lung cancer clinical features and staging

Question 1

how common is lung cancer

Answer 1

1 in 5 cancer deaths are lung cancer and is leading cause of cancer death in both men and women

Question 2

risk factors

Answer 2

smoking, passive smoking, exposure to asbestos, radon, air pollution and diesel exhaust

Question 3

symptoms

Answer 3

chronic coughing, haemoptosis, wheeze, chest and bone pain, chest infections, nail clubbing, sob, difficulty swallowing, raspy hoarse voice, unexplained weight loss

Question 4

metastatic symptoms

Answer 4

bone pain, thrombosis, spinal cord compression- limb weakness, paraesthesia, bladder or bowel dysfunction, cerebral metastases- headache, vomiting, dizziness, focal weakness, ataxia

Question 5

clinical signs

Answer 5

clubbing, chest signs, lymphadenopathy, horners syndrome, pan coast tumour, superior vena cava obstruction, heptomegaly, skin nodules

Question 6

initial investigations

Answer 6

chest x ray, CT, full blood count, renal and liver functions, clotting screen, spirometry

Question 7

ways of getting tissue diagnosis

Answer 7

bronchoscopy, EBUS, image guided lung biopsy, image guided liver biopsy, excision of cerebral metastasis, mediastinoscopy, surgical excision biopsy

Question 8

treatment decisions depend on

Answer 8

performance status, patients wishes, histological type and stage, multidisciplinary team, aims of treatment

Question 9

reasons for hoarse voice

Answer 9

left recurrent laryngeal nerve palsy secondary to direct tumour compression or superior tracheobronchial lymph node enlargement on nerve

Question 10

reasons for ipsilateral diaphragm paralysis

Answer 10

phrenic nerve compression

Question 11

reasons for Horners syndrome

Answer 11

cervical sympathetic chain compression

Question 12

why take full blood count

Answer 12

to check for anaemia

Question 13

why take urea and electrolyte levels

Answer 13

to check overall renal function

Question 14

why take calcium levels

Answer 14

check for hypercalcaemia