Lung cancer

Question 1

Outline the disease course, position and histological characterstics of small cell lung cancer

Answer 1

15% of lung CAs and most agressive form, metastasizing early and widely

tumours tend to arise centrally with mediastinal involvement

can secrete ADH and ACTH

histology

• oval to spindle shaped cells
• inconspicious nucleoli
• scant cytoplasm

Question 2

what are the types of non-small cell lung CA?

Answer 2

adenocarcinoma (40%)
squamous cell carcinoma (30%)
large cell carcinoma (10%)

Question 3

outline adenocarcinoma of the lung

Answer 3

tends to arise in the periphery, sometimes in relation to scarring

often arises in non-smokers

Question 4

outline SCC of the lung

Answer 4

arise centrally from major bronchi, often from dysplastic epithelium following squamous metasplasia

they are slow growing and can undergo cavitation

can cause recurrent pneumonia

can secrete PTH

histologically they show keratinisation and/or intracellular bridges

Question 5

what are the symptoms of lung CA?

Answer 5

cough 
haemoptysis 
SOB 
chest pain 
lethargy 
weight loss 
recurrent pneumonia (SCC)

Question 6

what are the signs of lung CA?

Answer 6

cachexia 
clubbing 
lymphadenopathy 
consolidation, collapse and effusion 
signs of mets 
hypertrophic pulmonary osteoarthropathy causing wrist pain

Question 7

what are the local complications of lung CA?

Answer 7

recurrent laryngeal nerve palsy (hoarsness and aphonia)

Phrenic nerve palsy (hemidiaphragm elevates)

SVCO

Horners syndrome

pericarditis

Question 8

what are the S&S of SVCO?

Answer 8

facial plethora 
increased JVP 
distended neck and chest veins 
SOB 
cough 
arm swelling

Question 9

small cell tumours can secrete which hormones?

Answer 9

ADH ( SIADH symptoms of water retention and hyponatraemia

ACTH (causing cushings)

Question 10

squamous cell carcinomas can secrete which hormones?

Answer 10

PTH (increased calcium)

Question 11

what InV are done in lung CA?

Answer 11

CXR

CT thorax and abdo

bronchoscopy and biopsy

FNA of LN’s

Sputum and pleural fluid cytology

Bone scan or PET-CT

PCR or FISH
- looks for EML4-ALK, EGFR, PDL-1 for immunotherapy

Question 12

what are the treatment options for lung cancer?

Answer 12

surgical excision

radio and chemo

EGFR tyrosine kinase inhibitor
- Gefitinib or afatinib

ALK inhibitor
- Crizotinib

BRAF inhibitor
- dabrafenib or vemurafinib

PD-1/PDL-1 inhibitors
- nivolumab

Question 13

how is SVCO treated?

Answer 13

SVC stent
radio
Dexamethasone