – supraclavicular or axillary nodes

Question 8

Investigations:

Answer 8

CXR – peripheral nodule, hilar enlargement, consolidation, lung collapse, pleural effusion, bony secondaries

Sputum and pleural fluid cytology

Bronchoscopy with brushings or biopsy – to give histology

CT/US-guided percutaneous biopsy

Lymph node biopsy
• Staging - requires CT/MRI of head, chest and abdomen. PET scans may also be useful
Staging = TNM

Radionuclide bone scan if suspected mets

Lung function tests to assess suitability for lobectomy

Bloods
o FBC
o U&Es
o Calcium (hypercalcaemia is a common feature)
o ALP (raised with bone metastases)
o LFTs + Pre-Op - ABG and pulmonary function tests