Lung Cancer

Question 1

What are the risk factors for lung cancer?

Answer 1

Lifestyle- smoking, obesity
Environmental- coal workers, asbestos, ionising radiation
Genetic- increasing age, fhx of lung cancer, M>F
Pre-existing disease- HIV, ILD, COPD, TB

Question 2

What are the 2ww referral guidelines for suspected lung cancer?

Answer 2

CXR findings suggestive of lung cancer

Aged 40 or over with unexplained haemoptysis

Question 3

What factors make you consider an urgent CXR?

Answer 3

Over 40 and 2 of the following or have ever smoked and one of the following:

Weight loss, cough, fatigue, SOB, Chest pain, anorexia

Over 40 and any of the following:
Persistent infections, finger clubbing, supraclavicular lymphadenopathy, chest signs consistent with cancer, thrombocytosis

Question 4

What investigations might you do for suspected lung cancer?

Answer 4

bloods- FBC, U&E, LFT, Calcium, LDH, bone profile
CXR

Staging CT

Biopsy- US guided neck node FNA/ bronchoscopy/ CT biopsy, thoracoscopy depending on where lesion is

PET scanning- particularly used to detect micrometastases in non small cell lung cancer

Question 5

Describe the treatment options for non small cell lung cancer

Answer 5

Evaluate performance status and FEV 1
Stage 1/2- if tumour is less than 5cm consider surgery with adjuvant chemo, if inoperable then radical radiotherapy

Stage 3/4- chemotherapy and radiotherapy

Specific treatments- squamous cell carcinoma- immunotherapy
Adenocarcinoma- EGFR tyrosine kinase inhibitor eg erlotinib, PDL1 inhibitors

Question 6

What are the different histological types of lung cancer?

Answer 6

Non small cell- includes squamous cell, adenocarcinoma, large cell, bronchoalveolar. Associated with hypercalcaemia, pancoast tumour- hroners syndrome, hoarse voice, wasting of arm muscles

Small cell- rapidly progressive, often metastatic at presentation. Associated with SIADH

Mesothelioma

Question 7

What are the treatment options for small cell lung cancer?

Answer 7

One place, <5cm- surgery
Limited local area- concurrent radiotherapy and chemotherapy. Often given prophylactic brain radiotherapy

If extensive- palliative chemo

Question 8

What symptoms can lung cancer present with?

Answer 8

Long term cough, chest pain, dyspnoea, sputum, haemoptysis, monophonic wheeze

General- weight loss, night sweats, anorexia

Cancer syndromes- horners syndrome, hypercalcaemia,SVC obstruction, SIADH, cushings, lambert eaton myaesthenic syndrome, thrombo-emobolic disease, clubbing

Metastasis- liver, adrenals, bone, pleura, CNS

Question 9

What signs might lung cancer present with?

Answer 9

General- cachexia, Clubbing, anaemia, supraclavicular lymphadenopathy

Chest- pleural effusion, consolidation, collapse

Cancer syndromes- SVCO/ horners syndrome