Lung cancer

Question 1

What are the types of lung cancer?

Answer 1

Bronchus carcinoma - either small cell or non-small cell. Non small cell includes squamous cell carcinoma, adenocarcinoma, and large cell.

Other types include carcinoid tumour and mesothelioma

Question 2

What are signs and symptoms of lung tumours?

Answer 2

Systemic: weight loss, malaise, night sweats. Finger clubbing, anaemia, lymphadenopathy

Central tumours: cough, haemoptysis, SOB

Peripheral tumours (usually adenocarcinoma): chest pain (pleura)

Mets: bone pain, hepatomegaly

Apical: Horner’s syndrome e.g. Ptosis, miosis, anhidrosis, hoarseness

Question 3

What are signs and symptoms of local spread of lung tumours?

Answer 3

Pleural effusion

Pericardial effusion

Mediastinum: SVC obstruction, recurrent laryngeal nerve, phrenic nerve

Question 4

What are the symptoms of metastases of lung cancer?

Answer 4

Most commonly spreads to liver, bone, brain, adrenal glands

Question 5

What are non-metastatic effects of lung tumours?

Answer 5

ACTH: Cushing’s
ADH: SIADH
PTHrP: hypercalcaemia

Usually small cell cancers, since these originate from neuroendocrine tissue

Question 6

What are differentials for lung cancer?

Answer 6

LRTI

interstitial lung disease

Question 7

What investigations in lung cancer?

Answer 7

Bloods: FBC, CRP, WCC, Ca.

CXR: mass, hilar enlargement, consolidation, collape , effusion

CT or PET scan: stage tumour, guide bronchoscopy

CT guided percutaneous needle biopsy (if peripheral lesion)

Cytology: of sputum and of pleural fluid to guide targeted therapies

Lymph node biopsy

Question 8

What is the management of lung cancer?

Answer 8

Small cell: often metastasises. Chemo and radio

Non-small cells: surgery is good. Do lung function tests.

Question 9

What are targeted therapies in lung cancer?

Answer 9

• EGFR inhibitors (erlotinib)
  
  • ALK inhibitors (crizotinib)
  • PDL1 inhibitors (nivolumab)

Question 10

What CXR changes do you see in lung cancer?

Answer 10

Mass lesion
lobar or lung collapse
Mediastinal widening or hilar lymph nodes
Pleural effusion
Consolidation

Question 11

What are emergencies associated with lung cancer?

Answer 11

SVC obstruction: due to mediastinal noes compresses SVC. Get swollen face and R arm, dysphagia, stridor. Vascular stents

Spinal cord compression: weakness/numbness in legs, reduced bladder and bowel control, UMN signs.

Treat both w steroids.