Lung Cancer

Question 1

Describe the incidence of lung cancer

Answer 1

The most common cause of cancer related deaths world wide

35,000 deaths per year in the UK

Question 2

What are some of the risk factors for developing lung cancer?

Answer 2

• Smoking is number 1
• Asbestos
• Radon (from mining or indoor exposure)
• Occupational carcinogens e.g. chromium, nickel, arsenic
• Genetic/ Familial risk

Question 3

What are some of the symptoms of primary lung cancer?

Answer 3

• Persistant cough
  
  • Non responsive to antibitoics or steroids
• Haemoptysis
• Dyspnoea
• Wheeze
• Weight loss
• Fatigue
• MAY HAVE NO SYMPTOMS

Question 4

What clinical signs suggest lung cancer?

Answer 4

• Cachexia (weakness/ wasting of body)
• Pale Conjunciva
• Finger clubbing
• Cervical lyphadenopathy
• Horner’s Syndrome (if in the apex)
• Consolidation
• Signs of pleual effusion
• Muffled heart sounds
• Liver enlargement

Question 5

Which imagine techniques are used to diagnose and stage lung cancer?

Answer 5

• CXR
• CT scan
• PET scan - shows glucose usage
• MRI
• USS
• Bone scan
• ECHO

Question 6

Descibe the common methods used to obtain material for histiological diagnosis

Answer 6

• Bronchoscopy
• USS- guidance for neck nodes, lung/ chest wall masses, pleural fluid and the liver
• CT Biopsy- lung and pleura
• Cervical lymph node fine needle aspiration
• Thorocoscopy
• Surgical

Question 7

What are the different types of lung cancer cells?

Answer 7

Carcinoma is an invasive malignant epithelial tumour

Main types are:

• Non-small cell lung cancer (40%)
• Squamous cell carcinoma (35%)
• Adenocarcinoma (5%)
• Large Cell Carcinoma
• Small Cell Carcinoma (very aggressive)

Question 8

Which type of cancer is this?

Answer 8

Non-small cell lung cancer

Question 9

Which type of cancer is this?

Answer 9

Small cell carcinoma

Question 10

Which type of cancer is this?

Answer 10

Squamous cell carcinoma

Question 11

Which type of cancer is this?

Answer 11

Adenocarcinoma

Question 12

Which type of cancer is this?

Answer 12

Large cell carcinoma

Question 13

How is lung cancer staged?

Answer 13

TNM staging

Question 14

Which type of lung cancer is the most operable?

Answer 14

Mainly non-small cell carcinoma

Question 15

What are the two types of radiotherapy that can be given for lung cancer?

Answer 15

1. Radical - with curative intent
2. Palliative - for symptom control

Question 16

How does survival improve with combination chemotherapy is small cell vs non small cell carcinoma?

Answer 16

Small cell - only potentially curative in a minority

Non small cell - modest survival increase

Question 17

How do biological immotherpies work?

Answer 17

Targetted treatment specific for tumour markers:

• EGFR
• ALK
• RAS
• PD1
• PDL1

Question 18

What palliative care and other treatment options are used for active symptom control in non curative cancer?

Answer 18

• analgesia
• radiotherapy
• airway stents
• anxiolytics
• nutritional support
• patient support groups
• treatment for tobacco addition
• coronary heart disease treatment