Lung cancer: clinical features

Question 1

Describe the risk factors of Lung cancer

Answer 1

Smoking (more than 85%)
Passive smoking
Exposure to Asbestos, Radon, air pollution, and diesel exhaust

Question 2

Describe the advanced disease metastatic symptoms

Answer 2

Bone pain, spinal cord compression, cerebral metastases and thrombosis

Question 3

Describe the advanced disease paraneoplastic symptoms

Answer 3

Hyponatraemia, anaemia, hypercalcaemia, dernmatomyotis

Question 4

What are the clincial signs of lung cancer?

Answer 4

Chest signs
Clubbing
Lymphadenopathy
Horner’s syndrome
Pancoast tumour
Superior vena cava  obstruction
Lymphadenopathy
Hepatomegaly
Skin nodules (metastases)

Question 5

What are the inital investigation that GP must do to someone suspected of lung cancer?

Answer 5

CXR
FBC
Renal, Liver functions  and Calcium
Clotting screen
Spirometry

Question 6

What are the main investigations used?

Answer 6

Bronchoscopy, EBUS, biopsy of lung and liver and FNA of neck node

Question 7

Which type of cancer by histology is the most common?

Answer 7

Adenocarcinoma

Question 8

Describe staging Ct and Ct-PET

Answer 8

PET – only in stage 1 and 2, sometimes stage 3
This is so then the patients are sent in confidently for some radical surgery/treatment

Isotope injected and is taken up by cancer cells – red image: stage 4 so no surgical treatment

Pet scan not good for brain metastasis, do MRI head before sending patient for surgical treatment

Question 9

Describe the performance status scale

Answer 9

0 = fully active
1 = symptoms but ambulatory
2 = “up and about” > 50%, unable to work
3 = “up and about” < 50%, limited self care
4 = bed or chair bound

Radical treatment offered to stage 0 and 1
Stage 2 depends on your judgement
Stage 3 and 4 are offered pallative

Question 10

Describe the different treatments provided to those with lung cancer

Answer 10

Surgery – around 18% of patients
Wedge resection
Lobectomy
Pneumonectomy

Radiotherapy
Radical
Palliative
Stereotactic

Chemotherapy
Part of radical or palliative treatment
Alone, combined with radiotherapy, adjuvant (after surgery)
Targeted agents e.g Tyrosine Kinase Inhibitors and monoclonal antibodies
erlotinib, gefitinib, crizotinib
Small cell e.g. cisplatin/etoposide
Adenocarcinoma e.g. cisplatin/pemetrexed
Squamous e.g. cisplatin/gemcitabine

Best supportive care

Co-ordination – Lung Cancer Specialist Nurse

Question 11

Describe what types of surgery those with lung cancer may be offered

Answer 11

Wedge resection
Lobectomy
Pneumonectomy

Question 12

Describe that types of radiotherapy those with lung cancer may be offered?

Answer 12

Radical
Palliative
Stereotactic

Question 13

Describe that types of chemotherapy those with lung cancer may be offered?

Answer 13

Part of radical or palliative treatment
Alone, combined with radiotherapy, adjuvant (after surgery)
Targeted agents e.g Tyrosine Kinase Inhibitors and monoclonal antibodies
erlotinib, gefitinib, crizotinib
Small cell e.g. cisplatin/etoposide
Adenocarcinoma e.g. cisplatin/pemetrexed
Squamous e.g. cisplatin/gemcitabine

Question 14

What does palliative management involve?

Answer 14

Symptom control
May include chemotherapy
May include radiotherapy e.g. pain, haemoptysis
Opiates, Bisphosphonates, Benzodiazepines
Treatment of hypercalcaemia, dehydration, hyponatraemia

Quality of life
Community support
Decisions and planning, resuscitation status, end of life care
Multidisciplinary team including lung cancer nurse and hospice