Lung cancer

Question 1

lung cancer risk factors

Answer 1

smoking 80% of cases 
air pollution
occupational hazards 
genetics 
link to COPD CF head and neck cancer

Question 2

symptoms

Answer 2

cough > 3 weeks Haemoptysis
Dyspnoea
Unexpected weight loss
Fatigue
Stridor
Pain in chest/shoulder/bones
Clubbing
Hoarseness

Question 3

diagnosis

Answer 3

further tests to confirm 
and to determine spread 
MRI 
Lung biopsy 
PET scan 
isotope bone scan

Question 4

treatment considerations

Answer 4

surgery - lobectomy
chemo - effect on bloods, peripheral neuropathy immunosupression
radiotherapy - radiation pneumonitis
fatigue swallow

Question 5

other complications

Answer 5

PE
pneumothorax
rib fracture
cough issues

Question 6

types of Lung cancer

Answer 6

Non Small Cell Lung Cancer (NSCLC)
Small Cell Lung Cancer (SCLC)
Mesothelioma

Question 7

NSCLC

Answer 7

most common 
squamous cell carcinoma 
adenocarcinoma 
large cell carcinoma 
bronchoaveolar carcinoma

Question 8

NSCLC staging

Answer 8

Stage I. Invasion of underlying lung tissue but no spread to lymph nodes
1A = Tumour small.
1B = cancer larger or growing in main bronchus.

Stage II. Spread to neighbouring lymph nodes or invaded chest wall

Stage IIIA. Spread to lymph nodes in mediastinum

Stage IIIB. Local Spread

Stage IV. Metastatic spread

Question 9

NSCLC Rx

Answer 9

Stage 1 often removed with surgery.
-If Px not fit for surgery, RT used
-Neo-adjuvant/Adjuvant chemo
Stage II
-Can also be possible to remove with surgery.
-RT may be used if Px not fit for surgery
-Often given adjuvant chemo

Stage III

• Surgery often not possible
• Neo-Adjuvant Chemo (Sometimes combined with RT) Often only chemo
• If surgery not possible, RT can be given instead.

Stage IV

- Spread to other parts of the body, or affects >1 lobe of the lung
- Radiotherapy may be used to shrink the cancer and reduce symptoms/relieve pain. 
- Neo Adjuvant/Adjuvant chemo may be given also
- Aim is to control symptoms and maintain a QOL for as long as possible.

Question 10

survival NSCLC

Answer 10

The 5-year survival rate for NSCLC is 24%
Localized NSCLC 61%
Regional NSCLC 35%
Metastatic 6%

Question 11

SCLC

Answer 11

1 / 5 lung cancers (Cancerbackup, 2006)

SCLC staged differently from NSCLC:

Limited. Cancer is confined to one lung and to its neighbouring lymph nodes.
Extensive. Cancer has spread beyond one lung and nearby lymph nodes, may have invaded both lungs, more remote lymph nodes or other organs

Question 12

SCLC Rx

Answer 12

Most SCLC have spread beyond the lungs by time of diagnosis
Surgery usually not an option.
Most effective treatment chemo, alone or in combination with RT
Treat mets – WBRT etc
5 year survival 6% for small cell lung cancer

Question 13

physio Rx

Answer 13

Patients become gradually deconditioned through disease & Rx
Often Rx with platinum chemo regimen –CIPN
May need Ax for O2
Mobility may decline due to SOB
May need education re POE / Activity Tolerance

D/c planning – consider prognosis /possible decline / Pts priorities
Brain Mets / MSCC
If encountered in ITU- Clinically reason Rx with Senior / Medical Team
End stage – Fan can help
St Francis Hospice – Breatheasy Clinic