Lung cancer

Question 1

define lung cancer?

Answer 1

● Primary malignant neoplasm of the lung

Question 2

what are the types of lung cancer?

Answer 2

▪	Small Cell Lung Cancer - 20%
▪	Non-Small Cell Lung Cancer - 80%
o	Adenocarcinoma (common in non smokers) 
o	Squamous cell (common in smokers) 
o	Large cell 
o	Alveolar cell carcinoma (rare)
o	Bronchial adenoma

Question 3

which kind of cancer has the worst prognosis?

Answer 3

● Small cell – made up of small cells that divide and spread rapidly (worse prognosis)

Question 4

major risk factors for lung cancer?

Answer 4

● Smoking
● Asbestos exposure
● Other occupational exposure

Question 5

epidemiology of lung cancer?

Answer 5

● 3 x more common in MALES

Question 6

presenting symptoms of lung cancer? - primary

Answer 6

o	Cough
o	Haemoptysis
o	Chest pain
o	Dyspnoea 
o	Weight loss 
o	Hoarseness 
o	Superior vena cava syndrome

Question 7

presenting symptoms of lung cancer? - local invasion

Answer 7

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

Question 8

presenting symptoms of lung cancer? - paraneoplastic phenomenon.

Answer 8

Small cell
o	Secretion of ADH (SIADH) 
o	Secretion of ACTH (Cushing’s) 
o	Lambert Eaton syndrome 
o	Hyponatraemia 

Squamous cell 
o	PTH release (hypercalcaemia) 
o	Clubbing 
o	TSH release (hyperthyroidism) 
o	Hypertrophic pulmonary osteoarthropathy 

Adenocarcinoma
o Gynaecomastia
o Hypertrophic pulmonary osteoarthritis

Question 9

recognise the signs of lung cn examination?

Answer 9

●	Fixed monophonic wheeze 
●	Cachexia
●	Anaemia
●	Clubbing
●	Signs of lobar collapse or pleural effusion

Question 10

first line investigation for lung cancer?

gold standard?

Answer 10

First Line: CXR

Gold standard: contrast enhanced CT scan

Question 11

why might a bronchoscopy be used?

Answer 11

biopsy for histological diagnosis

Question 12

what investigations are required for staging?

Answer 12

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

Question 13

what might the bloods show?

Answer 13

o	FBC – raised platelets 
o	U&Es – hyponatraemia 
o	Calcium (hypercalcaemia is a common feature)
o	ALP (raised with bone metastases) 
o	LFTs