Lung Cancer

Question 1

Definition

Answer 1

Primary malignant neoplasm of the lung

o WHO classification of bronchocarcinoma:
· Small Cell Lung Cancer - 20%
· Non-Small Cell Lung Cancer - 80%

Question 2

Aetiology/risk factors

Answer 2

· Smoking
· Asbestos exposure
· Other occupational exposure: polycyclic hydrocarbons, nickel, radon
· Atmospheric pollution

Question 3

Epidemiology

Answer 3

· Most common FATAL cancer in the west (18% of cancer mortality worldwide)

· 3 x more common in MALES

Question 4

Presenting symptoms (primary)

Answer 4

o Cough
o Haemoptysis
o Chest pain
o Recurrent pneumonia

Question 5

Presenting symptoms (local invasion)

Answer 5

o Brachial plexus invasion –> shoulder/arm pain
o Left recurrent laryngeal nerve invasion –> hoarse voice and bovine cough
o Dysphagia
o Arrhythmias
o Horner’s syndrome

Question 6

Presenting symptoms (metastatic disease or paraneoplastic phenomenon)

Answer 6

o Weight loss
o Fatigue
o Fractures
o Bone pain

Question 7

Signs on physical examination

Answer 7

· May be NO SIGNS

· Fixed monophonic wheeze (suggesting that there is a single obstruction)

· Signs of lobar collapse or pleural effusion

· Signs of metastases (e.g. supraclavicular lymphadenopathy or hepatomegaly)

Question 8

Investigations

Answer 8

· Diagnosis
o CXR
o Sputum cytology
o Bronchoscopy with brushings or biopsy
o CT/US-guided percutaneous biopsy
o Lymph node biopsy

· Staging - requires CT/MRI of head, chest and abdomen. PET scans may also be useful

· Bloods
o FBC
o U&Es
o Calcium (hypercalcaemia is a common feature)
o ALP (raised with bone metastases)
o LFTs

· Pre-Op - ABG and pulmonary function tests