Lung Cancer - Clinical Features and Staging

Question 1

What are the main signs and symptoms of lung cancer?

Answer 1

Chronic cough (>3wks) with blood.
Wheeze.
Chest and bone pain.
Chest infections.
Difficulty swallowing.
Raspy, hoarse voice.
SOB.
Unexplained weight loss.
Nail clubbing.

Question 2

What are the metastatic symptoms of lung cancer?

Answer 2

Bone pain.
Spinal cord compression (limb weakness, bladder and bowel dysfunction).
Cerebral metastases (headache, vomiting, dizziness, ataxia, focal weakness).
Thrombosis.

Question 3

What are the paraneoplastic symptoms of lung cancer?

Answer 3

Hyponatraemia - SIADH.
Anaemia.
Hypercalcaemia (bone metastases).
Dermatomyositis and polymyositis (proximal muscle weakness).
Eaton-Lambert Syndrome - upper limb weakness.
Cerebellar ataxia.
Sensorimotor neuropathy.

Question 4

What are the clinical signs of lung cancer?

Answer 4

Chest signs.
Clubbing.
Lymphadenopathy.
Horner’s syndrome.
Pancoast tumour.
SVC obstruction.
Hepatomegaly.
Skin nodules (metastases).

Question 5

What are the initial investigations in primary care for lung cancer?

Answer 5

CXR, CT.
FBC.
Spirometry.
Clotting screening.
Renal and liver function tests.

Question 6

What are the tissue diagnoses for lung cancer?

Answer 6

Bronchoscopy.
EBUS.
Image-guided lung and liver biopsies.
Bone and surgical excision biopsies.
Fine needle aspiration of skin metastases.
Excision of cerebral metastases.
Mediastinoscopy or mediastinotomy.

Question 7

How is performance status graded for lung cancer?

Answer 7

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

Question 8

What treatment decisions are made for lung cancer?

Answer 8

Patient wishes.
Histological type and stage.
MDT.
Aims of treatment (radical or palliative).

Question 9

What are the different types of treatment for lung cancer?

Answer 9

Surgery - ~18% of patients. Wedge resection, lobectomy, and pneumonectomy.
RT - radical, palliative, stereotactic.

Question 10

What is palliative management in lung cancer?

Answer 10

Chemotherapy or RT for pain and haemoptysis.
Opiates, bisphosphonates, benzodiazepines.
Treatment of hypercalcemia, dehydration, and hyponatraemia.
QoL, community support.
End of life care, DNACPR.