Lung cancer

Question 1

What are the 2 main types?

Answer 1

Small cell LC and non-small cell LC

Types of NSCLC: adenocarcinoma, squamous cell carcinoma, large cell, alveolar carcinoma, bronchial adenoma.

Question 2

Risk factors

Answer 2

Smoking
Male
Asbestos exposure

Question 3

Symptoms

Answer 3

Cough 
Haemoptysis
Malaise
Weight loss
Hoarse voice
Stridor/wheeze
Lymphadenopathy
Pleural effusion
Paraneoplastic syndromes
SVC obstruction
Clubbing

Question 4

Small cell lung cancer

Answer 4

Type seen in smokers.
Originates in APUD cells, central tumours.
Fast growing with rapid progression and poor outcomes.
See paraneoplastic syndromes due to ectopic ADH and ACTH production.
Treatment: Surgery if very early stage. RT and chemotherapy.

Question 5

SCLC- paraneoplastic syndromes

Answer 5

Ectopic ADH production- hyponatraemia
Ectopic ACTH production- Cushing’s syndrome, bilateral adrenal hyperplasia. High cortisol can lead to hypokalaemic alkalosis.
Lambert Eaton Syndrome- antibodies to Ca2+ channels cause myasthenic like syndrome. Muscle weakness, relieved by exercise, trouble walking, eyelid drooping, tingling hands and feet.

Question 6

NSCLC - adenocarcinoma

Answer 6

Adenocarcinoma- most common, seen in non-smokers, peripheral tumours.
See gynaecomastia.

Question 7

NSCLC- SSC

Answer 7

SCC- central tumours. Often present as pneumonia secondary to obstructed bronchus. Associated with smoking.
See PTHrp production causing hypercalcaemia.
See hypertrophic pulmonary osteoarthropathy (HPOA)
Often see finger clubbing.

Question 8

NSCLC- large cell

Answer 8

Peripheral tumours, poorly differentiated, poor prognosis.

See bhCG production

Question 9

SVC obstruction

Answer 9

Symptoms: dyspnoea, swelling in face and neck, headache, visual disturbances, jugular venous distension.
Treatment: Dexamethasone, balloon venoplasty, stenting.

Question 10

Pancoast tumour

Answer 10

Tumour in the pulmonary apex, can locally spread to brachial plexus and sympathetic trunk.
Causing shoulder pain, muscle atrophy, oedema of upper limb, Horner’s syndrome (miosis, ptosis and anhidrosis. Hoarse voice due to compression of recurrent laryngeal nerve.

Question 11

Investigations

Answer 11

Refer down USC pathway if CXR suggestive of LC or > 40 yrs with haemoptysis OR 2 or more typical symptoms OR 1 typical symptom and a smoking history.
Aim for CXR < 2 weeks.
Other tests:
Contrast CT, bronchoscopy for biopsy, PET CT, blood (may show raised platelets)

Question 12

NSCLC treatment

Answer 12

20% suitable for surgery.
Contraindications: stage IIIb or IV disease, FEV1<1.5L, pleural effusion, tumour near hilum, vocal cord paralysis, SVC obstruction.
Main treatment is radiotherapy.