Lung cancer

Question 1

Define lung cancer

Answer 1

Primary malignant neoplasm of the lung

WHO classification of bronchocarcinoma:
•Small Cell Lung Cancer -20%
•Non-Small Cell Lung Cancer -80%

Question 2

Explain the aetiology/risk factors of lung cancer

Answer 2

Smoking
Asbestos exposure
Other occupational exposure: polycyclic hydrocarbons, nickel, radon
Atmospheric pollution

Question 3

Summarise the epidemiology of lung cancer

Answer 3

Most common FATAL cancer in the west (18% of cancer mortality worldwide)

3 x more common in MALES

Question 4

Recognise the presenting symptoms of lung cancer

Answer 4

May be ASYMPTOMATIC

Symptoms due to primary:
Cough
Haemoptysis
Chest pain
Recurrent pneumonia

Symptoms due to local invasion:
Brachial plexus invasion –> shoulder/arm pain
Left recurrent laryngeal nerve invasion –> hoarse voice and bovine cough
Dysphagia
Arrhythmias
Horner’s syndrome

Symptoms due to metastatic disease or paraneoplastic phenomenon:
Weight loss
Fatigue
Fractures
Bone pain

Question 5

Recognise the signs of lung cancer on physical examination

Answer 5

May be NO SIGNS

Fixed monophonic wheeze (suggesting that there is a single obstruction)

Signs of lobar collapse or pleural effusion

Signs of metastases (e.g. supraclavicular lymphadenopathy or hepatomegaly)

Question 6

Identify appropriate investigations for lung cancer

Answer 6

Diagnosis:
CXR
Sputum cytology
Bronchoscopy with brushings or biopsy
CT/US 
guided percutaneous biopsy
Lymph node biopsy

Staging - requires CT/MRI of head, chest and
abdomen. PET scans may also be useful

Bloods
FBC
U&Es
Calcium (hypercalcaemia is a common feature)
ALP (raised with bone metastases)
LFTs 

Pre-Op ABG and pulmonary function test