Lung cancer

Question 1

Describe the referral pathway / criteria for referral for suspected lung cancer.

Answer 1

urgent cancer referral (appointment within 2 weeks) with one of the following

• CXR suggesting lung cancer
• > 40yrs unexplained haemoptysis

offer urgent CXR (within 2 weeks) in patients > 40 yrs + 2 of the following or > 40yrs + smoke + 1 of the following;

• fatigue
• cough
• weight loss
• appetite loss
• chest pain

consider urgent CXR (within 2 weeks) in patients > 40yrs with one of the following

• thrombocytosis
• recurrent chest infections
• recurrent cervical lymphadenopathy or supraclvciular lymphadenopathy
• finger clubbing
• chest signs consistent with lung cancer

Question 2

what is the treatment for SCLC?

Answer 2

if stage T1-2a, NO, MO = surgery

chemo + radiotherapy

if extensive disease = palliative chemotherapy

Question 3

what is the treatment for NSCLC?

Answer 3

if stage I-IIIa = surgery

radiotherapy
doesn’t respond to chemo

Question 4

what paraneoplastic syndromes are associated with;

• SCLC?
• squamous cell?
• adenocarcinoma?

Answer 4

squamous cell;

• PTHrP = hypercalcaemia
• TSH = hyperthyroidism
• HPOA = hypertrophic osteoarthropathy

SCLC;

• ACTH = cushings
• ADH = hyponatraemia
• Lambert Eaton syndrome = myaesthenia like symptoms

adenocarcinoma;

• gynaecomastia
• HPOA

Question 5

a patient with lung cancer has hypokalaemia alkalosis.

what might be the explanation for this?

Answer 5

small cell lung cancer associated with paraneoplastic syndrome of ACTH production = cushings
high levels of cortisol can cause hypochloraemic alkalosis (metabolic alkalosis)

Question 6

what type of lung cancer is found in non-smokers?

Answer 6

adenocarcinoma

Question 7

what the of lung cancer is strongly associated with finger clubbing?

Answer 7

squamous cell

Question 8

what are contraindications for surgery in lung cancer?

Answer 8

stage 3b-4
tumour near the hilum
SVC obstruction 
FEV1 < 1.5 litres 
malignant pleural effusion 
vocal cord paralysis