Lung Cancer

Question 1

Lung Cancer Definition/Statistics:

Answer 1

Lung cancer is one of the most common and serious types of cancer. Mainly caused by smoking. The smoke affects the lung epithelium, and the tabacco smoke activates carcinogens in the lungs.

Question 2

Lung Cancer Types:

Answer 2

Non-small cell lung carcinoma: NSCLC: 80%:
(Squamous Cell Carcinoma - 35%, Adenocarcinoma 27%, Large Cell Carcinoma)
Small Cell Lung Carcinoma: 20%

Question 3

Tumours of the Lung:

Answer 3

Lymphoma
Sarcoma
Tumours of Bronchial Glands
Carcinoid Tumour

Question 4

Lung Cancer Symptoms:

Answer 4

Cough 80%
Haemoptysis 70%
Breathlessness 60%
Chest Pain 40%
Chest Infections
Bone Pain 
Wheeze
Weight Loss
Sputum 
Loss of Appetite
Tired/Weak

Question 5

Lung Cancer Signs: FLPNN HHHOT

Answer 5

Finger Clubbing
Lymphadenopathy
Pancoast Tumour
Non-metastatic effects - HPOA, Finger clubbing, ACTH, siADH, Nephrotic Syndrome

Hoarseness
Horner's Syndrome
Hepatomegaly - enlarged liver
Obstructed Superior Vena Cava
Tracheal Deviation

Question 6

Lung Cancer: Investigations:

Answer 6

CXR - look for pleural effusion, chest wall invasion, phrenic nerve palsy, collapsed lung/lobe
Blood Tests - Anaemia,liver function, bone profile
CT - tumour size, mediastinal nodes, metastasis, pleural effusion, diaphragmatic involvement
MRI
Isotope Bone Scan - mets
Bronchoscopy - histology and assess operability
Fine Needle Aspiration FNA
PET Scan - staging
ECHO
Trans-throacic core biopsy
Sputum Cytology - send at least 20 ml

Question 7

Lung Cancer: Prognostic Markers: Tx directives

Answer 7

Adenocarcinoma: EGFR, KRAS, HER2, BRAF, ALK translocations

Squamous Cell: FGFR1, DDR2, FGF22 mutations

Question 8

Lung Cancer: Treatment: Small Cell Lung Cancer

Answer 8

Limited Disease = Chemotherapy

Extensive Disease = 4 Cycles of Combination Chemo

Question 9

Lung Cancer: Treatment: Non-Small Cell Lung Cancer

Answer 9

Surgery (Lobectomy)
Adjuvant Therpay (post-op chemo, stage 1 or 2)
Neo-Adjuvant Therapy (pre-op chemo: stage 3)
Stages by TNM, Tumour Type, ECOG Performance Status.

Question 10

Lung Cancer: Treatment: Surgery

Answer 10

Bronchoscopy
Mediastinoscopy 
Before surgery you have to assess if the patient has any respiratory or CVS problems. Mental illness.
Do spirometry to assess lung function
Perform cardiac tests

Question 11

Lung Cancer can present as:

Answer 11

Superior Vena Cava Syndrome

Question 12

NICE recommends that patients with known or suspected lung cancer are offered what scan?

Answer 12

Contrast-enhanced CT scan of chest, liver, adrenals

Question 13

Paraneoplastic manifestations of Small Cell Lung Cancer:

Answer 13

Ectopic production of ACTH & ADH

ACTH production produces a Cushing’s Syndrome