Lung Cancer

Question 1

Define lung cancer

Answer 1

Malignant epithelial tumours arising from the cells of the lower respiratory tract (lungs)

Question 2

What are the two types of lung cancer?

Answer 2

Non-small cell lung cancer (85%)
• Adenocarcinoma – peripheral
• Squamous cell carcinoma – bronchi
• Large cell carcinoma
• Adenosquamous carcinoma
Small-cell lung cancer (15%) – arise from neuroendocrine Kulchitsky cells

Question 3

What are the causes/risk factors for lung cancer?

Answer 3

• Older age
• Smoking
• COPD (probably due to strong correlation with smoking)
• Family history
• Occupational exposures e.g. polycyclic hydrocarbons, asbestos, radon

Question 4

What are the symptoms of lung cancer?

Answer 4

• Cough
• Dyspnoea
• Haemoptysis
• Chest/shoulder pain
• Weight loss
• Fatigue
• Hoarseness/bovine cough (L recurrent laryngeal nerve)
• Dysphagia (oesophagus)

Pancoast’s tumour -> syndrome
• Weakness/ paraesthesia/ pain in
hand and arm

Metastases
• Nausea & vomiting
• Headache
• Seizure
• Personality changes
• Confusion
• Bone pain/fractures

Question 5

What are the signs of lung cancer?

Answer 5

• Fixed monophonic wheeze
• Crackles
• Decreased breath sounds
• Dullness on percussion (collapse,
pleural effusion)
• Clubbing
• Hypertrophic pulmonary
osteoarthropathy – clubbing,
painful/swollen wrists/ankles

Pancoast’s tumour -> syndrome
• Horner’s syndrome
• Wasting of small muscles of the
hand

SVCO
• Facial swelling
• Upper limb oedema
• Neck vein distension

Metastases
• Supraclavicular lymphadenopathy
• Hepatomegaly

Question 6

What are the investigations for lung cancer?

Answer 6

small cell:
• chest x-ray - central mass, hilar lymphadenopathy, pleural effusion
• CT chest, liver, and adrenal glands - massive lymphadenopathy and direct mediastinal invasion are common features of SCLC; determines extent of disease
• sputum cytology - malignant cells in sputum