Lung Cancer

Question 1

Which cancer has the highest rates of mortality?

Answer 1

lung cancer

Question 2

Which cancer is the most deadly?

Answer 2

pancreatic

Question 3

How do patients with lung cancer present?

Answer 3

Incidentally (6%)/Screening
Symptoms/Signs of Primary Tumor
Symptoms/Signs of Metastases
Paraneoplastic Syndromes

Question 4

What are the sign and symptoms of primary lung cancer?

Answer 4

Central tumours – cough, hemoptysis, SOB, SVC Obstruction

Peripheral tumours- usually asymptomatic, may present with chest wall pain or as a Pancoast tumor
- Pancoast syndrome – shoulder/arm pain, Horner’s syndrome, arm weakness/muscle atrophy

Question 5

what is horner’s syndrome?

Answer 5

Horner’s- miosis (constriction of the pupils), anhidrosis (lack of sweating), ptosis (drooping of the eyelid), enophthalmos (recession of the eyeball within the orbit)

Question 6

What usually happens with SVCO?

Answer 6

One of the signs sometimes seen with SVCO includes engorgement of superficial chest vascular, as collateralization of blood flow occurs.

Question 7

What is a pancoast tumor?

Answer 7

Pancoast tumours, or superior sulcus tumours, present in the apex of the lung and involve the cervical sympathetic and brachial plexus, resulting in the aforementioned signs and symptoms.

Question 8

What are usually sign/symptoms of metastatic lung cancer?

Answer 8

Nodal : neck mass
Bone : pain, pathological fracture, spinal cord compression
Liver : right upper quadrant pain, weight loss, fatigue anorexia
Brain : headache, neurological deficit, seizures, nausea

Question 9

What is paraneoplastic syndrome?

Answer 9

Signs and symptoms caused by the cancer but not directly related to the primary or its metastases:
Endocrine
Hypercalcemia, hyponatremia (SIADH), Cushing’s syndrome

Neurologic
Immune-mediated with autoantibodies

Hematologic
Anemia, leukocytosis, thrombocytosis

Dermatologic
Hypertrophic pulmonary osteoarthropathy (clubbing)

Question 10

T or F: it is common for solid tumors from other sites to metastasize to lungs

Answer 10

T:
ie. Breast cancer
GI cancers
Renal cell carcinoma
Melanoma

Question 11

For a primary lung cancer, what is the most important pathological info ?

Answer 11

Non-small cell [surgical disease] versus small cell

Question 12

Why cancer staging is important?

Answer 12

Vital for :
treatment decisions
prognosis
comparing outcomes of different treatments
communicating with other physicians

Question 13

What characteristic does the NSCLC (non-small cell lung cancer) staging system use?

Answer 13

T ( tumour)
N (node)
M (metastases)

Question 14

How does the SCLC stage work?

Answer 14

limited disease vs. extensive disease

Question 15

What is limited disease according to SCLC?

Answer 15

confined to one hemithorax including mediastinal and supraclavicular nodes

can encompass all disease in a tolerable radiation volume

treated with curative intent (median survival still only 18 months, ~15% long term survivors)

Question 16

What is extensive disease according to SCLC?

Answer 16

anything else
65%-70% present with extensive disease
palliative

Question 17

What is the usual investigation for lung cancer suspicion?

Answer 17

Chest X-ray: central/peripheral, effusion, mediastinal nodes, other nodules, bone mets

CT Scan (chest/upper abd): mediastinal nodes, metastases

Bronchoscopy: tissue diagnosis and staging

Mediastinoscopy: tissue diagnosis and staging
- Surgical procedure

Percutaneous transthoracic biopsy

Pulmonary function tests
- Important to assess pulmonary reserve prior to treatment

Positron Emission Tomography (PET) Scan

Question 18

What is the treatment for a patient with NSCLC at stage 1/2?

Answer 18

Treatment of choice is surgical resection of lung

Adjuvant chemotherapy after surgical resection in certain patients

Question 19

What is the treatment for a patient with NSCLC at stage 3?

Answer 19

Selected patients who are not resectable are treated with chemotherapy and radiotherapy with curative intent

Question 20

What is the treatment for a patient with NSCLC at stage 4?

Answer 20

85% of patients will either present with or develop metastatic disease

Treatment intent is palliation of symptoms and prolongation of survival

Patients with localized symptoms (cough, SOB, hemoptysis, bone pain, brain mets) usually receive palliative radiation therapy initially

Question 21

What is the treatment for a patient with SCLC ?

Answer 21

Chemotherapy the mainstay of treatment and is the only treatment shown to alter the course of the disease

-In patients with limited stage disease, combined with thoracic radiation therapy