Lung cancer

Question 1

What is lung cancer?

Answer 1

Lung cancer is classified into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)

Question 2

What are some risk factors of lung cancer?

Answer 2

(Nicotine) smoking causes approx. 90% of lung cancers
(Occupational and environmental exposure to carcinogens) passive smoking, asbestos, arsenic, radon, uranium
(Family history)

Question 3

What are the types of lung cancer?

Answer 3

(Small cell lung cancer)
(Non-small cell lung cancer) 3 main sub-types: Adenocarcinoma (glandular tissue), squamous cell carcinoma, large cell carcinoma (poorly differentiated)

Question 4

What are the clinical features of lung cancer?

Answer 4

(Pulmonary) Cough (chronic or recently developed)
Hemoptysis
Progressive dyspnea
Chest pain
(Extra-pulmonary) Constitutional symptoms (weight loss, fever, weakness)
Clubbing of the fingers and toes
Superior vena cava syndrome
Paralysis of the recurrent laryngeal nerve: hoarseness
Paralysis of the phrenic nerve: results in diaphragmatic elevation and dyspnea

Question 5

What are the paraneoplastic features of lung cancer?

Answer 5

(Small cell) ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

(Squamous cell) parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

(Adenocarcinoma) gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

Question 6

What is a pancoast tumour?

Answer 6

Peripheral lung carcinoma (predominantly NSCLC) that is located in the superior sulcus of the lung; often involves the cervical sympathetic nerves and brachial plexus.

Question 7

What are the clinical features of pancoast tumours?

Answer 7

Severe, localized pain in the axilla and shoulder
Horner syndrome
Atrophy of arm and hand muscles
Edema of the arm, facial swelling, morning headache

Question 8

How is lung cancer diagnosed?

Answer 8

(Chest X-ray)
(Bronchoscopy) Allow of biopsies
(PET scanning)
(Blood test, investigate extra-pulmonary involvement) CBC, serum chemistry (calcium, alkaline phosphatase, liver function test, kidney function test)

Question 9

What is the treatment for small cell lung cancer?

Answer 9

(Early, T1-2a, N0, M0) Surgery, otherwise usually mix of radiotherapy and chemo
(Metastatic) Palliative chemotherapy

Question 10

What is the treatment for non-small cell lung cancer?

Answer 10

(20% suitable for surgery)

Curative or palliative radiotherapy; poor response to chemo