Lung Cancer

Question 1

Causes

Answer 1

SMOKING
asbestos
radiation
arsenic
chromium
coal tar and oils
iron oxides
pollution

Question 2

Smoking when already diagnosed

Answer 2

Increases LE

Does not lower risk back

Question 3

2 Types

Answer 3

Small cell (oat cell) (10%)
Non small cell

Question 4

Types of non small cell

Answer 4

Squamous cell carcinoma >
Adenocarcinoma!!
Large cell carcinoma

Question 5

Small cell features

Answer 5

aggressive
early spread
chemo response
endocrine cells produce hormones

Question 6

Squamous cell features

Answer 6

Cavitates

Smokers

Question 7

Large cell features

Answer 7

Early metastasis

undifferentiated

Question 8

Bronchoalveolar cell features (adenocarcinoma in situ)

Answer 8

resembles pneumonia

Question 9

Indications for urgent CXR

Answer 9

haemoptysis
>3 weeks of = 
cough
weight loss
chest signs
dyspnoea
chest/shoulder pain
hoarseness
clubbing
features of mets
supraclavicular/cervical lymphadenopathy

Question 10

Chest signs

Answer 10

Visible swelling
Facial swelling
distended veins
reduced expansion
Dullness = reduced TV and RV
Wheeze
reduced breath sounds

Question 11

Paraneoplastic syndromes in Small cell

Answer 11

Cushings = ectopic ACTH
SIADH
Lambert Eaten myasthenic syndrome
limbic encephalitis
cerebellar syndrome

Question 12

Paraneoplastic syndrome in squamous cell carcinoma

Answer 12

Hypercalcaemia

Question 13

When is the 2 week wait

Answer 13

• if CXR or CT suggests cancer with pleural effusion or slowly resolving consolidation
• if CXR or CT normal but high clinical suspicion

Question 14

When should there be an urgent referral

Answer 14

• persistent haemoptysis in smokers/ex older than 40 years
• SVC obstruction signs
• stridor

Question 15

Ix for diagnosis and staging

Answer 15

• bronchoscopy
• CT guided biopsy
• PET scan
• MRI for Pancoast tumours
• bloods
• bone scan
• brain CT/MRI
• mediastinoscopy
• FNA

Question 16

TNM Staging

Answer 16

T = size and location (T1 = small, peripheral, surgical removal T4 advanced large invading)
N = which lymph nodes involved (1 = hilar, 2  = mediastinal, 3 = contralateral)
M = if metastases present

Question 17

Common sites of metastases

Answer 17

brain, liver, lungs, adrenals, bones

Question 18

Surgical treatment

Answer 18

• for localised non invading
• no spread
• only chance of cure

Question 19

Radical Radiotherapy

Answer 19

• squamous cell carcinoma
• not possible for surgery as lymph nodes involved or patient not fit
• complication = early post radiation pneumonitis and later fibrosis

Question 20

Palliative radiotherapy

Answer 20

• relieves pain, haemoptysis, neurological problems

Question 21

Chemotherapy

Answer 21

• cisplatin, docetaxel, gemcitabine
• ORAL = EGFR ant (gefitinib, erlotinib)
• ALK = certiib, alectinib, crizotinib
• NEW = atezolizumab, durvalumab
• immunotherapy = pembrolizumab (PD-L1 positive tumours)

Question 22

Adjuvant chemo

Answer 22

• after surgery to reduce recurrence chance

- if disease in hilar LN

Question 23

Neo-adjuvant chemo

Answer 23

• before surgery to make sure cancer well controlled

Question 24

Palliative

Answer 24

Endobronchial laser 
Stenting = relieves breathlessness
Endobronchial radiotherapy (brachytherapy)
- painkillers
- antitussives
- oxygen
- steroids

Question 25

Cancer nurse specialist

Answer 25

psychosocial support

counselling

Question 26

Ideal pathway

Answer 26

• patient presents
• CXR
• CXR abnormal = refer to chest physician
• require CT
• OPA and PET request
• bronchoscopy/CT/EUS
• histology
• decide on chemo/RT/surgery

Question 27

Further management

Answer 27

• inform GP within 24 hrs of giving diagnosis to patient
• ensure all required materials sent to surgeon/oncologist
• confirm appointment from tertiary centre
• further follow ups 3 monthly